Pharmacepidemiology in the elderly: medications pneumonia risk and confounding

老年人药物流行病学：药物肺炎风险和混杂因素

• 批准号: 7907677
• 负责人: SASCHA DUBLIN
• 金额: $ 16.64万
• 依托单位: KAISER FOUNDATION HEALTH PLAN OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-09-15 至 2012-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7907677
• 关键词: Accounting; Acids; Address; Adult; Affect; Age; Aging; Angiotensin-Converting Enzyme Inhibitors; Anti-Inflammatory Agents; Anti-inflammatory; Aspirate substance; Award; Benefits and Risks; Benzodiazepines; Clinical; Clinical Trials; Cognitive; Cohort Studies; Communities; Comorbidity; Coughing; Data; Dementia; Disease Outcome; Elderly; Epidemiologic Studies; Event; Future; Geriatrics; Goals; Health; Impaired cognition; Instruction; Integrated Delivery of Health Care; Internal Medicine; Laboratories; Lead; Life; Link; Lower respiratory tract structure; Measures; Medical Records; Mentors; Methods; Morbidity - disease rate; Nested Case-Control Study; Observational Study; Patients; Persons; Pharmaceutical Preparations; Pharmacy facility; Pneumonia; Population; Predisposition; Proton Pump Inhibitors; Provider; Reflex action; Research; Research Methodology; Research Personnel; Residual state; Resources; Risk; Risk Factors; Safety; Source; Stable Populations; Stomach; System; Testing; Training; Universities; Washington; Work; age related; career; computerized; follow-up; functional disability; functional status; human HRH2 protein; improved; mortality; pathogen; population based; programs; respiratory

DESCRIPTION (provided by applicant): Dr. Sascha Dublin is a Senior Fellow in General Internal Medicine at the University of Washington. She seeks to develop a career studying medication risks and benefits in the elderly. The elderly are often excluded from clinical trials, and thus observational studies-which may have important biases- are often the only source for information about medication effects in this population. Dr. Dublin will address a key methodologic problem in this field: bias due to confounding by cognitive and functional status. Through this award, she proposes to 1) gain additional background in aging research through didactic instruction; 2) pursue advanced training in relevant aspects of clinical geriatrics; and 3) conduct mentored research guided by her sponsors Drs. Eric Larson and Noel Weiss, distinguished researchers in the field of aging. RESEARCH: The goal of Dr. Dublin's research is two-fold. First, she will investigate associations between use of specific medications-acid-suppressing medications, benzodiazepines, angiotensin-converting enzyme inhibitors (ACEIs), and statins-and risk of pneumonia, a common and serious illness. Second, she will use this research to examine the impact of functional and cognitive status as confounders in studies of medication effects in the elderly. The results of some prior studies suggest that acid-suppressing medications and benzodiazepines are associated with increased pneumonia risk, while ACEIs and statins are associated with decreased risk. However, residual bias related to cognitive and functional impairment could explain all of these associations. She will carry out 3 linked projects within the Adult Changes in Thought cohort study, which includes more than 3300 elderly persons with 22,000 person-years of follow-up. Project 1 examines use of these 4 medication classes in relation to cognitive and functional impairment, and Project 2 evaluates cognitive and functional impairment as risk factors for pneumonia. Finally, Project 3 examines pneumonia risk in relation to use of these 4 medication classes, with adjustment for confounders including cognitive and functional status and comorbid illness. SIGNIFICANCE: This work will provide pilot data for future proposals and establish a direction for Dr. Dublin's future research career. It also will provide information on potentially reversible causes of pneumonia, a common and often devastating illness, and contribute to improved methods in studies of medication effects in the elderly.

描述（由申请人提供）：都柏林Sascha博士是华盛顿大学一般内科医学高级研究员。她试图发展一个职业，研究老年人的药物风险和益处。老年人通常被排除在临床试验之外，因此观察性研究可能具有重要的偏见 - 通常是该人群中有关药物影响的唯一信息。都柏林博士将解决该领域的关键方法论问题：由于认知和功能状态而引起的偏见。通过这个奖项，她提议1）通过教学教学获得额外的衰老研究背景； 2）在临床老年医学的相关方面进行高级培训； 3）由她的赞助商Drs指导的指导研究指导研究。埃里克·拉尔森（Eric Larson）和诺埃尔·魏斯（Noel Weiss），陈年领域的杰出研究人员。研究：都柏林博士的研究的目标是两倍。首先，她将研究使用特定药物抑制药物，苯二氮卓类药物，血管紧张素转化酶抑制剂（ACEIS），汀类药物及他的汀类药物风险（一种常见和严重疾病）之间的关联。其次，她将利用这项研究来研究老年人药物效应研究中的功能和认知状况的影响。一些先前研究的结果表明，供酸抑制的药物和苯二氮卓类药物与肺炎风险增加有关，而阿塞斯和他汀类药物与风险降低有关。但是，与认知和功能障碍有关的残留偏见可以解释所有这些关联。她将在成人队列研究的成人变更中进行3个链接的项目，其中包括3300多名老年人，有22,000人的随访。项目1研究了与认知和功能障碍有关的这4种药物类别的使用，项目2评估认知和功能障碍作为肺炎的危险因素。最后，项目3研究了与使用这4种药物类别有关的肺炎风险，并针对包括认知和功能状况以及合并症在内的混杂因素进行了调整。意义：这项工作将为未来的提案提供试验数据，并为都柏林博士未来的研究职业建立指导。它还将提供有关肺炎的潜在可逆原因的信息，肺炎是一种常见且经常毁灭性的疾病，并有助于改善老年人药物效应的方法。