Optimizing Treatment of Older Adults with Hypertension: A Net Benefit Analysis of Falls Injury vs Cardiovascular Outcomes

a MiCDA Research Project Description

Investigators: Lillian Min, Timothy P. Hofer, Kenneth M. Langa, Neil Burton Alexander, Andrzej T. Galecki, Eve Askanas Kerr, Hyungjin Myra Kim

Funding: National Institute on Aging, 2015-2020 (1 R01 AG 047178 01 A1)

Every year, one in 10 older people fall and sustain injury requiring medical care. Fall-related injury is the number one cause of accidental death in older Americans. However, fall injury is rarely considered as a outcome in controlled trials, which have traditionally focused on death and cardiovascular events. Until recently, we lacked methods of capturing fall-related injury in large healthcare databases. We will first use the Health and Retirement Study, a national study of older Americans, to develop a method of classifying severe fall injury in found in Medicare claims data across acute, ambulatory, and long-term care (Aim 1).
Next, we will study how a national healthcare system, the Veterans Health Administration (VHA), delivers aggressive hypertension care (AHC) and whether AHC results in net benefit or harm due to cardiovascular events and severe fall-related injury. Hypertension is the single most common chronic condition in older adults. Medication treatment prevents important cardiovascular events (strokes, myocardial infarctions and heart failure), however also contributes to risk of falls. We do not fully understand the net benefits and harms among our oldest patients in clinical practice, especially after age 75 ? those most prone to severe fall-injury. Thus, we aim to study the net harms and benefits associated with AHC, defined as low blood pressure (BP,

Research Signature Theme:

Health and well-being in later life: Chronic Disease