Due to copyright issues, an electronic copy of the thesis must be ordered from the faculty. For the faculty to have time to process the order, the order must be received by the faculty at the latest 2 days before the public defence. Orders received later than 2 days before the defence will not be processed. After the public defence, please address any inquiries regarding the thesis to the candidate.
Trial Lecture – time and place
See Trial Lecture.
Adjudication committee
- First opponent: Professor Else Marie Skjøde Damsgaard, Aarhus University, Denmark
- Second opponent: Associate Professor Håvard Skjellegrind, NTNU - Norwegian University of Science and Technology
- Third member and chair of the evaluation committee: Professor Trygve Holmøy, University of Oslo
Chair of the Defence
Associate Professor Trygve Skonnord, University of Oslo
Principal Supervisor
Professor Torgeir Bruun Wyller, University of Oslo
Summary
Older people are prescribed an increasing number of medications, and although many drugs may have good clinical indications individually, polypharmacy is also associated with adverse health outcomes. Especially among multimorbid and frail older people, the trade-off between benefit and harm can be challenging to assess, and there is a need for strategies that can guide clinicians on how to provide the benefits of drug treatment but at the same time avoid negative consequences.
The main objective of the thesis was to evaluate the effect of a thorough clinical drug review upon health-related quality of life (HRQoL) and other patient-related outcomes in older, home-dwelling patients exposed to polypharmacy. The study was conducted as a cluster randomized controlled trial with an intervention that included a clinical geriatric assessment as well as direct collaboration between the geriatrician and the patients’ family physician (FP). The primary outcome was HRQoL measured by the 15D instrument.
A total of 174 patients with a mean age of 83 years were included. The main finding was that the intervention resulted in positive effects on HRQoL. Mean 15D scores deteriorated in both groups, but at a slower pace in the intervention group. Most secondary outcomes on physical and cognitive function were also in favor of the intervention, although not all reached statistical significance. There were more drug changes in the intervention group compared to the control group. Post-hoc analyses indicated that the patients with more inappropriate drug use at baseline benefited most from the intervention.
The study concludes that clinical geriatric assessments and drug reviews carried out in collaboration with the patients’ FP have the potential to improve HRQoL among older people exposed to polypharmacy, and may also have positive effects on physical and cognitive functioning.
Additional information
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