Research
Palliative Care for Hospitalized Patients with Advanced Cancer
Principal Investigator: Meier, NCI/NINR funded
This series of analyses will contribute to the overall OAIC theme by examining the effect of inpatient palliative care consultation teams (PCCT) on hospital costs, hospital and intensive care unit lengths of stay, and readmission rates using sophisticated statistical methods not commonly applied to aging-related research. The parent study is a multi-site, observational controlled trial of PCCT compared to usual care for 6900 patients hospitalized with advanced cancer in five U.S. hospitals. RC-RDA will provide cost and use data collection, and analyses of cost effects using propensity score matching.
Pain and Delirium in an RCT of Perioperative Cognitive Protection
Principal Investigator: Silverstein, NIA funded
This series of analyses will contribute to the overall OAIC theme by examining the relationships among postoperative pain, pain treatment, delirium and cognitive impairment in older adults using sophisticated statistical methods. The parent study is an RCT of the effect of perioperative infusion of dexmedetomidine, an α2A-adrenergic agonist, compared with standard care on postoperative delirium and cognitive dysfunction in 706 older adults undergoing major non-cardiac surgery at 7 U.S. hospitals. We will conduct analyses not funded by the parent grant first to test the hypothesis that higher pain scores are associated with an increased incidence of post-operative delirium by the CAM assessment, using multivariable logistic regression.
Second, we will test the hypotheses that patients receiving patient-controlled analgesia (PCA) will have lower opioid requirements, reduced pain, and a lower incidence of post-operative delirium, using propensity score methodology to match patients receiving PCA to those receiving clinician controlled analgesia and using multivariate logistic regression to examine the association of PCA with post-operative delirium.
Third, we will test the hypothesis that opioids with active metabolites (oxycodone, morphine) are associated with an increased risk of delirium as compared to opioids without active metabolites (fentanyl, hydropmorphone), and examine the relationship between opioid dose and delirium. We hypothesize a U-shaped relationship between opioid dose and delirium such that low and high doses of opioids will increase the risk of delirium whereas moderate doses will be protective. We will use propensity score methodology to match patients receiving each opioid type and multivariable logistic regression to examine the relationship between drug type and post-operative delirium.
To test whether both low and high doses of opioids are associated with greater delirium, we will include a squared opioid dose term in the model. The signs on the estimate of the dose and dose squared terms indicate whether the relationship is U shaped. All models will control for delirium risk factors, treatment group, opioid dose, and other important covariates. RC-RDA will provide propensity score methodology, modeling consultation and data analysis.
Symptoms and Function during Acute Illness in Nursing Home Residents
Principal Investigator: Boockvar; Co-PI Hung, VA funded
This series of analyses will contribute to the overall OAIC theme by examining the relationships between pain and other symptoms, medication use, acute illness and function in nursing home residents using sophisticated statistical methods. The parent study is a prospective observational cohort of residents of 2 nursing homes in New York City who have experienced 150 acute illness episodes (e.g., urinary and respiratory infections).
We will conduct analyses not funded by the parent study to describe the impact on pain, function, and other symptoms of 2 exposures: 1) periods of acute illness and 2) periods of interruption in opioid analgesics which are common. Levels of pain, function, and other symptoms during exposure periods will be compared with pre-exposure periods, controlling for repeated observations of subjects over time and clustering of subject observations by provider and nursing home, using GEE. RC-RDA will provide modeling consultation accounting for clustered observations, and statistical programming for data analysis.
Palliative Care for Hospitalized Patients with Advanced Cancer
Principal Investigator: Meier, NCI/NINR funded
This series of analyses will contribute to the overall OAIC theme by examining the effect of inpatient palliative care consultation teams (PCCT) on hospital costs, hospital and intensive care unit lengths of stay, and readmission rates using sophisticated statistical methods not commonly applied to aging-related research. The parent study is a multi-site, observational controlled trial of PCCT compared to usual care for 6900 patients hospitalized with advanced cancer in five U.S. hospitals. RC-RDA will provide cost and use data collection, and analyses of cost effects using propensity score matching.
Pain and Delirium in an RCT of Perioperative Cognitive Protection
Principal Investigator: Silverstein, NIA funded
This series of analyses will contribute to the overall OAIC theme by examining the relationships among postoperative pain, pain treatment, delirium and cognitive impairment in older adults using sophisticated statistical methods. The parent study is an RCT of the effect of perioperative infusion of dexmedetomidine, an α2A-adrenergic agonist, compared with standard care on postoperative delirium and cognitive dysfunction in 706 older adults undergoing major non-cardiac surgery at 7 U.S. hospitals. We will conduct analyses not funded by the parent grant first to test the hypothesis that higher pain scores are associated with an increased incidence of post-operative delirium by the CAM assessment, using multivariable logistic regression.
Second, we will test the hypotheses that patients receiving patient-controlled analgesia (PCA) will have lower opioid requirements, reduced pain, and a lower incidence of post-operative delirium, using propensity score methodology to match patients receiving PCA to those receiving clinician controlled analgesia and using multivariate logistic regression to examine the association of PCA with post-operative delirium.
Third, we will test the hypothesis that opioids with active metabolites (oxycodone, morphine) are associated with an increased risk of delirium as compared to opioids without active metabolites (fentanyl, hydropmorphone), and examine the relationship between opioid dose and delirium.
We hypothesize a U-shaped relationship between opioid dose and delirium such that low and high doses of opioids will increase the risk of delirium whereas moderate doses will be protective. We will use propensity score methodology to match patients receiving each opioid type and multivariable logistic regression to examine the relationship between drug type and post-operative delirium.
To test whether both low and high doses of opioids are associated with greater delirium, we will include a squared opioid dose term in the model. The signs on the estimate of the dose and dose squared terms indicate whether the relationship is U shaped. All models will control for delirium risk factors, treatment group, opioid dose, and other important covariates. RC-RDA will provide propensity score methodology, modeling consultation and data analysis.
Symptoms and Function during Acute Illness in Nursing Home Residents
Principal Investigator: Boockvar; Co-PI Hung, VA funded
This series of analyses will contribute to the overall OAIC theme by examining the relationships between pain and other symptoms, medication use, acute illness and function in nursing home residents using sophisticated statistical methods. The parent study is a prospective observational cohort of residents of 2 nursing homes in New York City who have experienced 150 acute illness episodes (e.g., urinary and respiratory infections).
We will conduct analyses not funded by the parent study to describe the impact on pain, function, and other symptoms of 2 exposures: 1) periods of acute illness and 2) periods of interruption in opioid analgesics which are common. Levels of pain, function, and other symptoms during exposure periods will be compared with pre-exposure periods, controlling for repeated observations of subjects over time and clustering of subject observations by provider and nursing home, using GEE. RC-RDA will provide modeling consultation accounting for clustered observations, and statistical programming for data analysis.