Active Cooperation for Improved Pharmacotherapy in Frail Elderly people - The COOP Study, 2019

More and more elderly people are using many medications. It can be a blessing because it helps with troublesome diseases, but it can also be a curse because the elderly are prone to torublesome or fatal side effects. The health services does not have good routines for finding the best balance of medication for each individual patient. Our hypothesis was that geriatric assessment followed by a structured drug review by geriatricians and General Practitioner together could improve patients health-related quality of life and other relevant aspects of patients health. 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. This project should provide better knowledge on how the health 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 randomized controlled trial (RCT) of a structured cooperation between a hospital-based physician trained in geriatric pharmacotherapy and the patients' family, physicians and nursing home services. The goal of the RCT was to improve the pharmacotherapy for the individual. Primary endpoint of the RCT was mobility, and secondary endpoints was delirium as well as other relevant outcomes for the patient, the family, and the local caring service. The second part was an epidemiological study of delirium among home-dwelling, frail elderly patients receiving municipal nursing and care. Delirium is common among frail elderly persons and is believed to be closely connected to inappropriate medication. It has devastating consequences for the individual, the family and the professional caregivers. Delirium is much less studied in the home dwelling setting than in hospitalized patients. The project studied the 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 was those most prone to develop delirium and 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.