Pharmacological Management of Pain in Alzheimer's Disease and Related Dementia

阿尔茨海默病和相关痴呆症疼痛的药理学治疗

基本信息

批准号：
10187473
负责人：
Yu-Jung Wei
金额：
$ 12.44万
依托单位：
UNIVERSITY OF FLORIDA
依托单位国家：
美国
项目类别：
财政年份：
2017
资助国家：
美国
起止时间：
2017-08-01 至 2022-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10187473
关键词：
Adverse drug event Age Aggressive behavior Aging Alzheimer&apos s disease related dementia Analgesics Anxiety Disorders Applications Grants Behavioral Behavioral Symptoms Caring Clinical Clinical assessments Constipation Data Data Set Development Disease Drug Prescriptions Effectiveness Elderly Evaluation Feasibility Studies Frail Elderly Future Goals Gold Guidelines Health Impaired cognition Knowledge Lead Left Link Literature Measurement Measures Medical Records Medicare Medication Management Medicine Mental Depression Mental Health Mental disorders Mentored Research Scientist Development Award Mentors Methods Nurses Nursing Homes Outcome Outcome Assessment Ownership Pain Pain Measurement Pain intensity Pain management Pain quality Patients Pharmaceutical Preparations Pharmacology Pharmacotherapy Population Prevention Procedures Psyche structure Psychoses Records Reporting Research Risk Role Safety Sample Size Sampling Schedule Serious Adverse Event Severities Sleep Disorders Testing Time Training Training Activity Treatment Side Effects base career career development chronic pain clinical practice comorbidity depressive symptoms improved insight longitudinal design multiple chronic conditions non-cancer pain nonalzheimer dementia older patient pain behavior pain symptom prevent skills symptom management validation studies vector

项目摘要

Summary: My career goal is to become an independent geriatric pharmacoepidemiologist with expertise in pharmacotherapy quality measurement and outcomes evaluation in the fields of pain and aging. The clinical focus of my research has centered on the management of multi-morbidity in older adults and particularly, the interplay of mental and physical disease and its treatment. One example of combination of health problems is elderly patients who live with Alzheimer's disease and related dementia (ADRD) and also suffer from chronic pain. To date, data on quality of pain medication prescribing and the sequelae of poor pain control in patients with ADRD are scarce. Studies investigating these associations are limited by small sample size, and none has attempted to establish the effect of adequate pain control on preventing mental health (MH) disorders. The goal of my K01 proposed research is to provide preliminary data that improve our understanding of current pain medication prescribing and potential discrepancies between practices and pain guidelines, and to formulate hypotheses for future research regarding the role of pain control in reducing MH problems in ADRD. We propose a longitudinal design using 4 years (2011-2014) of Medicare 5% sample whose billing records are linked to nursing home resident assessment data (Minimum Data Set, MDS, 3.0). Because it is unclear whether MDS 3.0 can accurately detect patients with pain and MH disorders, we first conduct a feasibility study of validating MDS-based pain, depression, and behavioral symptoms against medical records at two nursing homes (Aim 1). With the nationally representative Medicare-MDS data, we explore the quality of pharmacological pain management and its determinants among ADRD and non-ADRD residents with non- cancer pain (Aim 2). The quality will be examined based on five common clinical standards--pain medication selection, pain medication scheduling, pharmacological prevention of drug adverse event, contraindicated medication use, and overall pain control. We then explore the extent to which pain control is associated with a decreased risk for select MH disorders, including depression, behavioral symptoms, anxiety, and sleep disorders in ADRD (Aim 3). This project is well tailored for me to apply the knowledge and skills that will be obtained from training activities with my Primary Mentor, Dr. Almut Winterstein (pharmacoepidemioloy, quality measurement and outcome assessment) and Co-Mentors: Drs. Roger Fillingim (pain), Marco Pahor (aging), Babette Brumback (advanced methods for longitudinal data), and Laurence Solberg (clinical geriatric care and assessment). For further guidance, I enlist the expertise of Dr. Siegfried Schmidt in the field of pain medicine and Dr. Steven DeKosky in ADRD. This K01 award will provide protected time for me to receive training needed to prepare an R01 grant application to examine pain medication practices and their impact on health outcomes in ADRD. The results from this line of research are expected to lead to better pharmacological pain management and improved pain and health outcomes in older adults with cognitive impairments.

