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| Name | Class |
|---|---|
| King's College London | OTHER |
| University of Oslo | OTHER |
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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.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Users | Elderly patients who use prescription benzodiazepines/Z-hypnotics or opiates Clinical interview, Substance misuse screening, EuroQol five dimensional health-related quality of life questionnaires (EQ-5D), Impulsivity screening, Cognitive screening, Functional tests, Cognistat Neurobehavioural cognitive status examination (Cognistat), Neuropsychological profiling, Medication use, Comorbidity |
| |
| Non-users | Age and gender matched controls not using the above Clinical interview, Substance misuse screening, EuroQol five dimensional health-related quality of life questionnaires (EQ-5D), Impulsivity screening, Cognitive screening, Functional tests, Cognistat Neurobehavioural cognitive status examination (Cognistat), Neuropsychological profiling, Medication use, Comorbidity |
| |
| Screening group | Patients over 65 admitted to hospital as in-patients Clinical interview, Substance misuse screening, EuroQol five dimensional health-related quality of life questionnaires (EQ-5D), Impulsivity screening, Cognitive screening, Functional tests, Medication use, Comorbidity |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Substance misuse screening | Diagnostic Test | 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) |
| Measure | Description | Time Frame |
|---|---|---|
| Dependence y/n | DSM-IV defined substance dependence assessed by MINI interview | Within 2 weeks of admission |
| Medication misuse y/n | Use of any of: opiates/benzodiazepine/Z-hypnotics >5 days per week for >3 months | Past year prior to in-hospital stay (data collected within 2 weeks of admission) |
| Measure | Description | Time Frame |
|---|---|---|
| MCI - Mild cognitive impairment | Defined by MMSE < 26 | Within 2 weeks of admission |
| MMSE | Numerical score of cognitive function | Within 2 weeks of admission |
| Measure | Description | Time Frame |
|---|---|---|
| Mortality | Crude mortality from patient registry data | 2 years |
| Mortality | Crude mortality from patient registry data | 5 years |
Inclusion Criteria:
Exclusion Criteria:
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All admitted elderly 65-90 years of age are screened, for case-control age and gender-matched pairs of Users and non-users will in addition be examined in depth with neuropsychological tests
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| Name | Affiliation | Role |
|---|---|---|
| Jorunn Rugkåsa, PhD | Coordinator of overall research program | Study Director |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Akershus University Hospital | Lørenskog | Norway |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 38387984 | Derived | Bjelkaroy MT, Simonsen TB, Siddiqui TG, Cheng S, Grambaite R, Benth JS, Lundqvist C. Mortality and health-related quality of life in older adults with long-term use of opioids, z-hypnotics or benzodiazepines: a prospective observational study at 5 years follow-up. BMJ Open. 2024 Feb 21;14(2):e079347. doi: 10.1136/bmjopen-2023-079347. | |
| 38329779 |
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|
|
| EQ-5D | Diagnostic Test | Health related Quality of life |
|
| Impulsivity screening | Diagnostic Test | Barratts impulsivity test v. 11, Behavioural inhibition/behavioural activation test |
|
| Cognitive screening | Diagnostic Test | Minimental state examination (MMSE), Hospital anxiety and depression scale (HADS), Trail-making test, clock drawing test |
|
| Functional tests | Diagnostic Test | Timed up and go (TUG), Single leg balancing test (SLB) |
|
| Cognistat | Diagnostic Test | Assessment of cognitive domains |
|
| Neuropsychological profiling | Diagnostic Test | Controlled Oral Word Association Test, Categorical fluency tests, Wechsler Adult Intelligence Scale, Color-Word Interference Test (CWIT) from the Delis-Kaplan Executive Function test |
|
| Clinical interview | Other | Interview for sociodemographics, utilisation of health care, economic varables, The De Jong Gierveld Loneliness Scale |
|
| Medication use | Other | Detailed screen of used medications, interactions, side effects in electronic patient registry |
|
| Comorbidity | Other | Charlson comorbidity index and Cumulated illness rating scale (CIRS) based on electronic patient registry |
|
| COGNISTAT | Cognitive profile | Within 2 weeks of admission |
| EQ-5D | Quality of life | Within 2 weeks of admission |
| BIS-11 | Impulsivity score | Within 2 weeks of admission |
| BIS/BAS score | Behavioura inhibition/activation score | Within 2 weeks of admission |
| TUG | Functional test score (time in secs) | Within 2 weeks of admission |
