Perioperative mental health intervention for older adults undergoing cardiac surgery

老年人心脏手术围术期心理健康干预

• 批准号: 10616808
• 负责人: Michael Simon Avidan
• 金额: $ 26.36万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-06-01 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10616808
• 关键词: Address; Antidepressive Agents; Anxiety; Attention; Behavior Therapy; Behavioral; Benzodiazepines; Cardiac; Cardiac Surgery procedures; Cessation of life; Clinical Research; Clinical Trials Design; Communication; Community Practice; Coupled; Delirium; Depressed mood; Effectiveness; Effectiveness of Interventions; Elderly; Emotional; Enrollment; Event; Evidence based intervention; Family; Fright; Goals; Grant; Heart Diseases; Hospitals; Hybrids; Individual; Intensive Care; Intervention; Mental Depression; Mental Health; Mental Health Services; Mental disorders; Mission; Morbidity - disease rate; Motivation; Multicenter Trials; National Institute of Mental Health; Older Population; Operative Surgical Procedures; Outcome; Participant; Patient Preferences; Patient-Focused Outcomes; Patients; Perioperative; Pharmaceutical Preparations; Phase; Polypharmacy; Population; Postoperative Period; Preparation; Prevalence; Prevention; Procedures; Process; Protocols documentation; Provider; Psyche structure; Public Health; Quality of life; Randomized; Randomized, Controlled Trials; Recovery; Research Personnel; Risk; Risk Factors; Symptoms; Targeted Research; Testing; Time; United States; adverse outcome; anxiety symptoms; anxious; clinical practice; clinically significant; compare effectiveness; depressive symptoms; dosage; effective therapy; effectiveness outcome; effectiveness testing; experience; falls; group intervention; hospital readmission; human old age (65+); implementation outcomes; implementation/effectiveness; improved; innovation; interactive feedback; medical complication; mortality; mortality risk; multidisciplinary; older patient; pharmacologic; programs; protocol development; randomized, clinical trials; reduce symptoms; shared decision making; social; therapy development; time interval; treatment as usual; trial design

Abstract/Project Summary – PROJECT 3 Depression and anxiety are common but undertreated in older adults undergoing cardiac surgical procedures. Approximately 400,000 older adults undergo cardiac surgery annually in the United States, and between a quarter and a half of these individuals have symptoms of preoperative anxiety or depression. Each of these individuals are at greater risk for depression/anxiety than the general older population. The perioperative period is a particularly vulnerable time, as the patient is concurrently confronted with social, functional and physical changes that accompany a major surgery. Most older adults with heart disease and depression or anxiety do not receive appropriate mental health treatment, and if they do, it is typically limited to pharmacologic interventions, further exacerbating already rampant polypharmacy. In this proposal, we will optimize and test a pharmacological and behavioral intervention bundle for older patients undergoing cardiac surgery, with clinically significant depressive and anxiety symptoms. We will institute a perioperative mental healthcare intervention bundle including: (1) applying a proven behavioral intervention, behavioral activation (BA), with strategies based on patient preferences and needs; and (2) medication optimization and deprescribing (MOD), targeting to optimize dosages of anti-depressant medications, and stopping harmful or ineffective medications. Aim 1 (Adaptation): Informed by a collaborative planning approach, we will adapt, develop and implement an optimal perioperative mental health intervention bundle for older adults undergoing major invasive cardiac procedures. Through stakeholder input, we will develop and iteratively adapt a behavioral and medication optimization intervention bundle for implementation in this population. Following initial protocol development, through treatment development trials, we will iteratively optimize the intervention through interactive feedback from patients over the age of 65 undergoing major cardiac intervention, and other stakeholders, noting barriers and facilitators to program completion. Aim 2 (Testing): Using a hybrid Type 1 randomized controlled trial design, we will compare the effectiveness of the intervention bundle with usual care in reducing symptoms of depression and anxiety in older patients undergoing cardiac surgery. For this aim, 100 patients with symptoms of depression and anxiety will be randomly assigned to the pharmacological and behavioral intervention bundle or usual care. Pre-operative depression and anxiety are associated with a host of adverse outcomes after surgery, including medical complications, falls, delirium, and mortality. Thus, medication optimization and deprescribing, in an intervention bundle with behavioral activation treatment of depression and anxiety in older adults undergoing cardiac surgery, is expected to improve not only symptoms of depression and anxiety but also other important post-operative outcomes.

摘要/项目摘要 - 项目3 抑郁和动画很常见，但在接受心脏外科手术的老年人中被抑郁症。 每年约有400,000名老年人在美国和 这些人中的四分之一半具有术前焦虑或抑郁的象征。每个 与普通老年人相比，个人患抑郁/焦虑的风险更大。循环系统 期间特别脆弱，因为患者同时面对社会，功能和 涉及大手术的身体变化。大多数患有心脏病和抑郁症或 焦虑无法接受适当的心理健康治疗，如果这样做，通常仅限于 药理干预措施，进一步加剧了已经猖ramp的多药。在此提案中，我们将 优化并测试接受心脏的老年患者的药理和行为干预捆绑 手术，具有临床意义的抑郁症和焦虑症状。我们将定期进行精神 医疗干预捆绑包包括：（1）应用行为干预，行为激活 （BA），采用基于患者的偏好和需求的策略； （2）药物优化和 分类（mod），靶向优化剂量的抗抑郁药，并停止有害或 无效的药物。目标1（适应）：通过协作计划方法告知，我们将适应， 开发和实施最佳的周期性心理健康干预捆绑 主要的侵入性心脏程序。通过利益相关者的投入，我们将发展并迭代地适应 行为和药物优化干预捆绑包用于该人群中的实施。下列的 最初的协议开发，通过治疗开发试验，我们将重新优化干预措施 通过65岁以上患者接受重大心脏干预的互动反馈，其他 利益相关者指出障碍和促进者进行计划完成。 AIM 2（测试）：使用混合类型1 随机对照试验设计，我们将比较干预束的有效性与通常的护理 在减少接受心脏手术的老年患者的抑郁症状和焦虑症状中。为此， 100例患有抑郁症和焦虑症状的患者将随机分配给药物 行为干预束或通常的护理。术前抑郁和动画与宿主有关 手术后的不良结局，包括医疗并发症，跌倒，del妄和死亡率。那， 在干预捆绑中进行药物优化和放弃，并进行行为激活处理 接受心脏手术的老年人的抑郁和动画不仅会改善症状 抑郁和焦虑，以及其他重要的术后结局。