摘要：我的职业目标是成为一名独立的老年药物流行病学家，具有以下方面的专业知识：疼痛和衰老领域的药物治疗质量测量和结果评估。临床上我的研究重点集中在老年人的多种发病率的管理上，特别是精神和身体疾病的相互作用及其治疗。健康问题组合的一个例子是患有阿尔茨海默病和相关痴呆症 (ADRD) 并患有慢性疾病的老年患者疼痛。迄今为止，关于止痛药处方质量和患者疼痛控制不良的后遗症的数据患有 ADRD 的人很少。调查这些关联的研究受到样本量较小的限制，并且没有一项研究试图确定充分的疼痛控制对预防心理健康（MH）疾病的效果。这我的 K01 拟议研究的目标是提供初步数据，以提高我们对当前止痛药处方以及实践和疼痛指南之间的潜在差异，并为未来研究制定关于疼痛控制在减少 ADRD 中的 MH 问题中的作用的假设。我们建议使用 4 年（2011-2014 年）Medicare 5% 样本进行纵向设计，其账单记录为链接到疗养院居民评估数据（最小数据集，MDS，3.0）。因为不清楚 MDS 3.0能否准确检测出患有疼痛和MH疾病的患者，我们首先进行可行性研究根据两次护理的医疗记录验证基于 MDS 的疼痛、抑郁和行为症状家园（目标 1）。借助具有全国代表性的 Medicare-MDS 数据，我们探索了 ADRD 和非 ADRD 居民的药物疼痛管理及其决定因素癌症疼痛（目标 2）。质量将根据五个常见的临床标准进行检查——止痛药选择、止痛药安排、药物不良事件的药理学预防、禁忌症药物使用和总体疼痛控制。然后我们探讨疼痛控制与疼痛的相关程度。降低特定 MH 疾病的风险，包括抑郁、行为症状、焦虑和睡眠 ADRD 疾病（目标 3）。这个项目是为我量身定制的，可以应用我将要学到的知识和技能从我的主要导师 Almut Winterstein 博士（药物流行病学、质量测量和结果评估）和共同导师：博士。 Roger Fillingim（疼痛）、Marco Pahor（衰老）、 Babette Brumback（纵向数据的高级方法）和 Laurence Solberg（临床老年护理和评估）。为了获得进一步的指导，我寻求 Siegfried Schmidt 博士在疼痛医学领域的专业知识以及 ADRD 的史蒂文·德科斯基 (Steven DeKosky) 博士。这个K01奖项将为我提供受保护的培训时间需要准备 R01 拨款申请来检查止痛药实践及其对健康的影响 ADRD 的结果。这一系列研究的结果预计将带来更好的药理学疼痛管理并改善患有认知障碍的老年人的疼痛和健康结果。

项目成果

期刊论文数量（5）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Concurrent use of prescription gabapentinoids with opioids and risk for fall-related injury among older US Medicare beneficiaries with chronic noncancer pain: A population-based cohort study.

患有慢性非癌性疼痛的美国老年医疗保险受益人同时使用处方加巴喷丁与阿片类药物以及跌倒相关损伤的风险：一项基于人群的队列研究。

DOI：
发表时间：
2022-03
期刊：
影响因子：
15.8
作者：
Chen, Cheng;Winterstein, Almut G;Lo;Tighe, Patrick J;Wei, Yu
通讯作者：
Wei, Yu

Prevalence of and Factors Associated With Long-term Concurrent Use of Stimulants and Opioids Among Adults With Attention-Deficit/Hyperactivity Disorder.

患有注意力缺陷/多动症的成人中长期同时使用兴奋剂和阿片类药物的患病率和相关因素。

DOI：
发表时间：
2018
期刊：
影响因子：
13.8
作者：
Wei, Yu;Zhu, Yanmin;Liu, Wei;Bussing, Regina;Winterstein, Almut G
通讯作者：
Winterstein, Almut G

Uncontrolled Pain and Risk for Depression and Behavioral Symptoms in Residents With Dementia.

失控的疼痛以及痴呆症患者抑郁和行为症状的风险。

DOI：
10.1016/j.jamda.2021.05.010
发表时间：
2021-10
期刊：
Journal of the American Medical Directors Association
影响因子：
7.6
作者：
Jenny Wei YJ;Chen C;Fillingim RB;DeKosky ST;Schmidt S;Pahor M;Solberg L;Winterstein AG
通讯作者：
Winterstein AG

Clinical utility and perils of prescription drug monitoring program-based alert systems.

基于处方药监测程序的警报系统的临床效用和风险。