Medications and the Risk of Motor Vehicle Crashes in Older Adults

老年人的药物和车祸风险

• 批准号: 10633192
• 负责人: Andrew Reis Zullo
• 金额: $ 44.18万
• 依托单位: BROWN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-15 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10633192
• 关键词: Accident and Emergency department; Acetylcholinesterase Inhibitors; Address; Adherence; Adult; Affect; Age; Aging; Alzheimer' s disease related dementia; Antidepressive Agents; Antipsychotic Agents; Automobile Driving; Belief; Biological; Central Nervous System; Central Nervous System Stimulants; Cessation of life; Characteristics; Cholinesterase Inhibitors; Counseling; Data; Data Set; Databases; Dose; Drowsiness; Drug Prescriptions; Drug usage; Elderly; Ensure; Equilibrium; Frequencies; Future; Goals; Health; Health Insurance; Impairment; Individual; Injury; Intervention; Licensing; Link; Medical; Medicare; Medication Management; Mental Depression; Mental disorders; Methods; Morbidity - disease rate; Motor Vehicles; Musculoskeletal Diseases; National Institute on Aging; Non-Steroidal Anti-Inflammatory Agents; Observational Study; Opioid; Opioid Analgesics; Outcome; Patients; Personal Satisfaction; Pharmaceutical Preparations; Physical Function; Physiological; Play; Policy Making; Polypharmacy; Population; Prevalence; Psychomotor Impairments; Psychotropic Drugs; Randomized, Controlled Trials; Recording of previous events; Research; Risk; Role; Safety; Schizophrenia; Sedation procedure; Sensory; Sleep; Sleep Disorders; Social isolation; Source; Stimulant; Subgroup; Testing; Time; Vehicle crash; Work; age related; aging in place; cognitive function; data resource; driving safety; epidemiologic data; evidence base; experience; human old age (65+); hypnotic; improved; innovation; longitudinal database; medication compliance; mortality; multiple chronic conditions; nervous system disorder; novel; older driver; preservation; primary outcome; response; sedative; therapy development; time use; transportation access; unsafe driving

PROJECT SUMMARY Despite the common belief that prescription drug use is a leading cause of motor vehicle crashes, data are scarce and controversy remains about the effects of medications on crashes in older adults aged ≥65 years. Unlike other determinants of crashes (e.g., medical conditions), medications are one of few modifiable potential determinants of the 6,800 crash-related deaths and 191,000 crash-related non-fatal injuries that occur annually among older adults. In particular, psychoactive drugs are commonly used among older drivers, but may interfere with safe driving. As more adults continue to drive into older age, there is an urgent need to understand the effects of medications and distinguish them from the effects of contemporaneous age-related medical conditions, impairments, and physiological changes. The overall objective of this proposal is to examine the causal effects of medications on crashes in older drivers, and the extent to which these medications disproportionately affect crash risk across subgroups [e.g., Alzheimer's disease and related dementias (ADRD), polypharmacy] and by medication adherence status. The central hypothesis is that sedating psychoactive medications (opioids, nonbenzodiazepine hypnotics, antidepressants, and antipsychotics) will increase crash risk while central nervous system (CNS)-activating drugs (cholinesterase inhibitors, CNS simulants) and others (non-steroidal anti- inflammatory drugs) will decrease the risk, and that these effects will be greatest among individuals with ADRD and those who are adherent to their medications. This hypothesis will be tested by pursuing three specific aims: 1) Estimate the effect of initiating sedating psychoactive, CNS-activating, and other medications, including dose, on crashes in older adults; 2) Quantify the effect of initiating sedating psychoactive, CNS-activating, and other medications on crashes across important subgroups of older adults, including those with ADRD; polypharmacy; multimorbidity; and sleep, psychiatric, neurological, and musculoskeletal disorders; and 3) Evaluate the effect of non-adherence to sedating psychoactive, CNS-activating, and other medications, each separately compared to adherence, on crash risk. To accomplish the three aims, our team will develop a unique database that combines data on older drivers' licensing and crash histories; Medicare health insurance and drug claims; and data on important determinants of medication use and crashes (e.g., access to transportation alternatives). This approach is innovative because it is the first to compile high-quality U.S. data on all three domains necessary to study the effect of medications on crashes—1) medical conditions (covariates); 2) medication use (exposure); and 3) crashes (outcome)—in a dataset that is large enough to precisely estimate effects using causal inference methods while accounting for differential driving frequency between drivers. The proposed research is significant because: 1) it will provide empirical evidence to help guide the management of medications to maximize older adults' ability to maintain safe mobility; and 2) it will establish a unique large data resource that can be used to conduct important future medication-related studies of older drivers. This proposal is responsive to PA-17-088.

