R03AG088730

Epidemiology and long-term effect of cardiometabolic medication substitution during post-acute care - Project summary/abstract

Nearly 70% of older adults experience medication discrepancy–inconsistencies in medication regimens when they transition from acute hospital to skilled nursing facilities (SNF).

Medication discrepancy in this period often results from inadequate reconciliation processes and formulary or financial restrictions in hospitals or SNFs.

Medication discrepancy can take the various forms, including omission, addition, duplication, and substitution.

Among these types, substitution accounts for up to 20% and frequently involves cardiovascular medications.

Clinical observations suggest that newer, high-cost cardiometabolic medications (e.g., angiotensin receptor neprilysin inhibitor, sodium-glucose cotransporter 2 inhibitors, and glucagon-like peptide 1 receptor agonists) are often substituted with less expensive and less efficacious alternatives in SNFs.

Such substitutions may impact chronic disease outcomes if the modified regimen is continued after SNF stay.

Despite the common occurrence of medication substitution during SNF stays and its potential clinical significance, systematic investigation has been hindered by the lack of a comprehensive database containing medication administration records from a large number of SNFs.

The objective of this study is to determine the epidemiology and clinical consequences of cardiometabolic medication substitution in SNF.

The investigators’ hypothesis is that persistent medication substitution beyond SNF stay is associated with worse outcomes compared with no substitution or resolved substitution during SNF stay.

To test this hypothesis, they will use the Long-Term Care Data Cooperative platform, which provides electronic health records data from nationwide SNFs linked with Medicare data.

The specific aims are:

1) To determine the frequency and factors associated with cardiometabolic medication substitution during post-acute SNF stay among older adults after elective orthopedic surgery; and

2) To determine long-term chronic disease outcomes associated with cardiometabolic medication substitution during post-acute SNF stay.

The project is innovative because it is the first national-scale study of medication substitution during the post-acute SNF stay.

The impact of this research is significant because the evidence generated from this research can enable optimal medication management of cardiometabolic conditions in the transitional period.

Moreover, the GEMSSTAR award will provide mentorship, training, and experience for the principal investigator to emerge as a leader in optimizing medication use for older adults.

Hebrew Rehabilitation Center

TO ENCOURAGE BIOMEDICAL, SOCIAL, AND BEHAVIORAL RESEARCH AND RESEARCH TRAINING DIRECTED TOWARD GREATER UNDERSTANDING OF THE AGING PROCESS AND THE DISEASES, SPECIAL PROBLEMS, AND NEEDS OF PEOPLE AS THEY AGE. THE NATIONAL INSTITUTE ON AGING HAS ESTABLISHED PROGRAMS TO PURSUE THESE GOALS. THE DIVISION OF AGING BIOLOGY EMPHASIZES UNDERSTANDING THE BASIC BIOLOGICAL PROCESSES OF AGING. THE DIVISION OF GERIATRICS AND CLINICAL GERONTOLOGY SUPPORTS RESEARCH TO IMPROVE THE ABILITIES OF HEALTH CARE PRACTITIONERS TO RESPOND TO THE DISEASES AND OTHER CLINICAL PROBLEMS OF OLDER PEOPLE. THE DIVISION OF BEHAVIORAL AND SOCIAL RESEARCH SUPPORTS RESEARCH THAT WILL LEAD TO GREATER UNDERSTANDING OF THE SOCIAL, CULTURAL, ECONOMIC AND PSYCHOLOGICAL FACTORS THAT AFFECT BOTH THE PROCESS OF GROWING OLD AND THE PLACE OF OLDER PEOPLE IN SOCIETY. THE DIVISION OF NEUROSCIENCE FOSTERS RESEARCH CONCERNED WITH THE AGE-RELATED CHANGES IN THE NERVOUS SYSTEM AS WELL AS THE RELATED SENSORY, PERCEPTUAL, AND COGNITIVE PROCESSES ASSOCIATED WITH AGING AND HAS A SPECIAL EMPHASIS ON ALZHEIMER'S DISEASE. SMALL BUSINESS INNOVATION RESEARCH (SBIR) PROGRAM: TO EXPAND AND IMPROVE THE SBIR PROGRAM, TO INCREASE PRIVATE SECTOR COMMERCIALIZATION OF INNOVATIONS DERIVED FROM FEDERAL RESEARCH AND DEVELOPMENT, TO INCREASE SMALL BUSINESS PARTICIPATION IN FEDERAL RESEARCH AND DEVELOPMENT, AND TO FOSTER AND ENCOURAGE PARTICIPATION OF SOCIALLY AND ECONOMICALLY DISADVANTAGED SMALL BUSINESS CONCERNS AND WOMEN-OWNED SMALL BUSINESS CONCERNS IN TECHNOLOGICAL INNOVATION. SMALL BUSINESS TECHNOLOGY TRANSFER (STTR) PROGRAM: TO STIMULATE AND FOSTER SCIENTIFIC AND TECHNOLOGICAL INNOVATION THROUGH COOPERATIVE RESEARCH DEVELOPMENT CARRIED OUT BETWEEN SMALL BUSINESS CONCERNS AND RESEARCH INSTITUTIONS, TO FOSTER TECHNOLOGY TRANSFER BETWEEN SMALL BUSINESS CONCERNS AND RESEARCH INSTITUTIONS, TO INCREASE PRIVATE SECTOR COMMERCIALIZATION OF INNOVATIONS DERIVED FROM FEDERAL RESEARCH AND DEVELOPMENT, AND TO FOSTER AND ENCOURAGE PARTICIPATION OF SOCIALLY AND ECONOMICALLY DISADVANTAGED SMALL BUSINESS CONCERNS AND WOMEN-OWNED SMALL BUSINESS CONCERNS IN TECHNOLOGICAL INNOVATION.

93.866 - Aging Research

National Institute on Aging (NIA) [HHS - NIH]

Roslindale, Massachusetts 021311000 United States

Single Zip Code

Grants for Early Medical/Surgical Specialists' Transition to Aging Research (GEMSSTAR) (R03 Clinical Trial Optional) (RFA-AG-24-047)