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SOP Researcher Awarded Major Grant from National Institute on Aging

Dr. Linda Simoni-Wastila will use $421,000 grant to study COPD treatment in older adults with depression.

By Malissa Carroll
February 19, 2014

Linda Simoni-Wastila, BSPharm, MSPH, PhD, professor and vice chair of research for the Department of Pharmaceutical Health Services Research (PHSR) at the University of Maryland School of Pharmacy, has been awarded a $421,000 grant from the National Institute on Aging to study chronic obstructive pulmonary disease (COPD) treatment in older adults with depression. The study will examine whether older adults with depression and COPD who adhere to — or take as prescribed — their antidepressant medications demonstrate improved adherence to their COPD medications and better health outcomes compared to patients who do not adhere to their antidepressant medications.

“One thing that patients often remind researchers of is that they are people who have multiple issues going on in their lives,” says C. Daniel Mullins, PhD, professor and interim chair of PHSR. “Depression and COPD are two chronic conditions that are particularly prevalent among older adults. However, research too often focuses only on a single medical condition or factor, and fails to address the more holistic view of health. By examining the interplay between physical and mental health, Dr. Simoni-Wastila’s research represents a groundbreaking effort to address the diverse needs of patients, rather than a narrow component of disease.”

Identified as the third leading cause of death in the United States, COPD refers to a group of lung diseases – namely emphysema and chronic bronchitis – that obstruct an individual’s air flow and interfere with normal breathing, resulting in a chronic cough that produces large amounts of mucus, wheezing, shortness of breath, and chest tightness. According to the American Lung Association, more than 12 million individuals have been diagnosed with COPD in the United States.

Because there is no cure for COPD, and the condition worsens over time, individuals with this disease are also often diagnosed with depression – a serious mood disorder that causes a persistent feeling of sadness and loss of interest. According to recent research, approximately 42 to 57 percent of individuals diagnosed with COPD also suffer from depression. Although the benefits associated with certain prescription medications designed to treat depression and COPD have been clearly illustrated in previous research, those medications continue to be underutilized in older adults. For older adults who are prescribed these medications, adherence remains low.

“Older adults are complex individuals who are often diagnosed with multiple chronic illnesses and require multiple medications to manage those conditions,” says Simoni-Wastila. “If we can demonstrate that successfully treating depression in older adults who have been diagnosed with both depression and COPD improves their health and life expectancy – in addition to reducing costs – this will help providers and patients better understand the need to treat the whole patient, not just one condition.”

Using data gathered from Medicare claims and Medicare Prescription Drug Coverage (Part D) from 2006 to 2011, the study will analyze the effects of individual treatments and medications on patients’ health outcomes, with a focus on any observed benefits associated with antidepressant treatment on patients’ adherence to their COPD medications and health outcomes.

“The goal of this study is to improve quality of life and health outcomes for older adults who have been diagnosed with multiple chronic conditions through improved management of their medications,” says Simoni-Wastila. “After analyzing the data, we will be able to identify the unique and joint contributions of depression and COPD to patients’ medication use and adherence. This will help us understand how medication use and adherence in one condition influences medication use and adherence in the other condition, allowing us to better characterize the unique and joint contributions of those treatments on patients’ health outcomes.”

She adds, “I believe that improving medication use and adherence in one condition, either depression or COPD, will have a positive effect on medication use and adherence in other conditions.”

Another important component of the study, which will be completed in August 2015, is the marginal structural modeling that Simoni-Wastila and her team will perform. This particular class of statistical models will control for the bias often introduced by time-varying confounders, such as disease severity.

“It is my hope that our findings will serve as the empiric evidence needed to develop new treatment guidelines, algorithms, or interventions to improve the clinical management of older adults with COPD and depression,” says Simoni-Wastila. “In addition, if these models prove correct, they will give us a fantastic analytic approach that we can apply to other disease combinations.”

Other researchers who will be collaborating with Simoni-Wastila on this study include Ilene Zuckerman, PharmD, PhD, principal research scientist and managing director at IMPAQ International and professor emerita of the School of Pharmacy; Patricia Langenberg, PhD, professor and vice chair for academic programs in the Department of Epidemiology and Preventive Medicine at the University of Maryland School of Medicine; Giora Netzer, MD, director of clinical research and assistant professor of medicine at the School of Medicine; Susan Lehmann, MD, associate professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine; and Yu-Jung “Jenny” Wei, PhD, post-doctoral fellow in PHSR.

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