项目摘要 尽管普遍认为处方药使用是造成汽车撞车的主要原因，但数据是 关于药物对≥65岁老年人的崩溃的影响，稀缺和争议仍然存在。 与其他崩溃的决定者不同（例如，医疗状况），药物是少数可修改的潜力之一 确定每年发生的6,800例与坠机有关的死亡和191,000次与坠机有关的非致命伤害 在老年人中。特别是，精神活性药物通常是在老年司机中使用的，但可能会干扰 安全驾驶。随着越来越多的成年人继续进入老年，迫切需要了解 药物的影响，并将其与当代与年龄相关的医疗状况的影响区分开 障碍和身体变化。该提案的总体目的是检查因果关系 老年司机撞车的药物以及这些药物在多大程度上影响的程度 跨亚组的崩溃风险[ 药物依从状态。中心假设是镇静精神药物（阿片类药物， 非苯并二氮卓类催眠药，抗抑郁药和抗精神病药）将增加碰撞风险，而中央则将增加 神经系统（CNS）激活药物（胆碱酯酶抑制剂，CNS模拟剂）等 炎症药）将降低风险，并且这些影响将在ADRD的个体中最大 以及那些遵守药物的人。该假设将通过追求三个具体目标来检验： 1）估计发起镇静精神活性，CNS激活和其他药物的效果，包括剂量， 老年人坠机事故； 2）量化启动镇静精神活性，CNS激活和其他的效果 老年人包括ADRD的老年人的撞车事故的药物；多药； 多种疾病；和睡眠，精神病，神经系统和肌肉骨骼疾病； 3）评估 对镇静精神活性，CNS激活和其他药物的不遵守性，每种药物分别比较 依从性，碰撞风险。为了实现这三个目标，我们的团队将开发一个独特的数据库 关于老年驾驶员的许可和崩溃历史的数据； Medicare健康保险和药物索赔；和数据 药物使用和崩溃的重要决定剂（例如，访问运输替代方案）。这 方法具有创新性，因为它是第一个在所有三个领域上编辑高质量的美国数据的方法 研究药物对崩溃的影响-1）医疗状况（协变量）； 2）使用药物（暴露）； 3）崩溃（结果） - 在一个足够大的数据集中，可以使用因果推理来精确估计效果 在考虑驱动程序之间的差异驾驶频率时的方法。拟议的研究很重要 因为：1）它将提供经验证据，以帮助指导药物管理以最大化老年 成年人保持安全流动性的能力； 2）它将建立一个独特的大数据资源 对老年驱动因素进行重要的未来药物相关研究。该提案对PA-17-088的响应敏感。

项目成果

Post-Acute Care Setting After Hip Fracture Hospitalization and Subsequent Opioid Use in Older Adults.

老年人髋部骨折住院和随后使用阿片类药物后的急性后护理环境。

• DOI: 10.1016/j.jamda.2023.03.012
• 发表时间: 2023
• 期刊: Journal of the American Medical Directors Association
• 影响因子: 7.6
• 作者: Cupp,MeghanA;Beaudoin,FrancescaL;Hayes,KaleenN;Riester,MelissaR;Berry,SarahD;Joshi,Richa;Zullo,AndrewR
• 通讯作者: Zullo,AndrewR

Correlation of long-term care facility vaccination practices between seasons and resident types.

• DOI: 10.1186/s12877-022-03540-3
• 发表时间: 2022-11-04
• 期刊: BMC GERIATRICS
• 影响因子: 4.1
• 作者: O'Neill, Emily T.;Bosco, Elliott;Persico, Erin;Silva, Joe B.;Riester, Melissa R.;Moyo, Patience;van Aalst, Robertus;Loiacono, Matthew M.;Chit, Ayman;Gravenstein, Stefan;Zullo, Andrew R.
• 通讯作者: Zullo, Andrew R.

Geospatial Distribution of Racial Disparities in Influenza Vaccination in Nursing Homes.

疗养院流感疫苗接种种族差异的地理空间分布。

• DOI: 10.1016/j.jamda.2023.08.018
• 发表时间: 2023
• 期刊: Journal of the American Medical Directors Association
• 影响因子: 7.6
• 作者: Silva,JoeBB;Howe,ChanelleJ;Jackson,JohnW;Bardenheier,BarbaraH;Riester,MelissaR;vanAalst,Robertus;Loiacono,MatthewM;Zullo,AndrewR
• 通讯作者: Zullo,AndrewR

Distance From Home to Motor Vehicle Crash Location: Implications for License Restrictions Among Medically-At-Risk Older Drivers.

从家到机动车事故地点的距离：对有医疗风险的老年驾驶员的驾照限制的影响。

• DOI: 10.1080/08959420.2022.2145791
• 发表时间: 2022
• 期刊: Journal of aging & social policy
• 影响因子: 5.1
• 作者: Joyce,NinaR;Khan,MarzanA;Zullo,AndrewR;Pfeiffer,MelissaR;Metzger,KristinaB;Margolis,SethA;Ott,BrianR;Curry,AllisonE
• 通讯作者: Curry,AllisonE

Incidence of New Dementia Diagnosis in Veterans Admitted to Nursing Homes After Heart Failure Hospitalization.

心力衰竭住院后入住疗养院的退伍军人中新痴呆症诊断的发生率。

• DOI: 10.3233/jad-221300
• 发表时间: 2023
• 期刊: Journal of Alzheimer's disease : JAD
• 作者: Bayer,ThomasA;Jiang,Lan;Erqou,Sebhat;Kunicki,ZacharyJ;Singh,Mriganka;Duprey,Matthew;Bozzay,Melanie;McGeary,JohnE;Zullo,AndrewR;Wu,Wen-Chih;Gravenstein,Stefan;Rudolph,JamesL
• 通讯作者: Rudolph,JamesL