Medication Misuse and Dependence Among Elderly

University Hospital, Akershus

Status: Active, not recruiting

Conditions: Mild Cognitive Impairment; Substance-Related Disorders; Elderly

Treatments: Diagnostic Test: Cognistat; Diagnostic Test: Functional tests; Other: Clinical interview; Diagnostic Test: EQ-5D; Diagnostic Test: Substance misuse screening; Diagnostic Test: Neuropsychological profiling; Diagnostic Test: Cognitive screening; Other: Medication use; Other: Comorbidity; Diagnostic Test: Impulsivity screening

Study type: Observational

Funder types: Other

Identifiers

NCT03162081

NRC256431WP2

Details and patient eligibility

About

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.

Full 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.

Enrollment: 500 estimated patients

Sex: All

Ages: 65 to 90 years old

Volunteers: No Healthy Volunteers

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

Trial design

500 participants in 3 patient groups

Users

Description:

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

Treatment:

Other: Comorbidity

Diagnostic Test: Impulsivity screening

Diagnostic Test: Neuropsychological profiling

Diagnostic Test: Cognitive screening

Diagnostic Test: Substance misuse screening

Other: Medication use

Other: Clinical interview

Diagnostic Test: Functional tests

Diagnostic Test: EQ-5D

Diagnostic Test: Cognistat

Non-users

Description:

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

Treatment:

Other: Comorbidity

Diagnostic Test: Impulsivity screening

Diagnostic Test: Neuropsychological profiling

Diagnostic Test: Cognitive screening

Diagnostic Test: Substance misuse screening

Other: Medication use

Other: Clinical interview

Diagnostic Test: Functional tests

Diagnostic Test: EQ-5D

Diagnostic Test: Cognistat

Screening group

Description:

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

Treatment:

Other: Comorbidity

Diagnostic Test: Impulsivity screening

Diagnostic Test: Cognitive screening

Diagnostic Test: Substance misuse screening

Other: Medication use

Other: Clinical interview

Diagnostic Test: Functional tests

Diagnostic Test: EQ-5D