Medication Misuse and Dependence Among Elderly

NCT ID: NCT03162081

Last Updated: 2024-09-04

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

ACTIVE_NOT_RECRUITING

Total Enrollment

500 participants

Study Classification

OBSERVATIONAL

Study Start Date

2017-05-03

Study Completion Date

2024-12-31

Brief Summary

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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.

Detailed Description

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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.

Conditions

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Mild Cognitive Impairment Elderly Substance-Related Disorders

Study Design

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Observational Model Type

CASE_CONTROL

Study Time Perspective

CROSS_SECTIONAL

Study Groups

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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

Substance misuse screening

Intervention Type 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)

EQ-5D

Intervention Type DIAGNOSTIC_TEST

Health related Quality of life

Impulsivity screening

Intervention Type DIAGNOSTIC_TEST

Barratts impulsivity test v. 11, Behavioural inhibition/behavioural activation test

Cognitive screening

Intervention Type DIAGNOSTIC_TEST

Minimental state examination (MMSE), Hospital anxiety and depression scale (HADS), Trail-making test, clock drawing test

Functional tests

Intervention Type DIAGNOSTIC_TEST

Timed up and go (TUG), Single leg balancing test (SLB)

Cognistat

Intervention Type DIAGNOSTIC_TEST

Assessment of cognitive domains

Neuropsychological profiling

Intervention Type 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

Intervention Type OTHER

Interview for sociodemographics, utilisation of health care, economic varables, The De Jong Gierveld Loneliness Scale

Medication use

Intervention Type OTHER

Detailed screen of used medications, interactions, side effects in electronic patient registry

Comorbidity

Intervention Type OTHER

Charlson comorbidity index and Cumulated illness rating scale (CIRS) based on electronic patient registry

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

Substance misuse screening

Intervention Type 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)

EQ-5D

Intervention Type DIAGNOSTIC_TEST

Health related Quality of life

Impulsivity screening

Intervention Type DIAGNOSTIC_TEST

Barratts impulsivity test v. 11, Behavioural inhibition/behavioural activation test

Cognitive screening

Intervention Type DIAGNOSTIC_TEST

Minimental state examination (MMSE), Hospital anxiety and depression scale (HADS), Trail-making test, clock drawing test

Functional tests

Intervention Type DIAGNOSTIC_TEST

Timed up and go (TUG), Single leg balancing test (SLB)

Cognistat

Intervention Type DIAGNOSTIC_TEST

Assessment of cognitive domains

Neuropsychological profiling

Intervention Type 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

Intervention Type OTHER

Interview for sociodemographics, utilisation of health care, economic varables, The De Jong Gierveld Loneliness Scale

Medication use

Intervention Type OTHER

Detailed screen of used medications, interactions, side effects in electronic patient registry

Comorbidity

Intervention Type OTHER

Charlson comorbidity index and Cumulated illness rating scale (CIRS) based on electronic patient registry

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

Substance misuse screening

Intervention Type 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)

EQ-5D

Intervention Type DIAGNOSTIC_TEST

Health related Quality of life

Impulsivity screening

Intervention Type DIAGNOSTIC_TEST

Barratts impulsivity test v. 11, Behavioural inhibition/behavioural activation test

Cognitive screening

Intervention Type DIAGNOSTIC_TEST

Minimental state examination (MMSE), Hospital anxiety and depression scale (HADS), Trail-making test, clock drawing test

Functional tests

Intervention Type DIAGNOSTIC_TEST

Timed up and go (TUG), Single leg balancing test (SLB)

Clinical interview

Intervention Type OTHER

Interview for sociodemographics, utilisation of health care, economic varables, The De Jong Gierveld Loneliness Scale

Medication use

Intervention Type OTHER

Detailed screen of used medications, interactions, side effects in electronic patient registry

Comorbidity

Intervention Type OTHER

Charlson comorbidity index and Cumulated illness rating scale (CIRS) based on electronic patient registry

Interventions

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Substance misuse screening

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)

Intervention Type DIAGNOSTIC_TEST

EQ-5D

Health related Quality of life

Intervention Type DIAGNOSTIC_TEST

Impulsivity screening

Barratts impulsivity test v. 11, Behavioural inhibition/behavioural activation test

Intervention Type DIAGNOSTIC_TEST

Cognitive screening

Minimental state examination (MMSE), Hospital anxiety and depression scale (HADS), Trail-making test, clock drawing test

Intervention Type DIAGNOSTIC_TEST

Functional tests

Timed up and go (TUG), Single leg balancing test (SLB)

Intervention Type DIAGNOSTIC_TEST

Cognistat

Assessment of cognitive domains

Intervention Type DIAGNOSTIC_TEST

Neuropsychological profiling

Controlled Oral Word Association Test, Categorical fluency tests, Wechsler Adult Intelligence Scale, Color-Word Interference Test (CWIT) from the Delis-Kaplan Executive Function test

Intervention Type DIAGNOSTIC_TEST

Clinical interview

Interview for sociodemographics, utilisation of health care, economic varables, The De Jong Gierveld Loneliness Scale

Intervention Type OTHER

Medication use

Detailed screen of used medications, interactions, side effects in electronic patient registry

Intervention Type OTHER

Comorbidity

Charlson comorbidity index and Cumulated illness rating scale (CIRS) based on electronic patient registry

Intervention Type OTHER

Eligibility Criteria

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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
Minimum Eligible Age

65 Years

Maximum Eligible Age

90 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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King's College London

OTHER

Sponsor Role collaborator

University of Oslo

OTHER

Sponsor Role collaborator

University Hospital, Akershus

OTHER

Sponsor Role lead

Responsible Party

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Christofer Lundqvist

Principal investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Jorunn Rugkåsa, PhD

Role: STUDY_DIRECTOR

Coordinator of overall research program

Locations

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Akershus University Hospital

Lørenskog, , Norway

Site Status

Countries

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Norway

References

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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.

Reference Type DERIVED
PMID: 38387984 (View on PubMed)

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.

Reference Type DERIVED
PMID: 38329779 (View on PubMed)

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.

Reference Type DERIVED
PMID: 38143014 (View on PubMed)

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.

Reference Type DERIVED
PMID: 35239678 (View on PubMed)

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.

Reference Type DERIVED
PMID: 34913326 (View on PubMed)

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.

Reference Type DERIVED
PMID: 32718926 (View on PubMed)

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.

Reference Type DERIVED
PMID: 31492795 (View on PubMed)

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.

Reference Type DERIVED
PMID: 31234786 (View on PubMed)

Other Identifiers

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NRC256431WP2

Identifier Type: -

Identifier Source: org_study_id

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