| SLB | Functional test score (time in secs) | Within 2 weeks of admission |
| Neuropsychological profiles | Tests as listed | Within 2 weeks of admission |
| Use of addictive medication y/n | Prescription use of any of the following: opiates, benzodiazepines, Z-hypnotics | 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 | Within 2 weeks of admission |
| No. of possible side effects | No. possible side effects of any of the following: opiates, benzodiazepines, Z-hypnotics | Within 2 weeks of admission |
| No. of possible serious interactions | No. possible serious interactions of any of the following: opiates, benzodiazepines, Z-hypnotics | 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) | Within 2 weeks of admission |
| No.of inappropriate medications for elderly during in-hospital stay | No.of inappropriate medications as defined by NORGEP criteria | Within 2 weeks of admission |
| No.of inappropriate medications for elderly at discharge | No.of inappropriate medications as defined by NORGEP criteria | 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) | Within 2 weeks of admission |
| No.of inappropriate medications for elderly during in-hospital stay | No.of inappropriate medications as defined by STOPP criteria | Within 2 weeks of admission |
| No.of inappropriate medications for elderly at discharge | No.of inappropriate medications as defined by STOPP criteria | 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 | Within 2 weeks |
| Readmission rate | Number of readmissions after index admission | 5 years |
| Total readmission days | Total number of readmission days | 5 years |
| Bjelkaroy MT, Simonsen TB, Siddiqui TG, Halset S, Cheng S, Grambaite R, Benth JS, Gerwing J, Kristoffersen ES, Lundqvist C. Brief Intervention as a Method to Reduce Z-Hypnotic Use by Older Adults: Feasibility Case Series. JMIR Form Res. 2024 Feb 8;8:e51862. doi: 10.2196/51862. |
| 38143014 | Derived | Bjelkaroy MT, Benth JS, Simonsen TB, Siddiqui TG, Cheng S, Kristoffersen ES, Lundqvist C. Measuring pain intensity in older adults. Can the visual analogue scale and the numeric rating scale be used interchangeably? Prog Neuropsychopharmacol Biol Psychiatry. 2024 Mar 2;130:110925. doi: 10.1016/j.pnpbp.2023.110925. Epub 2023 Dec 22. |
| 35239678 | Derived | Siddiqui TG, Bjelkaroy MT, Cheng S, Kristoffersen ES, Grambaite R, Lundqvist C. The effect of cognitive function and central nervous system depressant use on mortality-A prospective observational study of previously hospitalised older patients. PLoS One. 2022 Mar 3;17(3):e0263024. doi: 10.1371/journal.pone.0263024. eCollection 2022. |
| 34913326 | Derived | Bjelkaroy MT, Cheng S, Siddiqui TG, Benth JS, Grambaite R, Kristoffersen ES, Lundqvist C. The association between pain and central nervous system depressing medication among hospitalised Norwegian older adults. Scand J Pain. 2021 Dec 16;22(3):483-493. doi: 10.1515/sjpain-2021-0120. Print 2022 Jul 26. |
| 32718926 | Derived | Siddiqui TG, Cheng S, Gossop M, Kristoffersen ES, Grambaite R, Lundqvist C. Association between prescribed central nervous system depressant drugs, comorbidity and cognition among hospitalised older patients: a cross-sectional study. BMJ Open. 2020 Jul 27;10(7):e038432. doi: 10.1136/bmjopen-2020-038432. |
| 31492795 | Derived | Cheng S, Siddiqui TG, Gossop M, Kristoffersen ES, Lundqvist C. Sociodemographic, clinical and pharmacological profiles of medication misuse and dependence in hospitalised older patients in Norway: a prospective cross-sectional study. BMJ Open. 2019 Sep 5;9(9):e031483. doi: 10.1136/bmjopen-2019-031483. |
| 31234786 | Derived | Cheng S, Siddiqui TG, Gossop M, Kristoffersen ES, Lundqvist C. The Severity of Dependence Scale detects medication misuse and dependence among hospitalized older patients. BMC Geriatr. 2019 Jun 24;19(1):174. doi: 10.1186/s12877-019-1182-3. |
| ID | Term |
|---|---|
| D060825 | Cognitive Dysfunction |
| D019966 | Substance-Related Disorders |
| D016739 | Behavior, Addictive |
| D007175 | Impulsive Behavior |
| D063487 | Prescription Drug Misuse |
| ID | Term |
|---|---|
| D003072 | Cognition Disorders |
| D019965 | Neurocognitive Disorders |
| D001523 | Mental Disorders |
| D064419 | Chemically-Induced Disorders |
| D003192 | Compulsive Behavior |
| D001519 | Behavior |
| D000076064 | Drug Misuse |
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| ID | Term |
|---|---|
| D008508 | Medication Errors |
| D015897 | Comorbidity |
| ID | Term |
|---|---|
| D004358 | Drug Therapy |
| D013812 | Therapeutics |
| D019300 | Medical Errors |
| D006296 | Health Services |
| D005159 | Health Care Facilities Workforce and Services |
| D015981 | Epidemiologic Factors |
| D011787 | Quality of Health Care |
| D017530 | Health Care Quality, Access, and Evaluation |
| D011634 | Public Health |
| D004778 | Environment and Public Health |
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