Bladder Antimuscarinics in Dementia: A Model of Decisions About Potentially Inappropriate Medicines

痴呆症中的膀胱抗毒蕈碱药：关于潜在不适当药物的决策模型

• 批准号: 9386214
• 负责人: Ariel Green
• 金额: $ 19.87万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-08-01 至 2021-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9386214
• 关键词: Address; Admission activity; Adoption; Adverse effects; Aging; Alzheimer' s Disease; Anti-Cholinergics; Antipsychotic Agents; Area; Award; Benzodiazepines; Bladder; Caregivers; Cessation of life; Cognitive; Conflict (Psychology); Constipation; Data; Decision Aid; Decision Making; Delirium; Dementia; Dementia caregivers; Development; Discourse analysis; Disease; Elderly; Epidemiology; Evaluation; Family; Fostering; Frequencies; Funding; Future; Geriatrics; Gerontology; Goals; Health; Health Care Costs; Hospitalization; Incontinence; Individual; Intervention Studies; Interview; Judgment; K-Series Research Career Programs; Knowledge; Lead; Learning; Link; Medicare claim; Medicine; Mentors; Modeling; Nature; Nursing Homes; Outcome; Patients; Persons; Pharmaceutical Preparations; Prevalence; Publications; Qualitative Methods; Quality of life; Randomized Controlled Trials; Research; Research Personnel; Resources; Retrospective cohort study; Safety; Source; Testing; Training; Universities; Urinary Incontinence; career; career development; caregiver strain; cost; experience; falls; improved; informal learning; medical schools; patient oriented; preference; professor; randomized trial; shared decision making; skills; systematic review; tool; trend

PROJECT SUMMARY Dr. Ariel Green is an Assistant Professor in the Department of Medicine, Division of Geriatric Medicine and Gerontology at the Johns Hopkins University School of Medicine. She seeks a K23 mentored career development award to obtain critical knowledge, skills and research experience to accelerate her development into a leader in patient-oriented geriatrics research. The training proposal details a four-year plan of formal and informal instruction in (1) epidemiology, particularly analytic skills using longitudinal, nationally-representative data linked to Medicare claims; (2) qualitative methods; (3) decision aid development and evaluation; and (4) interventional research in persons with Alzheimer's disease and related dementias. Short-term career goals include completing coursework in the above-mentioned areas, disseminating high-quality mentored research through publications and presentations, engaging in career development activities, and applying for independent R01 funding beginning in the third year of the award period. Long-term career goals are to be an independent geriatrics investigator who is a leader in shared decision making and medication safety in vulnerable older adults. Informing patients and families about potential outcomes and involving them in decision making could lead to a reduction in the use of potentially inappropriate medicines in patients with Alzheimer's disease and related dementias. The use of bladder antimuscarinics for treatment of urinary incontinence (UI) in older adults with dementia is an ideal model to learn how to improve decision making and develop an approach that could be applied to other potentially inappropriate medicines in people with dementia. The broad objective of this proposal is to address deficiencies in decision-making relating to antimuscarinic therapy in patients with dementia and UI. This will be accomplished through the following specific aims: (1) Among older adults (>65) with dementia and UI, to determine associations between antimuscarinic therapy and subsequent hospitalization, admission to NHs and death. (2a) To understand how patients, caregivers and clinicians communicate about antimuscarinic therapy in patients with dementia and UI. (2b) To determine how barriers to informed decision making about the use of antimuscarinic drugs in patients with dementia can be addressed. (3) To pilot an antimuscarinic decision aid for patients with dementia and UI and their caregivers. Completion of these aims will lay the groundwork for a future randomized trial to test an antimuscarinic decision aid for patients with dementia and UI and their caregivers.

项目摘要 Ariel Green博士是老年医学系医学系的助理教授 约翰·霍普金斯大学医学院的老年病学。她寻求K23指导职业 开发奖以获得批判知识，技能和研究经验以加速她的发展 成为以患者为导向的老年医学研究的领导者。培训建议详细介绍了一个四年制正式计划和 （1）流行病学中的非正式教学，尤其是使用纵向，代表性的分析技能 与Medicare主张有关的数据； （2）定性方法； （3）决策援助发展和评估； （4） 患有阿尔茨海默氏病和相关痴呆症患者的介入研究。短期职业目标 包括在上述领域完成课程，传播高质量的指导研究 通过出版和演讲，从事职业发展活动并申请 独立R01资金从奖励期的第三年开始。长期职业目标是成为一个 独立的老年医学研究者，他是共享决策和药物安全的领导者 脆弱的老年人。 告知患者和家人潜在的结果，并参与决策可能 导致在阿尔茨海默氏病和 相关痴呆症。老年人使用膀胱抗毒氨酸氨基酸盐治疗尿失禁（UI） 使用痴呆症是学习如何改善决策和开发一种可能的方法的理想模型 将其应用于痴呆症患者中其他潜在不适当的药物。这个广泛的目标 提案是解决与患者的抗毒疗法有关的决策缺陷 痴呆和UI。这将通过以下特定目的完成：（1）老年人（> 65） 与痴呆症和UI一起，确定抗毒酸疗法和随后的痴呆症 住院，入院和死亡。 （2a）了解患者，看护人和临床医生如何 关于痴呆和UI患者的抗毒疗治疗的交流。 （2b）确定如何障碍 可以解决有关在痴呆症患者中使用抗毒性药物的明智决策。 （3）为痴呆症和UI及其护理人员的患者试用抗毒品决策援助。完成 这些目标将为未来的随机试验奠定基础，以测试针对抗杂经的决策辅助 痴呆症和UI及其护理人员的患者。