Epidemiology and Clinical Outcomes of Electroconvulsive Therapy Use in Nursing Home Residents with Dementia

痴呆症疗养院居民的流行病学和电休克治疗的临床结果

基本信息

批准号：
10661910
负责人：
Taeho Gregory Rhee
金额：
$ 13.77万
依托单位：
UNIVERSITY OF CONNECTICUT SCH OF MED/DNT
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-06-01 至 2025-02-28
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10661910
关键词：
Address Adult Advisory Committees Aggressive behavior Aging Agitation Alzheimer&apos s disease related dementia American Psychiatric Association Antidepressive Agents Antipsychotic Agents Behavior Therapy Bipolar Disorder Caring Case Series Certification Cessation of life Clinical Clinical Trials Clinical assessments Cohort Studies Data Data Analyses Data Set Dementia Depressed mood Development Discipline of Nursing Effectiveness Elderly Electroconvulsive Therapy Epidemiology Fire - disasters Future General Anesthesia Guidelines Health Health Services Research Incidence Individual Intervention Knowledge Life Link Long-Term Care Longitudinal Studies Longitudinal cohort Maintenance Medicaid Medicare Medicare claim Mental Depression Mental disorders Methods Modality Modeling Morbidity - disease rate Neurodegenerative Disorders Nursing Homes Observational Study Outcome Patient Preferences Patterns of Care Population Prevalence Provider Public Health Quality of Care Quality of life Randomized, Controlled Trials Recommendation Reporting Research Resources Risk Safety Scalp structure Schizoaffective Disorders Seizures Skilled Nursing Facilities Stimulus Surveys Syndrome Techniques Therapeutic Time United States Centers for Medicare and Medicaid Services brain cell care providers caregiver education depressed patient design effective therapy environmental adaptation follow-up frailty functional disability functional outcomes human old age (65+)improved indexing innovation insight longitudinal analysis mixed dementia mortality mortality risk multiple data sources neuropsychiatric symptom older patient person centered pharmacologic population based psychotic depression response sociodemographics treatment response treatment-resistant depression

项目摘要

Project Abstract Alzheimer’s disease and related dementias (ADRD) are the most prevalent, debilitating neuro-degenerative diseases of aging, and current treatments for neuropsychiatric symptoms (NPS) (e.g., agitation, aggression, and depression) of ADRD are mixed. While non-pharmacological behavioral interventions are recommended as first-line treatments for these NPS of ADRD, they require substantial time and resources, and may be less effective for severely agitated, aggressive, or depressed older patients with ADRD. Electroconvulsive therapy (ECT) is an effective and safe treatment for a range of psychiatric disorders, including treatment-resistant depression, schizoaffective disorder, and bipolar disorder. Case series and uncontrolled naturalistic studies support preliminary evidence for the efficacy of ECT to treat severe agitation, depression, or other NPS in ADRD. Associations of ECT with long-term improvement in NPS and geriatric syndromes (e.g., functional disability and frailty), as well as with all-cause mortality rates among older adults with ADRD in nursing home settings are largely unexplored. The proposed nationwide cohort study explicitly addresses these knowledge gaps. Using the Centers for Medicare and Medicaid Services’ 2018-2020 Medicare claims data (Parts A, B, and D) linked to multiple data sources (e.g., Minimum Data Set [MDS] and National Death Index [NDI]), this proposed study features the following specific aims: 1) to examine incidence and prevalence rates of ECT use and socio-demographic and clinical factors associated with ECT use; 2) to investigate longitudinal associations of ECT with NPS and geriatric syndromes; and 3) to examine differential risks of all-cause mortality rates by ECT use among older adults with ADRD in nursing home settings. Longitudinal data analyses, such as generalized linear mixed modeling and competing-risk regression methods, will be used for Aims 2 and 3. In this nationwide cohort study, we will employ propensity-score matching and instrumental variable techniques to adjust for both observed and unobserved confounders. Intent-to-treat and as-treated analyses will also be conducted. Earlier studies support that ECT is associated with improvement in NPS of ADRD and our analyses show that ECT use with presence of both depression and ADRD was associated with a lower likelihood of all- cause mortality rates; we thus hypothesize that ECT may also be protective against geriatric syndromes. This is the first nationwide cohort study investigating the long-term effectiveness and safety of ECT among older adults with ADRD in nursing home settings. The proposed study is innovative since it will provide a better understanding of ECT use and its association with NPS, geriatric syndromes, and other related health outcomes. Findings from this study will inform clinical guidance on ECT use in older adults with ADRD in nursing home settings.

项目摘要阿尔茨海默氏病和相关痴呆症（ADRD）是最普遍的，令人衰弱的神经变性。衰老疾病和神经精神症状（NP）的当前治疗方法（例如，躁动，侵略， ADRD的抑郁症是混合的。建议采用非药理行为干预措施作为对ADRD的NP的一线治疗，它们需要大量的时间和资源，并且可能更少对严重搅动，侵略性或抑郁的ADRD患者有效。电击疗法（ECT）是针对一系列精神疾病的有效且安全的治疗，包括耐药性抑郁症，精神分裂症和躁郁症。案例系列和不受控制的自然研究支持ECT治疗严重搅动的效率的初步证据，抑郁症或ADRD中的其他NP。 ECT与长期改善NP和老年的关联综合征（例如功能障碍和脆弱），以及老年人的全因死亡率在护士家庭环境中，ADRD在很大程度上是出乎意料的。拟议的国家范围范围的队列研究明确解决这些知识差距。使用Medicare和Medicaid服务中心的2018 - 2020 Medicare索赔数据（A，B部分和 d）链接到多个数据源（例如，最小数据集[MDS]和国家死亡指数[NDI]），此拟议的研究具有以下特定目的：1）检查ECT使用的事件和患病率以及与ECT使用相关的社会人口统计学和临床因素； 2）研究纵向关联 NP和老年综合征的ECT； 3）检查全因死亡率的差异风险在护士家庭环境中有ADRD的老年人中使用ECT。纵向数据分析，例如广义线性混合建模和竞争风险回归方法将用于目标2和3。这项在全国范围的研究中，我们将采用倾向得分匹配和仪器变量技术来调整观察到的混杂因素和未观察到的混杂因素。意图对治疗和经过处理的分析也将是实施。早期的研究支持ECT与ADRD的NP和我们的分析有关表明ECT在抑郁和ADRD的情况下使用ECT与全能的可能性较低有关导致死亡率；因此，我们假设ECT也可以受到细胞综合征的保护。这是首次研究ECT之间的长期有效性和安全性的全国范围内队列研究在护士家庭环境中有ADRD的老年人。拟议的研究具有创新性，因为它将提供更好的了解ECT使用及其与NP，老年综合症和其他相关健康的了解结果。这项研究的发现将为ADRD老年人的ECT使用的临床指南提供信息护理家庭环境。