Research projects to focus on elderly patients receiving medical treatment
20.05.2020 l Latest news
The use of medication by the elderly is associated with a wide range of risks. With funding from VELUX FONDEN, three research projects will focus on how serious errors in the use of medication for elderly patients can be minimised.
The medical treatment of elderly patients is associated with many risks. Elderly patients, for example, often suffer from several diseases, and consequently are being treated with several different types of medicine. Together, the different medications can constitute a dangerous cocktail, and one to which the elderly patient may be particularly susceptible.
The grantee projects will focus on the problems associated with polypharmacy – treatment with five or more types of medication at the same time.
The three projects:
Professor Christian Backer Mogensen, consultant, PhD, Focused Research Unit in Emergency Medicine, University of Southern Denmark (SDU) (DKK 586,000)
The risk of drug interaction increases with the number of medicines, but also because of the increased sensitivity of elderly patients to drug interactions. Elderly patients who have been discharged from hospital are at particular risk, as most patients will find that several changes are made to their medication. Therefore, discharges from the hospital as well as other sector transitions are critical elements in a course of treatment, with the risk of knowledge loss, misunderstandings and patient safety incidents.
Despite the fact that information on medicines is sent from the hospital to the elderly person’s own general practitioner (GP), and that health professionals can access the Joint Medicine Card (Fælles Medicinkort (FMK)), which is designed to improve cooperation and safety as regards incorrect medication, it is not possible for all the different parties involved in the treatment process to exchange information. Thus, it is therefore necessary to develop one or more tools for reviewing and reorganising medication which can be used together by several parties.
The purpose of this project is therefore, together with patients, caregivers and healthcare professionals, to develop a method whereby the patient can receive exactly the right medication following discharge from hospital. The project will examine the needs, wishes and barriers among the various stakeholders, and together with patients, caregivers, doctors, pharmacists and home-helpers is seeking to develop a solution which can be further developed, adapted and tested. The project will be carried out under the auspices of the research programme ‘PÅ FORKANT’ (At the forefront), which is a collaboration between hospitals, municipalities and GPs in the municipalities in question, as well as universities. In addition, there are four users in the project steering group.
Associate professor Maria Skaalum Petersen, Department of Occupational Medicine and Public Health, National Hospital of the Faroe Islands (DKK 1,218,602)
Worldwide, the elderly account for a larger proportion of the population, with those aged 90 years and over being the fastest growing group. Growing older is often accompanied by polypharmacy – the use of five or more types of medication – but this can be harmful if inappropriate drug interactions occur as well as side-effects, despite the fact that each preparation on its own is a correct treatment.
Little is known about medicine consumption among elderly Faroese, or about the prevalence of inappropriate medication, but the use of an integrated electronic health record system across different sectors combined with the small and homogenous population results, according to the researchers’ hypothesis, in fewer challenges in connection with medicine use by the elderly.
The aim of the project is therefore to examine medicine consumption among elderly Faroese and to contribute to more appropriate medication and sector transition for frail elderly patients. The project will examine attitudes towards medicine consumption among elderly aged 90 years and over through qualitative and quantitative methods, including home visits. The project will also examine attitudes towards medication among doctors in connection with discharging elderly patients from hospital.
The project is being carried out through a cooperation between universities, hospitals, associations and local authorities, while also collaborating with Professor Kaare Christensen from the University of Southern Denmark (SDU).
Senior researcher Anne Estrup Olsen, Clinical Pharmacology Unit, Aalborg University Hospital (DKK 1,983,222)
Patient safety incidents are the most frequently reported type of adverse incident in the health care system, and elderly people receiving municipal care are at particular risk. Studies have shown that there is a link between the patient safety culture among staff and actual patient safety.
However, studies of patient safety culture are limited by the fact that they are primarily based on foreign observational studies without control groups. It is therefore necessary to design and test new interdisciplinary and intersectoral interventions in randomised trials with a view to reducing the risk of patient safety incidents.
The aim of the PhD project is therefore to develop and test an intervention which can improve patient safety culture when medically treating weak elderly people which could potentially be rolled out in practice. In addition, studies will be carried out to establish whether the intervention has a clinical and health economic effect. Data will be collected before, during and after the intervention through interviews, questionnaires and registers. The intervention is being developed by an intersectoral and interdisciplinary panel comprising staff, citizens, caregivers and GPs, so the project therefore has a high level of user involvement.
The project will be carried out in cooperation with the Clinical Pharmacology Department at Aalborg University Hospital, Aalborg University, University College of Northern Denmark (UCN), GPs and the Municipality of Aalborg.
VELUX FONDEN will continue to focus on research into the use of medicines by the elderly to generate knowledge-based solutions for the safer and the more considerate use of medical treatment.
User involvement a priority
One criterion for awarding grants to projects has been that practitioners and municipalities take part in the project, and that either patients or caregivers are actively involved in all parts of the research process. According to Lise Bonnevie, programme manager at VELUX FONDEN, user involvement strengthens the individual projects:
“User involvement is part of the requirement for grants, as it results in more sustainable and relevant projects that increase the level of knowledge for both researchers and patients.”
Anne Estrup Olesen is a senior researcher at Aalborg University’s Clinical Pharmacology Unit. For her project, Patient safety incidents in the primary care sector – can we do better?, user involvement plays a crucial role:
“It is key to improving health care that ideas are developed and tested by the employees who treat and care for citizens, and that the citizens themselves and their caregivers are also involved. It ensures that the projects can be completed and incorporated into daily routines.”
Also, for Christian Backer Mogensen, professor of emergency medicine and project manager on the project Developing solutions for optimising medicine use in elderly patients after discharge, user involvement is an important factor:
“When patients are hospitalised urgently, their medication is often adjusted, and the patient is discharged quickly from the hospital again. Therefore, we want to develop a solution that helps both the hospital, the patient and the patient’s GP to ensure that the patient receives the right medication at the right time. With the grant from VELUX FONDEN, we can bring together patients, caregivers, doctors, pharmacists and home-helpers to develop a solution that works, even when everyone is busy.”
Since the first grant was made to support research into the elderly and medication in June 2017, almost DKK 18.2 million has been granted for a total of 12 research projects.