Tahreem Ghazal Siddiqui

• Siddiqui, Tahreem Ghazal; Bjelkarøy, Maria Torheim; Simonsen, Tone Breines; Selle, Maria Lie & Lundqvist, Anders Christofer (2026). Brief Intervention for Discontinuing Inappropriate Z-Hypnotic Use Among Older Patients in Primary Care: Protocol for a Cluster Randomized Controlled Trial With a Single Crossover. JMIR Research Protocols. 15(1). doi: 10.2196/75670. Full text in Research Archive
• Siddiqui, Tahreem Ghazal; Simonsen, Tone Breines; Selle, Maria Lie & Lundqvist, Anders Christofer (2026). Brief intervention for inappropriate z-hypnotics use in older adults: a before and after intervention study in primary care. Scandinavian Journal of Primary Health Care. ISSN 0281-3432. 44(1), p. 1–11. doi: 10.1080/02813432.2026.2660168. Full text in Research Archive
• Siddiqui, Tahreem Ghazal; Simonsen, Tone Breines; Bjelkarøy, Maria Torheim; Selle, Maria Lie & Lundqvist, Anders Christofer (2026). A brief intervention to discontinue inappropriate z-hypnotics use by older patients in primary care: a randomised controlled trial. BMC Primary Care. 27(1). doi: 10.1186/s12875-026-03212-w. Full text in Research Archive
• Lundqvist, Christofer; Simonsen, Tone Breines & Siddiqui, Tahreem Ghazal (2025). Self-reported sleep disturbance and inappropriate z-hypnotic use among older adults in general practice. Scandinavian Journal of Primary Health Care. ISSN 0281-3432. 43(3), p. 555–562. doi: 10.1080/02813432.2025.2475300. Full text in Research Archive Show summary

  Background Sleep disorders such as insomnia may occur in old age, potentially leading to z-hypnotic use. However, few studies have explored older adults’ self-reported sleep concerns in relation to z-hypnotic use. We aim to examine this relationship. Methods We conducted a cross-sectional study using a web-based questionnaire to assess sleep disturbances and medication use (z-hypnotics, benzodiazepines, and opioid analgesics) among 5,194 older adults through 21 GPs in southeast Norway. The main outcome, inappropriate z-hypnotic use, was defined as self-reported use for ≥4 weeks at ≥ three times per week. We used descriptive statistics and exploratory logistic regression mixed-effects models for data analysis. Results Among the 687 patients included in the study, 22% (N = 153) reported sleep disturbances. Of these, 84% (N = 575) did not use z-hypnotics, while 16% (N = 112) used z-hypnotics, 63% (N = 71) of these used them inappropriately. (≥4 weeks, ≥ three times per week). Patients with sleep disturbances (OR: 12.1, CI: 6.77 − 21.6, p < 0.001), trouble falling or staying asleep (OR: 14.6, CI: 5.04–42.0, p < 0.001), and multiple reasons for disturbances (pain, overthinking, or a family death) (OR: 3.58, CI: 1.85–6.93, p < 0.001) had higher odds of inappropriate z-hypnotic use compared to those with no or occasional disturbances. Men had lower odds (OR: 0.54, CI: 0.30–0.97, p = 0.039) than women. GP prescribing was not associated with inappropriate use, but men had lower odds (OR: 0.34, CI: 0.14–0.84, p = 0.020) when prescribed by male GPs compared to women prescribed by female GPs. Conclusion A high proportion of patients used z-hypnotics inappropriately. This inappropriate use was associated with experienced sleep disturbances, particularly trouble falling asleep, trouble staying asleep, and multiple reasons for sleep disturbances. The prescribing GP was not significantly associated with inappropriate use.

• Bjelkarøy, Maria Torheim; Simonsen, Tone Breines; Siddiqui, Tahreem Ghazal; Cheng, Socheat; Grambaite, Ramune & Benth, Jurate Saltyte [Show all 7 contributors for this article] (2024). 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. 14(2). doi: 10.1136/bmjopen-2023-079347. Full text in Research Archive Show summary

