Drug Safety
Drug safety scientist puts faces to her geriatric drug research.
Health data scientists consume copious numbers and figures, yet seldom meet the people their research benefits. But Yu-Jung “Jenny” Wei, Ph.D., a rising star in the field of drug safety, gets the chance to put faces to the numbers behind her antipsychotic drug research.
Thanks to a Career Development Award, or K award, sponsored by the National Institutes of Health’s National Institute on Aging, Wei interacts with patients as she shadows physicians at UF Health Family Medicine at Main and the Oak Hammock retirement community in
Gainesville. The NIH award gives Wei, an assistant professor in the department of pharmaceutical outcomes and policy, research infrastructure and mentoring support designed to help young investigators become independent researchers.
“Shadowing in the practice helps me discover new problems and key issues of pain management in older adults, which could otherwise go unnoticed,” she said. “It allows me to understand the meaning behind the data, make sure the conclusions I am reaching are valid and outlines steps for my future research agenda.”
One of Wei’s current research areas is the study of antipsychotic medications, covering the complete age range from preschoolers to the elderly. Her K award focuses specifically on understanding how geriatric care and pain management are delivered in nursing homes — places that provide care for people with cognitive impairments.
ANTIPSYCHOTIC USE IN THE ELDERLY
Wei’s research into antipsychotic prescriptions among the elderly has focused on their comparative fall and fracture risk with other commonly prescribed psychotropic prescriptions like antidepressants, as well as the impact of inappropriate antipsychotic prescribing on mortality risk.
In one of Wei’s studies, she compares the risk of falls and fractures among Alzheimer’s patients prescribed antipsychotics versus those prescribed antidepressants.
Prescribing antipsychotics to Alzheimer’s patients is not FDA-approved and is a controversial issue as 179,000 nursing home patients continue to receive these drugs every week, according to Human Rights Watch. These drugs are incorrectly used as a sedative to reduce calls for help and to calm behavior, Wei said. As antipsychotics have been highly scrutinized, many prescribers turn to antidepressants that also have sedative properties.
Yet using Medicare claims data, Wei’s research found that prescribed antidepressants are associated with higher fall and fracture risk compared to antipsychotics in the management of older adults with Alzheimer’s disease and related dementia who experience moderate to severe behavioral symptoms.
Wei recommends clinicians assess the ongoing risks and benefits of antidepressants for these symptoms, especially in light of the increasingly prevalent use of these medications.
In another study, Wei examined mortality rates and antipsychotic medication. Through a 5 percent random sampling of Medicare beneficiaries, Wei’s team found that mortality risk increases when patients with serious mental illnesses are inappropriately prescribed higher than recommended antipsychotic doses on short-term regimens.
The mortality risk decreases when prescribed within recommended dose ranges on long-term regimens. The greatest difficulty with this long-term treatment is getting patients to adhere to instructions.
Wei recommends prescribers monitor antipsychotic dosage throughout the course of treatment and customize dose and duration regimens to an individual’s indications.
Her future studies will address pain control approaches that consider and manage mental health problems in older adults with ADRD.
Yu-Jung “Jenny” Wei, Ph.D., discusses antipsychotic research with her graduate students.
Donovan Baltich
ANTIPSYCHOTIC USE IN CHILDREN
Antipsychotics, also known as neuroleptics or major tranquilizers, are FDA-approved to treat mental illnesses such as bipolar disorder in children ages 6 and up. There are many side effects associated with antipsychotic prescriptions in children, including diabetes, obesity, hyperlipidemia, hyperprolactinemia, cardiovascular disease and extrapyramidal symptoms.
Wei and her research team used data from the Florida Medicaid Prior Authorization program to research outcomes among preschoolers. The team worked to identify which of the six side effects is most prevalent.
The study found that two side effects are particularly prevalent: obesity and extrapyramidal symptoms, or drug-induced movement disorders. Wei concluded that risk for both extrapyramidal symptoms and obesity deserves clinical attention during antipsychotic treatment among preschoolers.
