Medication Misuse and Dependence in Elderly Patients
Overview
- Phase
- Not Applicable
- Intervention
- Not specified
- Conditions
- Mild Cognitive Impairment
- Sponsor
- University Hospital, Akershus
- Enrollment
- 500
- Primary Endpoint
- Dependence y/n
- Status
- Active, not recruiting
- Last Updated
- 2 years ago
Overview
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.
Investigators
Christofer Lundqvist
Principal investigator
University Hospital, Akershus
Eligibility Criteria
Inclusion Criteria
- •Admitted to geriatric or Neurology dept of hospital during inclusion time
Exclusion Criteria
- •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
Outcomes
Primary Outcomes
Dependence y/n
Time Frame: Within 2 weeks of admission
DSM-IV defined substance dependence assessed by MINI interview
Medication misuse y/n
Time Frame: 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 Outcomes
- TUG(Within 2 weeks of admission)
- COGNISTAT(Within 2 weeks of admission)
- No of days of use of defined addictive medications/month(Within 2 weeks of admission)
- No.of inappropriate medications for elderly at discharge(Within 2 weeks (index stay may in some cases be somewhat longer))
- MCI - Mild cognitive impairment(Within 2 weeks of admission)
- BIS-11(Within 2 weeks of admission)
- BIS/BAS score(Within 2 weeks of admission)
- MMSE(Within 2 weeks of admission)
- EQ-5D(Within 2 weeks of admission)
- SLB(Within 2 weeks of admission)
- Neuropsychological profiles(Within 2 weeks of admission)
- No.of inappropriate medications for elderly at admission(Within 2 weeks of admission)
- Substance use disorder(Within 2 weeks)
- Use of addictive medication y/n(Within 2 weeks of admission)
- No. of possible side effects(Within 2 weeks of admission)
- No. of possible serious interactions(Within 2 weeks of admission)
- No.of inappropriate medications for elderly during in-hospital stay(Within 2 weeks of admission)