Epidemiology and Risk of Antipsychotic Use in Hospitalized Elderly with Delirium

患有谵妄的住院老年人的流行病学和使用抗精神病药物的风险

基本信息

批准号：
9980746
负责人：
Dae Hyun Kim
金额：
$ 53万
依托单位：
BRIGHAM AND WOMEN'S HOSPITAL
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：
2018-08-01 至 2022-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9980746
关键词：
Acute Address Adverse event Algorithms Antidepressive Agents Antipsychotic Agents Arrhythmia Behavior Benzodiazepines Cardiac Caring Clinical Clinical Data Clinical Trials Cognition Cohort Studies Communities Community Hospitals Confusion Data Data Set Databases Delirium Dementia Elderly Epidemiology Event Exhibits Exposure to Funding Hospital Mortality Hospitals Individual Inpatients Label Lead Length of Stay Life Longitudinal trends Measures Methodology Methods Mission National Institute on Aging Neurologic Nursing Homes Observational Study Operative Surgical Procedures Outcome Patient Care Patients Pharmaceutical Preparations Pharmacoepidemiology Pneumonia Population Postoperative Period Psychotropic Drugs Public Health Research Research Design Research Methodology Research Personnel Risk Safety Subgroup Therapeutic United States National Institutes of Health Validation Work adverse event risk atypical antipsychotic base clinical care cohort comparative falls functional status hospital readmission hypnotic improved innovation medication safety mortality novel off-label drug off-label use older patient patient safety patient subsets postoperative delirium routine care trend

项目摘要

PROJECT SUMMARY/ABSTRACT Each year 2 million older adults receive antipsychotic medications (APMs) in the hospital, mainly for delirium. Although the harms of APMs are well documented and their use has declined in older adults with dementia, the scope and risk of off-label APM exposure in hospitalized older adults remain largely unknown. The objective of this application is to determine the prescribing trends and risks of APMs and their alternatives in hospitalized older adults with postoperative delirium. The research team will analyze data from 2 national inpatient data- bases and detailed clinical data from 5 NIH-funded cohorts to generate evidence on the comparative safety of APMs and their alternatives that is generalizable to real-world patients. The central hypothesis is that off-label APM use is associated with increased risk of adverse events compared with no use in hospitalized older adults with postoperative delirium; in particular, newer “atypical” APMs may be more harmful than conventional “typi- cal” APM for short-term use. The applicant's preliminary data showed that, although atypical APMs may be as harmful as typical APM in hospitalized older surgical patients, use of atypical APMs and certain psychoactive drugs has been rising in recent years. The APM prescribing rates also vary more than 30 folds across the US hospitals, which suggests potentially inappropriate prescribing. Lack of safety data on APMs for hospitalized older adults, as well as little evidence on safer alternatives seems to contribute to these trends. The rationale for this application is that the available safety data from dementia patients may not generalize to hospitalized older surgical patients and that evidence on the comparative safety of APMs and other psychoactive drugs in routine care patients cannot be generated from clinical trials alone. This 3-year proposal has 3 specific aims: 1) determine the risk of in-hospital mortality, institutional discharge, prolonged length of stay, and readmission associated with different APMs in older patients with delirium after major surgery; 2) determine the risk of in- hospital non-fatal adverse events associated with different APMs; and 3) identify psychoactive drugs that may be prescribed as therapeutic alternatives to APMs by examining longitudinal prescribing trends. The investiga- tors will apply innovative research methodologies of leveraging existing large claims datasets and cohort data to enhance generalizability to routine care populations, increase statistical power to address safety for patient subgroups and individual drugs, and reduce bias. By conducting validation of case-identification algorithms, the investigators will improve how in-hospital adverse events are measured in inpatient drug safety research. The impact of this research is significant, because high-quality evidence on the comparative safety of APMs and their alternatives can guide clinicians to reduce excessive APM use and promote rational and safe APM prescribing, thereby improving safety and clinical care of older surgical patients.

项目概要/摘要每年有 200 万老年人在医院接受抗精神病药物 (APM)，主要用于治疗谵妄。尽管 APM 的危害已有充分记录，并且其在患有痴呆症的老年人中的使用已经减少，但住院老年人中超说明书 APM 暴露的范围和风险仍然很大程度上未知。该应用程序旨在确定 APM 及其替代方案在住院期间的处方趋势和风险研究小组将分析来自 2 个国家住院患者数据的数据 - 来自 5 个 NIH 资助的队列的基础和详细临床数据，以生成有关相对安全性的证据 APM 及其替代方案适用于现实世界的患者核心假设是标签外。与不使用住院老年人相比，使用 APM 会增加不良事件的风险特别是对于术后谵妄，新型“非典型”APM 可能比传统“典型”危害更大。申请人的初步数据表明，尽管非典型APM可能是短期使用的。对于住院的老年外科患者来说，典型的 APM 是有害的，使用非典型的 APM 和某些精神活性药物近年来，美国各地的 APM 处方率也出现了 30 倍以上的差异。医院，这表明缺乏住院 APM 的安全数据。老年人以及几乎没有关于更安全替代品的证据似乎促成了这些趋势。对于此应用，痴呆症患者的可用安全数据可能无法推广到住院患者老年手术患者以及 APM 和其他精神活性药物相对安全性的证据这项为期 3 年的提案有 3 个具体目标： 1) 确定院内死亡、出院、住院时间延长和再入院的风险与大手术后谵妄的老年患者的不同 APM 相关；2) 确定 in- 的风险；与不同 APM 相关的医院非致命不良事件；以及 3) 识别可能的精神活性药物；通过检查纵向处方趋势，将其作为 APM 的治疗替代方案。管理者将应用创新的研究方法来利用现有的大型索赔数据集和队列数据增强对常规护理人群的普遍性，增强统计能力以解决患者安全问题亚组和个别药物，并通过验证病例识别算法来减少偏差，研究人员将改进住院药物安全研究中院内不良事件的衡量方法。这项研究的影响是重大的，因为有关 APM 相对安全性的高质量证据及其替代方案可以指导忠实用户减少APM的过度使用，促进合理、安全的APM 处方，从而提高老年手术患者的安全性和临床护理。

项目成果

期刊论文数量（3）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Outcomes of Common Major Surgical Procedures in Older Adults With and Without Dementia.

患有和不患有痴呆症的老年人常见主要外科手术的结果。

DOI：
发表时间：
2020
期刊：
影响因子：
13.8
作者：
Masutani, Rebecca;Pawar, Ajinkya;Lee, Hemin;Weissman, Joel S;Kim, Dae Hyun
通讯作者：
Kim, Dae Hyun

Preoperative Frailty Status and Intensity of End-of-Life Care Among Older Adults After Emergency Surgery.

急诊手术后老年人的术前虚弱状况和临终关怀强度。

DOI：
发表时间：
2021
期刊：
影响因子：
4.7
作者：
Sokas, Claire;Lee, Katherine C;Sturgeon, Daniel;Streid, Jocelyn;Lipsitz, Stuart R;Weissman, Joel S;Kim, Dae H;Cooper, Zara
通讯作者：
Cooper, Zara

Clinical outcomes of cardiovascular procedures in older patients with dementia.

老年痴呆症患者心血管手术的临床结果。