Browsing Theses and Dissertations School of Pharmacy by Subject "Older people"
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Management of Traumatic Brain Injury with Statins among Older Medicare BeneficiariesBackground: Traumatic brain injury (TBI) is a major health concern for older adults aged 65 and older. Older TBI patients are at increased risk of primary injury (in-hospital and all-cause mortality) and secondary injury (stroke, depression, and Alzheimer's disease and related dementias (ADRD)). There is limited research regarding optimal pharmacotherapeutic options and management of TBI patients; however, several studies have highlighted statins, used to treat hyperlipidemia, as potential pharmacologic agents to reduce inflammation and improve impaired cerebral blood flow associated with primary and secondary injury. The objectives of the study are to: 1) quantify statin utilization, and 2) determine the associations between statin use and primary and secondary injury among TBI patients. Methods: Statin use (atorvastatin, fluvastatin, lovastatin, pravastatin, rosuvastatin, and simvastatin), primary injury, and secondary injury were examined among Medicare beneficiaries hospitalized with a TBI between 2006 and 2010. Logistic regression was used to investigate the relationship between pre-TBI statin use and in-hospital mortality, while discrete time analysis was used to investigate the relationship between statin use following TBI and all-cause mortality and secondary injury. Results: Among the 75,698 beneficiaries who met study criteria, 37,874 (50.0%) beneficiaries used a statin at least once during the study period. The most common statin used was simvastatin, followed by atorvastatin. Fluvastatin was the least used statin. Pre-TBI use of atorvastatin (odds ratio (OR) 0.88; 95% confidence interval (CI) 0.82, 0.96), simvastatin (OR 0.84; 95% CI 0.79, 0.91), and rosuvastatin (OR 0.79; 95% CI 0.67, 0.94) were associated with significant decreases in the risk of in-hospital mortality. Any statin use was associated with reduced all-cause mortality following TBI-hospitalization discharge. Atorvastatin and simvastatin use also were associated with reductions in all secondary injury outcomes. Conclusion: Tens of thousands of older adults are hospitalized annually with TBI and experience disabling primary and secondary injury; findings from these analyses have salient implications for reducing the risk of TBI complications among older adults. The evidence generated suggests that preemptive use of statins may decrease the risk of in-hospital and all-cause mortality, as well as reduce the likelihood of stroke, depression, and ADRD.