Multiple drug use or polypharmacydue to medications from different classes that share similar pharmacol- ogical side effects is of concern in older adults. CNS polypharmacy is a commonand important exampleof this phenomenon. CNS polypharmacy may contribute to the development of geriatric syndromes.Geriatric syndromes such as cognitive impairment, urinary incontinence and mobility/instability problems are also common, morbid and costlyfor older adults. With the trend towards increased use of medications, information is needed regarding the impact of CNS polypharmacy on geriatric syndromesin older adults. The long term objectiveis to enhance the health of the elderly by determining the dynamic effects over time of exposure and changes in CNS polypharmacy on geriatric syndromes, so that interventions can be designed, health outcomes improved and health care costs reduced. Using a longitudinal design, the immediate objective is to determine the impact over time of CNS polypharmacyon geriatric syndromes.CNS poly- pharmacy will be defined as: 1)the use of 2 or more medications from any of six medication classes (i.e., benzodiazepines, other anxiolytics/ hypnotics, opioid analgesics, antidepressants, antipsychotics and anti- epileptics) and 2) combined standardized daily dosage of these multiple CNS medications. We will determine mobility/instability performance (i.e., EPESE lower extremity battery, 400 meter walk, balance, self-reported falls), cognitive function (i.e., 3MS), and self-reported urinary incontinence. The specific hypotheses to be tested are that, compared with non affected elders, elderly participants with prevalent, incident and increasing CNS polypharmacy will have greater mobility/instability decline, increased cognitive decline, and increased likelihood of urinary incontinence after controlling for important covariates (e.g. comorbidities).This study capitalizes on data from the NIA-funded longitudinal Health ABC study. The current proposal is likely to be highly cost-effective and can be expected to yield results that are valid and generalizable to older adults.

Agency
National Institute of Health (NIH)
Institute
National Institute on Aging (NIA)
Type
Research Project (R01)
Project #
5R01AG027017-03
Application #
7388842
Study Section
Special Emphasis Panel (ZRG1-HOP-R (50))
Program Officer
Nayfield, Susan G
Project Start
2006-04-01
Project End
2010-03-31
Budget Start
2008-04-01
Budget End
2010-03-31
Support Year
3
Fiscal Year
2008
Total Cost
$173,813
Indirect Cost
Name
University of Pittsburgh
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
004514360
City
Pittsburgh
State
PA
Country
United States
Zip Code
15213
Downer, Brian; Garcia, Marc A; Saenz, Joseph et al. (2018) The Role of Education in the Relationship Between Age of Migration to the United States and Risk of Cognitive Impairment Among Older Mexican Americans. Res Aging 40:411-431
Downer, Brian; González-González, Cesar; Goldman, Noreen et al. (2018) The effect of adult children living in the United States on the likelihood of cognitive impairment for older parents living in Mexico. Ethn Health 23:57-71
Naples, Jennifer G; Marcum, Zachary A; Perera, Subashan et al. (2016) Impact of Drug-Drug and Drug-Disease Interactions on Gait Speed in Community-Dwelling Older Adults. Drugs Aging 33:411-8
Sevick, Mary Ann; Piraino, Beth M; St-Jules, David E et al. (2016) No Difference in Average Interdialytic Weight Gain Observed in a Randomized Trial With a Technology-Supported Behavioral Intervention to Reduce Dietary Sodium Intake in Adults Undergoing Maintenance Hemodialysis in the United States: Primary Outcomes of t J Ren Nutr 26:149-58
Downer, Brian; Veeranki, Sreenivas P; Wong, Rebeca (2016) A Late Life Risk Index for Severe Cognitive Impairment in Mexico. J Alzheimers Dis 52:191-203
St-Jules, David E; Woolf, Kathleen; Pompeii, Mary Lou et al. (2016) Exploring Problems in Following the Hemodialysis Diet and Their Relation to Energy and Nutrient Intakes: The BalanceWise Study. J Ren Nutr 26:118-24
St-Jules, David E; Woolf, Kathleen; Pompeii, Mary Lou et al. (2016) Reexamining the Phosphorus-Protein Dilemma: Does Phosphorus Restriction Compromise Protein Status? J Ren Nutr 26:136-40
Marcum, Zachary A; Hardy, Susan E (2015) Medication Management Skills in Older Skilled Nursing Facility Residents Transitioning Home. J Am Geriatr Soc 63:1266-8
Marcum, Zachary A; Driessen, Julia; Thorpe, Carolyn T et al. (2015) Regional variation in use of a new class of antidiabetic medication among medicare beneficiaries: the case of incretin mimetics. Ann Pharmacother 49:285-92
Gray, Shelly L; Anderson, Melissa L; Dublin, Sascha et al. (2015) Cumulative use of strong anticholinergics and incident dementia: a prospective cohort study. JAMA Intern Med 175:401-7

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