  Objectives Disease and medication use in older age is a consequence of age-related declining health. Multimorbidity followed by polypharmacy is common. Central nervous system depressing (CNSD) drugs such as opioids, benzodiazepines and z-hypnotics are not recommended for long-term use in older adults but are in use by many. We aimed to assess mortality and change in health-related quality of life (HRQoL) in older adults with long-term use of CNSDs. Method A prospective observational study was conducted at Akershus University Hospital, Norway, 2017–2019, with follow-up in 2021–2022, including 246 participants aged 65–90. At 5-year follow-up, 78 (32%) participants had passed away. Mortality data were collected from patient electronic health records. Of the surviving 168 (68%), we collected further follow-up data from 38 (16%) participants. Follow-up included demographic and clinical data. The EuroQuol Group EQ-5D-5L questionnaire was used to measure HRQoL. Analysis include Cox regression model for survival data and linear mixed model for change in HRQoL over time. Results At follow-up, 78 (31.7%) were deceased. Mean survival time was 3.3 years. Total time for survival data was 4.7 years. Mortality was higher among participants with long-term use of CNSD (HR 1.9 95% CI (1.2 to 3.2), p=0.01). The multivariable analysis found being older (HR 1.1 95% CI (1.0 to 1.1), p=0.020) and male sex (HR 2.1 95% CI (1.2 to 3.5), p=0.008) to be associated with increased risk of mortality. According to the linear mixed model (n=38), there was no significant difference between surviving users and non-users in change in HRQoL EQ-5D-5L index from baseline to follow-up. Conclusion Mortality was higher for long-term users of CNSDs at 5-year follow-up. Being older and male sex were associated with mortality. Among survivors, there was no significant difference between the groups in change of HRQoL over time.

• Bjelkarøy, Maria Torheim; Simonsen, Tone Breines; Siddiqui, Tahreem Ghazal; Halset, Sigrid; Cheng, Socheat & Grambaite, Ramune [Show all 10 contributors for this article] (2024). Brief Intervention as a Method to Reduce Z-Hypnotic Use by Older Adults: Feasibility Case Series. JMIR Formative Research. 8(1). doi: 10.2196/51862. Full text in Research Archive Show summary

  Background: Z-hypnotics or z-drugs are commonly prescribed for insomnia and sleep difficulties in older adults. These drugs are associated with adverse events and dependence and are not recommended for long-term use. Despite evidence of older adults being more sensitive to a wide array of adverse events and clinical guidelines advocating limiting use, inappropriate use in this population is still prevalent. Previous intervention studies have focused mainly on prescriber information. Simple, individually focused intervention designs are less studied. Brief intervention (BI) is a simple, easily transferable method mainly used to treat patients at risk of alcohol overuse. Objective: Our objective was to design and test the feasibility and acceptability of a BI intervention adapted to address individual, inappropriate use of z-hypnotics among older adults. This preparatory study aimed to optimize the intervention in advance of a quantitative randomized controlled trial investigating the treatment effect in a larger population. Methods: This feasibility case series was conducted at Akershus University Hospital, Norway, in autumn 2021. We included 5 adults aged ≥65 years with long-term (≥4 weeks) use of z-hypnotics and 2 intervening physicians. Additionally, 2 study investigators contributed with process evaluation notes. The BI consists of information on the risk of inappropriate use and individualized advice on how to reduce use. The focus of the intervention is behavioral and aims, in cooperation with the patient and based on shared decision-making, to change patient behavior regarding sleep medication rather than physician-based detoxification and termination of z-hypnotic prescriptions. Qualitative and descriptive quantitative data were collected from intervening physicians, study investigators, and participants at baseline, immediately after the intervention, and at the 6-week follow-up. Results: Data were obtained from 2 physicians, 2 study investigators, and 5 participants (4 women) with a median age of 84 years. The average time spent on the BI consultation was 15 minutes. All 5 participants completed the intervention without problems. The participants and 2 intervening physicians reported the intervention as acceptable and were satisfied with the delivery of the intervention. After the intervention, 2 participants stopped their use of z-hypnotics completely and participated in the follow-up interview. Study investigators identified logistical challenges regarding location and time requirements. Identified aspects that may improve the intervention and reduce dropouts included revising the intervention content, focusing on rebound insomnia, adding an information leaflet, and supporting the patient in the period between the intervention and follow-up. The notion that the intervention should best be located and conducted by the patient's own general practitioner was supported by the participants. Conclusions: We identified important aspects to improve the designed intervention and found that the BI is feasible and acceptable for incorporation into a larger randomized trial investigating the treatment effect of BI for reducing z-hypnotic use by older adults. Trial registration: ClinicalTrials.gov NCT03162081; http://tinyurl.com/rmzx6brn.

• Bjelkarøy, Maria Torheim; Benth, Jurate Saltyte; Simonsen, Tone Breines; Siddiqui, Tahreem Ghazal; Cheng, Socheat & Kristoffersen, Espen Saxhaug [Show all 7 contributors for this article] (2023). Measuring pain intensity in older adults. Can the visual analogue scale and the numeric rating scale be used interchangeably? Progress in Neuro-psychopharmacology and Biological Psychiatry. ISSN 0278-5846. 130. doi: 10.1016/j.pnpbp.2023.110925. Full text in Research Archive Show summary

