Perioperative mental health intervention for older adults undergoing hip and knee arthroplasty for osteoarthritis

老年骨关节炎髋关节和膝关节置换术的围手术期心理健康干预

• 批准号: 10616806
• 负责人: Eric J Lenze
• 金额: $ 20.92万
• 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/10616806
• 关键词: Address; Adult; Antidepressive Agents; Anxiety; Attention; Behavior Therapy; Behavioral; Benzodiazepines; Clinical Trials Design; Communication; Community Practice; Degenerative polyarthritis; Delirium; Depressed mood; Effectiveness; Effectiveness of Interventions; Elderly; Elective Surgical Procedures; Emotional; Enrollment; Event; Evidence based intervention; Family; Goals; Grant; Healthcare Systems; Hospitals; Hybrids; Individual; Intervention; Life; Mental Depression; Mental Health; Mental Health Services; Motivation; Multicenter Trials; Neurocognitive; Operative Surgical Procedures; Orthopedic Procedures; Orthopedic Surgery; Orthopedics; Outcome; Pain; Participant; Patient Preferences; Patient-Focused Outcomes; Patients; Perioperative; Pharmaceutical Preparations; Phase; Population; Postoperative Period; Predisposition; Preparation; Process; Protocols documentation; Provider; Psyche structure; Quality of life; Randomized; Randomized, Controlled Trials; Recovery; Rehabilitation therapy; Replacement Arthroplasty; Reporting; Research Personnel; Risk; Second Look Surgery; Testing; Time; adverse outcome; age group; anxiety symptoms; anxiety treatment; anxious; clinical practice; clinically significant; compare effectiveness; depressive symptoms; dosage; effective intervention; effectiveness outcome; effectiveness testing; experience; falls; group intervention; hip replacement arthroplasty; hospital readmission; human old age (65+); implementation outcomes; implementation/effectiveness; improved; innovation; interactive feedback; knee replacement arthroplasty; multidisciplinary; older patient; opioid use; pharmacologic; physically handicapped; programs; protocol development; psychologic; randomized, clinical trials; reduce symptoms; shared decision making; symptomatic improvement; therapy development; time interval; treatment as usual; trial design

Abstract/Project Summary – PROJECT 1 By 2030, 4 million older adults will undergo elective total hip or knee arthroplasty (THA/TKA), the most common elective surgical procedures intended to mitigate pain and physical disability in this age group. Mental health problems are highly prevalent in these patients, with 20-30% reporting substantial symptoms of anxiety and depression both pre- and post-operatively. Depression and anxiety worsen THA/TKA outcomes by (i) reducing participation in rehabilitation, thereby impeding recovery, (ii) heightening susceptibility to pain which increases the risk of revision surgery and increases the likelihood of prolonged opioid use, and (iii) raising the risk for delirium and delayed neurocognitive recovery. Despite the documented impact on individuals and our health care system, effective interventions that treat anxiety and depression have not been applied to and evaluated for older adults undergoing THA/TKA. In this proposal, we will optimize and test a pharmacological and behavioral intervention bundle for older patients undergoing total joint arthroplasty for osteoarthritis, with clinically significant depressive and anxiety symptoms. In this proposal, we will institute a perioperative mental healthcare 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 orthopedic 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 orthopedic 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 orthopedic 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 complications, falls, delirium, and pain. Thus, medication optimization, deprescribing, and behavioral treatment of depression and anxiety in older adults undergoing total joint arthroplasty may improve symptoms of depression and anxiety as well as other important post-operative outcomes.

摘要/项目摘要 - 项目1 到2030年，有400万老年人将接受选修课总臀部或膝关节置换术（THA/TKA），这是最多的 常见的选修手术程序旨在减轻该年龄段的疼痛和身体残疾。精神的 这些患者的健康问题非常普遍，有20-30％的健康问题报告了大量动画症状 和术前和后的抑郁症。 （i）的抑郁症和动画更糟的是tha/tka结果 减少参加康复的参与，从而阻碍康复，（ii）对疼痛的敏感性增加 增加了修订手术的风险，并增加了长期使用使用的可能性，并提高了（iii） ir妄的风险和延迟的神经认知恢复。尽管有记录对个人和我们的影响的影响 医疗保健系统，治疗动画和抑郁的有效干预措施尚未应用于和 评估接受THA/TKA的老年人。在此提案中，我们将优化和测试药品。 以及接受骨关节炎全关节性关节置换术的老年患者的行为干预束，患有 临床上显着的抑郁症和焦虑症状。在此提案中，我们将定期进行精神 医疗保健捆绑包包括：（1）应用行为干预，行为激活（BA），并使用 基于患者的偏好和需求的策略； （2）药物优化和划分（mod）， 靶向优化抗抑郁药的剂量，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 接受主要骨科的老年人的最佳定期心理健康干预捆绑 程序。通过利益相关者的输入，我们将发展并迭代地适应行为和药物 在该人群中实施的优化干预捆绑包。在初始协议开发之后， 通过治疗开发试验，我们将通过交互式反馈迭代地优化干预措施 来自65岁以上的患者接受重大骨科干预措施，以及其他利益相关者 障碍和促进者计划完成。 AIM 2（测试）：使用混合类型1随机控制 试验设计，我们将比较干预捆绑包的有效性与通常的护理减少符号 接受骨科手术的老年患者的抑郁和动画。为此，有100名患者 抑郁和焦虑的症状将随机分配给药理和行为 干预捆绑或通常的护理。术前抑郁和动画与大量广告有关 手术后的结局，包括并发症，跌倒，del妄和疼痛。那就是药物优化， 抑郁症和动画的行为对待老年人的抑郁和动画的行为治疗 关节置换术可以改善抑郁症和动画的症状以及其他重要的术后 结果。