The project focuses on investigating problematic medication use, especially overuse of potentially addictive drugs among the elderly. The investigators aim firstly to develop and validate instruments for detecting and describing behavioral aspects and consequences of dependence on, and misuse of, prescription medication among elderly. In addition to evaluating diagnostic utility of screening instruments, the investigators aim to identify and report characteristics, risk factors and consequences of medication misuse and dependence among the elderly.
Elderly represent a particularly vulnerable group with many contributing factors including age-related multifactorial morbidity, cognitive function, polypharmacy, dependence and multiple prescribers with suboptimal communication. Centrally active pain killers and sedative/hypnotic medications give increased risk of addiction, adverse drug events, reduced physical and/or cognitive function. The project comprises diagnostic accuracy, descriptive screening, cross-sectional and case-control studies, with aims to: i) assess diagnostic utility of instruments for elderly patients; ii) describe risk factors for medication misuse and dependence; iii) describe consequences of the use of centrally active medications among elderly compared to a control population. Moreover, the investigators aim to examine the association between medication misuse and changes in cognitive function, focusing on deficits in specific domains of cognition. An additional aim is to explore the possibility of dissociating such cognitive changes from other causes of mild cognitive impairment (MCI) associated with development of dementia.
Study Type
OBSERVATIONAL
Enrollment
500
Diagnostic and Statistical manual of mental disorders, version 4 (DSM-IV)/MINI-international Neuropsychiatric interview (MINI interview) for Diagnostics of dependence, additional questions for DSM-V classification, severity of dependence scale (SDS)
Health related Quality of life
Barratts impulsivity test v. 11, Behavioural inhibition/behavioural activation test
Minimental state examination (MMSE), Hospital anxiety and depression scale (HADS), Trail-making test, clock drawing test
Timed up and go (TUG), Single leg balancing test (SLB)
Assessment of cognitive domains
Controlled Oral Word Association Test, Categorical fluency tests, Wechsler Adult Intelligence Scale, Color-Word Interference Test (CWIT) from the Delis-Kaplan Executive Function test
Interview for sociodemographics, utilisation of health care, economic varables, The De Jong Gierveld Loneliness Scale
Detailed screen of used medications, interactions, side effects in electronic patient registry
Charlson comorbidity index and Cumulated illness rating scale (CIRS) based on electronic patient registry
Akershus University Hospital
Lørenskog, Norway
Dependence y/n
DSM-IV defined substance dependence assessed by MINI interview
Time frame: Within 2 weeks of admission
Medication misuse y/n
Use of any of: opiates/benzodiazepine/Z-hypnotics \>5 days per week for \>3 months
Time frame: Past year prior to in-hospital stay (data collected within 2 weeks of admission)
MCI - Mild cognitive impairment
Defined by MMSE \< 26
Time frame: Within 2 weeks of admission
MMSE
Numerical score of cognitive function
Time frame: Within 2 weeks of admission
COGNISTAT
Cognitive profile
Time frame: Within 2 weeks of admission
EQ-5D
Quality of life
Time frame: Within 2 weeks of admission
BIS-11
Impulsivity score
Time frame: Within 2 weeks of admission
BIS/BAS score
Behavioura inhibition/activation score
Time frame: Within 2 weeks of admission
TUG
Functional test score (time in secs)
Time frame: Within 2 weeks of admission
SLB
Functional test score (time in secs)
Time frame: Within 2 weeks of admission
Neuropsychological profiles
Tests as listed
Time frame: Within 2 weeks of admission
Use of addictive medication y/n
Prescription use of any of the following: opiates, benzodiazepines, Z-hypnotics
Time frame: Within 2 weeks of admission
No of days of use of defined addictive medications/month
No. days of use of any of the following: opiates, benzodiazepines, Z-hypnotics
Time frame: Within 2 weeks of admission
No. of possible side effects
No. possible side effects of any of the following: opiates, benzodiazepines, Z-hypnotics
Time frame: Within 2 weeks of admission
No. of possible serious interactions
No. possible serious interactions of any of the following: opiates, benzodiazepines, Z-hypnotics
Time frame: Within 2 weeks of admission
No.of inappropriate medications for elderly at admission
No.of inappropriate medications as defined by NORGEP criteria (Norwegian general practice criteria)
Time frame: Within 2 weeks of admission
No.of inappropriate medications for elderly during in-hospital stay
No.of inappropriate medications as defined by NORGEP criteria
Time frame: Within 2 weeks of admission
No.of inappropriate medications for elderly at discharge
No.of inappropriate medications as defined by NORGEP criteria
Time frame: Within 2 weeks of admission
No.of inappropriate medications for elderly at admission
No.of inappropriate medications as defined by STOPP criteria (Screening tool of older patients prescriptions)
Time frame: Within 2 weeks of admission
No.of inappropriate medications for elderly during in-hospital stay
No.of inappropriate medications as defined by STOPP criteria
Time frame: Within 2 weeks of admission
No.of inappropriate medications for elderly at discharge
No.of inappropriate medications as defined by STOPP criteria
Time frame: Within 2 weeks (index stay may in some cases be somewhat longer)
Substance use disorder
DSM-IV criteria assessed through additional questions to MINI interview
Time frame: Within 2 weeks
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.