Active cooperation for improved pharmacotherapy in frail elderly people - The COOP Study. A randomised controlled trial

Det å bruke mange medisiner kan i en del tilfeller være både nødvendig og fornuftig, men det øker også risikoen for uhensiktsmessig behandling og bivirkninger. I denne studien undersøkte vi ut om man kan oppnå gunstige effekter av å gjøre helhetlige legemiddelvurderinger hos eldre i nært samarbeid mellom en geriater og deltakernes fastleger. Hensikten var å se om eventuelle medisinendringer som følge av en slik vurdering kan bidra til bedre funksjon og livskvalitet. Prosjektet var en randomisert kontrollert studie der deltakerne ble tilfeldig fordelt til å få oppfølging som vanlig eller en spesielt tilrettelagt vurdering i nært samarbeid mellom fastlege og geriater. Oppfølgingen og analysearbeidet er fullført, og resultatene er under publisering.

The main results from the Project will be published in 2019. Based on the resultas, further dissemination of the organisational model will be considered.

Polypharmacy is considered a major health concern in frail elderly patients, increasing the risk of delirium ("acute confusional state") as well as several other adverse drug effects. We propose a project that should provide better knowledge on how the he alth and care services at the local level, and in particular its cooperation with families, local communities and the specialist health care services, should be organized in order to deliver high-quality health and care services, lower the incidence of un desirable incidents, and provide better security for the individual patient living at home and using multiple medications. The project has two main parts. The first is a randomised controlled trial (RCT) of a structured cooperation between a hospital-base d physician trained in geriatric pharmacotherapy and the patients' family physicians and nursing home services, in order to improve the pharmacotherapy for the individual. Primary endpoint of the RCT will be mobility, and secondary endpoints will be delir ium as well as other relevant outcomes for the patient, the family, and the local caring service. The second part is an epidemiological study of delirium among home-dwelling, frail elderly patients receiving municipal nursing and care. Delirium is common among frail elderly persons, is believed to be closely connected to inappropriate medication, and has devastating consequences for the individual, the family and the professional carers. It is, however, much less studied in the home dwelling setting than in hospitalised patients. We will study occurrence of delirium in this patient group, its relation to medication as well as other risk factors, its clinical profile, and its consequences. The study population will be those most prone to develop delirium a nd other adverse drug effects, i.e. those with the most pronounced degree of polypharmacy defined as the use of eight regular medications or more, and at the same time receiving home nursing at least once a week.