Use of Psychotropic Medications Among Older Adults Receiving Hospice Care

接受临终关怀的老年人使用精神药物的情况

基本信息

批准号：
9762817
负责人：
Lauren Beth Gerlach
金额：
$ 11.7万
依托单位：
UNIVERSITY OF MICHIGAN AT ANN ARBOR
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-08-15 至 2022-01-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9762817
关键词：
Address Adverse effects Agitation Anti-Anxiety Agents Anti-Cholinergics Antidepressive Agents Antipsychotic Agents Behavioral Symptoms Belief Benefits and Risks Benzodiazepines Caregivers Characteristics Clinical Communities Comorbidity Data Delirium Dementia Depressed mood Diagnosis Distress Elderly Enrollment Ethnic Origin Exposure to Family member Feeling Female Focus Groups Gender Geographic Locations Guidelines Haloperidol Hospice Care Impaired cognition Knowledge Life Expectancy Light Link Medical Medicare Medicare claim Mental disorders Mentors Methods Mood stabilizers Neuraxis Pain management Palliative Medicine Patients Pattern Perception Pharmaceutical Preparations Placebos Polypharmacy Prevalence Provider Psychiatric therapeutic procedure Quality of life Race Randomized Clinical Trials Reporting Research Personnel Sampling Services Symptoms Thinking Variant anxious beneficiary career end of life end of life care expectation experience falls hospice environment improved innovation insight mortality patient population physical conditioning programs psychological symptom public health relevance side effect symptom management treatment guidelines

项目摘要

The number of Medicare beneficiaries enrolled in hospice has continued to grow, and older adults account for the largest proportion of patients receiving hospice services. Behavioral and psychological symptoms that do not meet criteria for a psychiatric disorder are common among patients in end of life care (e.g., feeling sad, anxious, or agitated), however the benefit of symptom-driven treatment with psychotropic medications for these patients is less clear. Additionally many medications considered essential in palliative medicine, such as benzodiazepines and conventional antipsychotics, are generally considered inappropriate for use in older adults given a variety of associated adverse effects, which can worsen quality of life at the end of life. Currently, little is known about how psychotropic medications are being used within end of life care and there are few treatment guidelines to guide appropriate and safe use. Despite the number of Medicare beneficiaries enrolled in hospice and the extent of psychotropic use suggested by previous studies, we know little about the factors associated with such widespread psychotropic use and whether particular patients are more likely to receive such treatment. This mixed-methods study will draw on Medicare hospice claims and Part D data to provide comprehensive national estimates of psychotropic medication use among Medicare beneficiaries receiving hospice care. We will build on this large-scale data approach using focus groups with family members and providers of hospice patients that will provide unique insights into the rationale of psychotropic medication use in end of life care, as well as how caregivers and hospice providers weigh the risks and benefits of commonly-used psychotropic medications. As the first national estimate of psychotropic use among older Medicare hospice beneficiaries, this study will provide insights to inform potential treatment guidelines for psychotropic medication use to minimize exposure to adverse effects while promoting quality of life at end of life. The GEMSSTAR program support, project, mentoring team, and educational plan will be invaluable as the candidate progresses towards a career as an independent investigator focused on integration and improving quality of psychiatric care within end of life care.

参加临终关怀的医疗保险受益人数量持续增长，老年人占接受临终关怀服务的患者比例最大。行为和心理症状不符合精神疾病标准在临终关怀患者中很常见（例如感到悲伤、焦虑或激动），但是使用精神药物进行症状驱动治疗对这些患者的好处患者不太清楚。此外，许多药物被认为是姑息医学中必不可少的药物，例如苯二氮卓类药物和传统抗精神病药物通常被认为不适合老年人使用成年人受到各种相关的不良影响，这可能会恶化临终时的生活质量。目前，人们对临终关怀中如何使用精神药物知之甚少。很少有治疗指南来指导适当和安全的使用。尽管医疗保险受益人数量众多入院临终关怀以及先前研究表明的精神药物使用程度，我们对此知之甚少与如此广泛使用精神药物相关的因素以及特定患者是否更有可能接受这样的待遇。这项混合方法研究将利用 Medicare 临终关怀索赔和 D 部分数据来提供医疗保险受益人精神药物使用情况的全面全国估计接受临终关怀。我们将利用家庭焦点小组建立这种大规模数据方法临终关怀患者的成员和提供者将为精神药物的基本原理提供独特的见解临终关怀中的药物使用，以及护理人员和临终关怀提供者如何权衡风险和常用精神药物的益处。作为对精神药物使用情况的首次全国估计对于老年医疗保险临终关怀受益人来说，这项研究将为老年医疗保险临终关怀受益人提供见解，为潜在的治疗指南提供信息使用精神药物可最大限度地减少不良反应，同时提高临终时的生活质量生活。 GEMSSTAR 计划支持、项目、指导团队和教育计划将非常宝贵，因为候选人将成为一名专注于整合和改进的独立调查员临终关怀中精神科护理的质量。

项目成果

期刊论文数量（2）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Factors Associated With Benzodiazepine and Antipsychotic Prescribing in Hospice: A Qualitative Study of Hospice Prescribers.

与临终关怀中苯二氮卓类和抗精神病药物处方相关的因素：临终关怀处方者的定性研究。

DOI：
发表时间：
2023-09
期刊：
影响因子：
7.6
作者：
Gerlach, Lauren B;Turnwald, Molly;Geczi, Kristin;O'Neil, Thomas;Watkins, Daphne;Bynum, Julie P W;Maust, Donovan T
通讯作者：
Maust, Donovan T

Pharmacological Management of Neuropsychiatric Symptoms of Dementia.

痴呆症神经精神症状的药理学管理。