Prescription Opioid Use Trajectories and Risk Factors Associated with Opioid-Related Hospitalizations in Older Adults

老年人处方阿片类药物使用轨迹和与阿片类药物相关住院相关的风险因素

• 批准号: 10004049
• 负责人: Yu-Jung Wei
• 金额: $ 4.85万
• 依托单位: UNIVERSITY OF FLORIDA
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-01 至 2022-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10004049
• 关键词: Prescription; Opioid; Use; Trajectories; Risk

AHRQ's recent notice regarding Interest in Health Services Research to Address the Opioid Crisis [NOT-HS-18- 015] recognized the alarming disproportionate increase of opioid-related hospitalizations among older adults. Despite an abundance of efforts to combat the national opioid epidemic, hospitalizations due to opioid dependence, abuse or poisoning among older adults have grown disproportionally. To accurately identify the high-risk elderly groups and implement effective preventive measures, it is important to understand the etiology of opioid-related hospitalizations, with a special emphasis on elderly-specific risk factors. This study will assess elderly high-risk prescription opioid use patterns, predisposing and prognostic factors and their associations with opioid-related hospitalizations. To understand the progress from prescription opioid initiation to the development of opioid-related hospitalization outcome, the target population is Medicare beneficiaries who initiate prescription opioids at an older age (aged 65+) included in a nationally representative sample of Medicare beneficiaries from 2001-20017. Our Aim 1 is to examine trajectories of prescription opioid use and their association with opioid-related hospitalizations after initiation among opioid-naïve Medicare older adults. Prescription opioid use will be assessed by four measures: 1) morphine-equivalent daily dose, 2) concomitant opioid use, 3) chronic opioid use, and 4) concurrent use with other psychotropic drugs (e.g., benzodiazepines). Our Aim 2 is to examine the extent to which elderly-specific predisposing and prognostic factors are associated with risk for opioid-related hospitalization outcome after opioid initiation among Medicare older adults. We will examine unique risk factors for the development of the outcome, including a frailty index, number of chronic conditions and polypharmacy. Innovative among published models in any population, we will also evaluate emerging prognostic factors— incident infections, cognitive impairment, and injuries, reflecting potential opioid misuse and overdose that lead to hospitalizations. Our study will provide first-hand nationally representative data on trajectories of prescription opioid use, predisposing characteristics and prognostic risk factors associated with opioid-related hospitalizations in elderly opioid initiators. Identified elderly-specific risk factors will provide the foundation for a future R01 aimed at developing, implementing and evaluating a dynamic elderly-specific risk score in clinical practice. The results from this line of research will assist clinicians to identify and manage elderly patients at risk for opioid-related adverse events, improving opioid prescribing and safety in geriatric populations.

AHRQ 最近关于对解决阿片类药物危机的卫生服务研究感兴趣的通知 [NOT-HS-18- 015]认识到老年人中与阿片类药物相关的住院人数惊人地不成比例地增加。 尽管为抗击全国阿片类药物流行病做出了大量努力，但因阿片类药物导致的住院治疗 老年人中的依赖、虐待或中毒现象已不成比例地增长。 针对老年高危人群，采取有效的预防措施，了解病因很重要 本研究将评估与阿片类药物相关的住院治疗，特别强调老年人的特定风险因素。 老年人高风险处方阿片类药物使用模式、诱发因素和预后因素及其与 了解阿片类药物相关住院治疗从处方阿片类药物开始到开发的进展。 阿片类药物相关的住院结果，目标人群是开始处方的医疗保险受益人 老年医疗保险受益人的全国代表性样本（65 岁以上）包含阿片类药物 2001-20017 年我们的目标 1 是研究处方阿片类药物的使用轨迹及其与阿片类药物相关的关系。 在未使用阿片类药物的医疗保险老年人中开始使用处方阿片类药物后，将对医院进行评估。 通过四项措施：1）吗啡当量每日剂量，2）同时使用阿片类药物，3）长期使用阿片类药物，4） 与其他精神药物（例如苯二氮卓类药物）同时使用我们的目标 2 是检查其影响程度。 老年人特有的诱发因素和预后因素与阿片类药物相关住院风险相关 我们将检查医疗保险老年人中阿片类药物使用后的独特风险因素。 结果的发展，包括虚弱指数、慢性病数量和复方用药。 在针对任何人群的已发表模型中，我们还将评估新出现的预后因素，这具有创新性—— 事件感染、认知障碍和伤害，反映了潜在的阿片类药物滥用和过量导致 我们的研究将提供有关处方轨迹的第一手全国代表性数据。 阿片类药物的使用、与阿片类药物相关的易感特征和预后危险因素 确定的老年人特有的危险因素将为老年阿片类药物引发者的住院治疗奠定基础。 未来的 R01 旨在开发、实施和评估临床中动态的老年人特定风险评分 该研究的结果将有助于识别和管理处于危险中的老年患者。 针对与阿片类药物相关的不良事件，改善老年人群的阿片类药物处方和安全性。