  Objectives Visual analogue scale (VAS) and numeric rating scale (NRS) are two commonly used instruments for measuring pain intensity. Both instruments are validated for use in both clinical and research settings, and share a range of similar aspects. Some studies have shown that the two instruments may be used interchangeably, but the results are conflicting. In this study we assessed whether the VAS and the NRS instruments may be used interchangeably when measuring pain intensity in older adults. Methods Data were collected in a cross-sectional study, as part of the follow-up in a larger longitudinal study conducted at the Akershus University Hospital, Norway 2021 to 2022 and included 39 older adults aged ≥65. Participants were regarded as a normal older adult population as they were not recruited on basis of a specific condition or reports of pain. The participants were asked to rate their pain intensity on an average day using VAS and NRS. Bland-Altman analysis was performed to assess agreement between the two instruments. Results Thirty-seven participants with mean (SD) age of 77 (5.9) were included in the analysis. Mean (SD) pain assessed by VAS and NRS was 2.8 (1.8) and NRS 4.7 (2.2), respectively. A mean difference (SD) of 2.0 (1.9) between the scores of the two instruments was statistically significantly different from zero (p < 0.001) confirming bias. The 95% limits of agreement were estimated to be −1.7 to 5.7. A post-hoc analysis, removing an outlier, resulted in similar conclusions. Conclusion There was poor agreement between the VAS and NRS scale for measuring pain intensity in older adults. This suggests that the two instruments should not be used interchangeably when assessing pain intensity in this population.

• Siddiqui, Tahreem Ghazal; Bjelkarøy, Maria Torheim; Cheng, Socheat; Kristoffersen, Espen Saxhaug; Grambaite, Ramune & Lundqvist, Christofer (2022). The effect of cognitive function and central nervous system depressant use on mortality—A prospective observational study of previously hospitalised older patients. PLOS ONE. 17(3). doi: 10.1371/journal.pone.0263024. Full text in Research Archive Show summary

  Background Older patients are often users of prolonged Central Nervous System Depressants (CNSD) (Z-hypnotics, benzodiazepines and opioids), which may be associated with reduced cognition. The long-term effects of CNSD use and reduced cognitive function in older patients are unclear. The aim of this study was to examine whether cognitive function and CNSD use at baseline hospitalisation were associated with all-cause mortality two years after discharge. Methods We conducted a prospective observational study, including baseline data (2017–2018) from previously hospitalised older patients (65–90 years), assessing all-cause mortality two years after discharge. We used logistic regression to assess the primary outcome, all-cause mortality two years after baseline hospitalisation. The primary predictors were cognitive function measured by The Mini Mental State Examination (MMSE) and prolonged CNSD use (continuous use ≥ 4 weeks). Adjustment variables: age, gender, education, the Hospital Anxiety and Depression Scale (HADS) and the Cumulative Illness Rating Scale for Geriatrics (CIRS-G), using receiver operating characteristics (ROC) to compare the predictive power of the models. In a sub-analysis we used, the Neurobehavioural Cognitive State Examination (Cognistat) and the Clock Drawing Test. Results Two years after discharge, out of 246 baseline patients, 43 were deceased at follow-up, among these 27 (63%) were CNSD users, and 16 (36%) were non-users at baseline, (p = 0.002). In the multivariable models cognitive function (MMSE score) was a predictor of mortality (OR 0.81 (95% CI 0.69; 0.96), p = 0.014). CNSD use was associated with mortality (OR 2.71 (95% CI 1.06; 6.95), p = 0.038), with ROC AUC: 0.74–0.77 for these models. Results using Cognistat supported the findings. The Clock Drawing Test was not significant predictor of mortality. Conclusion Two years after discharge from the hospital, older patients with reduced cognitive function and CNSD use during hospital stay had higher mortality. This underlines that inappropriate (prolonged and concurrent) use of CNSDs should be avoided by older patients, particularly in patients with reduced cognitive function.

• Cheng, Socheat; Siddiqui, Tahreem Ghazal; Gossop, Michael; Wyller, Torgeir Bruun; Kristoffersen, Espen Saxhaug & Lundqvist, Anders Christofer (2021). The patterns and burden of multimorbidity in geriatric patients with prolonged use of addictive medications. Aging Clinical and Experimental Research. ISSN 1594-0667. 33, p. 2857–2864. doi: 10.1007/s40520-021-01791-5. Full text in Research Archive Show summary

