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) 是最常见的、使人衰弱的神经退行性疾病衰老疾病以及神经精神症状 (NPS)（例如，激动、攻击性、 ADRD 的治疗效果参差不齐，而建议采用非药物行为干预措施。作为 ADRD 的这些 NPS 的一线治疗方法，它们需要大量的时间和资源，而且可能更少对于严重烦躁、攻击性或抑郁的老年 ADRD 患者有效。电休克疗法 (ECT) 是治疗一系列精神疾病的有效且安全的方法，包括难治性抑郁症、分裂情感障碍和躁郁症病例系列和不受控制的自然主义研究支持 ECT 治疗严重躁动的功效的初步证据， ECT 与 NPS 和老年病的长期改善的关联。综合症（例如功能障碍和虚弱）以及老年人的全因死亡率拟议的全国性队列研究在很大程度上尚未明确探讨疗养院环境中 ADRD 的情况。解决这些差距。使用 Medicare 和 Medicaid 服务中心的 2018-2020 年 Medicare 索赔数据（A、B 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具体目标：1）检查 ECT 使用的发生率和流行率与 ECT 使用相关的社会人口统计和临床因素；2) 调查纵向关联； ECT 与 NPS 和老年综合征的结合；3) 通过以下方式检查全因死亡率的不同风险：在疗养院环境中患有 ADRD 的老年人中使用 ECT 进行纵向数据分析，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。在这项全国性队列研究中，我们将采用倾向得分匹配和工具变量技术来还将对观察到的和未观察到的混杂因素进行调整。早期的研究支持 ECT 与 ADRD 的 NPS 改善相关，并且我们的分析也是如此。表明在同时存在抑郁症和 ADRD 的情况下使用 ECT 与降低所有- 导致死亡率；因此我们认为 ECT 也可以预防老年综合症。这是第一个全国性队列研究，调查 ECT 的长期有效性和安全性拟议的研究具有创新性，因为它将提供更好的治疗方案。了解 ECT 的使用及其与 NPS、老年综合征和其他相关健康的关系这项研究的结果将为患有 ADRD 的老年人提供 ECT 的临床指导。疗养院设置。