Medication Misuse and Dependence Among Elderly
- Conditions
- Substance-Related DisordersMild Cognitive ImpairmentElderly
- Registration Number
- NCT03162081
- Lead Sponsor
- University Hospital, Akershus
- Brief Summary
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.
- Detailed Description
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.
Recruitment & Eligibility
- Status
- ACTIVE_NOT_RECRUITING
- Sex
- All
- Target Recruitment
- 500
- Admitted to geriatric or Neurology dept of hospital during inclusion time
- MMSE < 21,
- diagnosis of pre-existing severe depression or psychotic disease,
- pre-existing dementia diagnosis,
- new pain requiring start-up of central pain killers not previously used,
- Palliative treatment.
- Insufficient Norwegian language
- Serious visual disturbance and hearing impairment
- Strongly reduced general health precluding partcipation in interview and questionnaires
Study & Design
- Study Type
- OBSERVATIONAL
- Study Design
- Not specified
- Primary Outcome Measures
Name Time Method Dependence y/n Within 2 weeks of admission DSM-IV defined substance dependence assessed by MINI interview
Medication misuse y/n Past year prior to in-hospital stay (data collected within 2 weeks of admission) Use of any of: opiates/benzodiazepine/Z-hypnotics \>5 days per week for \>3 months
- Secondary Outcome Measures
Name Time Method TUG Within 2 weeks of admission Functional test score (time in secs)
COGNISTAT Within 2 weeks of admission Cognitive profile
No of days of use of defined addictive medications/month Within 2 weeks of admission No. days of use of any of the following: opiates, benzodiazepines, Z-hypnotics
No.of inappropriate medications for elderly at discharge Within 2 weeks (index stay may in some cases be somewhat longer) No.of inappropriate medications as defined by STOPP criteria
MCI - Mild cognitive impairment Within 2 weeks of admission Defined by MMSE \< 26
BIS-11 Within 2 weeks of admission Impulsivity score
BIS/BAS score Within 2 weeks of admission Behavioura inhibition/activation score
MMSE Within 2 weeks of admission Numerical score of cognitive function
EQ-5D Within 2 weeks of admission Quality of life
SLB Within 2 weeks of admission Functional test score (time in secs)
Neuropsychological profiles Within 2 weeks of admission Tests as listed
No.of inappropriate medications for elderly at admission Within 2 weeks of admission No.of inappropriate medications as defined by STOPP criteria (Screening tool of older patients prescriptions)
Substance use disorder Within 2 weeks DSM-IV criteria assessed through additional questions to MINI interview
Use of addictive medication y/n Within 2 weeks of admission Prescription use of any of the following: opiates, benzodiazepines, Z-hypnotics
No. of possible side effects Within 2 weeks of admission No. possible side effects of any of the following: opiates, benzodiazepines, Z-hypnotics
No. of possible serious interactions Within 2 weeks of admission No. possible serious interactions of any of the following: opiates, benzodiazepines, Z-hypnotics
No.of inappropriate medications for elderly during in-hospital stay Within 2 weeks of admission No.of inappropriate medications as defined by STOPP criteria