  <i>Background</i> - Multimorbidity and prolonged use of addictive medications are prevalent among older patients, and known to increase the risk of adverse drug events. Yet, the relationship between these two entities has remained understudied.<br><br> <i>Aims</i> - This study explored the association between multimorbidity burden and prolonged use of addictive medications in geriatric patients, adjusted for clinically important covariates. Furthermore, we identified comorbidity patterns in prolonged users.<br><br> <i>Methods</i> - We conducted a cross-sectional study on a consecutive sample of 246 patients, aged 65–90 years, admitted to a large public university hospital in Norway. We defined prolonged use of addictive medications as using benzodiazepines, opioids and/or z-hypnotics beyond the duration recommended by clinical guidelines (≥ 4 weeks). Multimorbidity was assessed with the Cumulative Illness Rating Scale for Geriatrics (CIRS-G), based on diagnoses made by independent physicians.<br><br> <i>Results</i> - Compared to non-prolonged use, prolonged use was significantly more common among patients who had psychiatric (19/27, 70%), liver (19/22, 86%), upper gastrointestinal tract (21/32, 66%), musculoskeletal (52/96, 54%), or nervous system disorders (46/92, 50%). Patients with prolonged use had a higher multimorbidity burden than those without such use (CIRS-G score, mean = 7.7, SD = 2.7 versus mean = 4.6, SD = 2.2, <i>p</i> < 0.001). Multivariable logistic regression indicated a significant association between multimorbidity burden and prolonged addictive medication use (OR = 1.72, 95% CI 1.42–2.08). Predictive margins postestimation showed a systematic increase in the predicted CIRS-G scores when the number of addictive drug used increases.<br><br> <i>Conclusions</i> - Multimorbidity is strongly associated with prolonged use of addictive medications. Multiple substance use may aggravate disease burden of older patients.

• Bjelkarøy, Maria Torheim; Cheng, Socheat; Siddiqui, Tahreem Ghazal; Benth, Jurate Saltyte; Grambaite, Ramune & Kristoffersen, Espen Saxhaug [Show all 7 contributors for this article] (2021). The association between pain and central nervous system depressing medication among hospitalised Norwegian older adults. Scandinavian Journal of Pain. ISSN 1877-8860. p. 1–11. doi: 10.1515/sjpain-2021-0120. Full text in Research Archive Show summary

  Objectives Central nervous system depressant medications (CNSD) including benzodiazepines, z-hypnotics and opioids are regularly prescribed for the older patient. These medications are linked to dependence and associated with severe side effects in some older patients. Consensus recommendations for this group suggest limiting their use. We have recently described a high proportion of long-term CNSD use and dependence among older in-hospital patients. In this study, we aim to investigate factors associated with pain intensity and presentation of pain among older adults with long-term use of CNSDs compared to non-users. Methods Two hundred and forty six elderly hospitalised patients were recruited consecutively in a cross-sectional study. Data was collected from patients and electronic health records (EHR). Independent variables were sex, age, education, emotional symptoms (hospital anxiety and depression scale [HADS]), cognitive function (Mini-mental State Examination test [MMSE]), comorbidity (cumulative illness rating score – geriatrics [CIRS-G]), loneliness (the six-item De Jong Gierveld Loneliness Scale) and prolonged (≥4 weeks) use of any CNSDs or prolonged use of opioids (≥4 weeks). All variables, including pain intensity, were collected at one time point consistent with the cross-sectional study design. Statistical analyses included descriptive statistics and linear regression models using the above mentioned variables and pain intensity (visual analogue scale for pain intensity [VAS] pain 0–100) as outcome. Additional information regarding pain presentation was extracted from the patients’ EHR. Results Mean pain intensity VAS (SD) was 35.2 (30.4) and 18.1 (24.2) respectively, for patients with vs. without prolonged use of CNSDs. In the multivariable linear regression analysis, prolonged use of CNSDs and opioids were positively associated with pain intensity (VAS) (regression coefficient (95% CI) 20.7 (11.0; 30.3), p<0.001, and 19.8 (5.7; 33.8), p=0.006, respectively), while sex, age, education, MMSE, HADS, CIRS-G and loneliness scores were not. Pain related to back (23.2%) and lower extremities (23.2%) were most common pain sites, and those with one or more pain sites reported overall higher pain intensity compared to those with no reported pain sites (p<0.006). Conclusions Prolonged use of CNSD medications as well as prolonged use of opioids are both positively associated with pain intensity. The results may have implications for treatment and long-term pain management for older patients.

• Siddiqui, Tahreem Ghazal; Cheng, Socheat; Mellingsæter, Marte; Grambaite, Ramune; Gulbrandsen, Pål & Lundqvist, Christofer [Show all 7 contributors for this article] (2020). “What should I do when I get home?” treatment plan discussion at discharge between specialist physicians and older in-patients: mixed method study. BMC Health Services Research. 20:1002. doi: 10.1186/s12913-020-05860-9. Full text in Research Archive Show summary

  Background During discharge from hospital, older patients and physicians discuss the plan for managing patients’ health at home. If not followed at home, it can result in poor medication management, readmissions, or other adverse events. Comorbidities, polypharmacy and cognitive impairment may create challenges for older patients. We assessed discharge conversations between older in-patients and physicians for treatment plan activities and medication information, with emphasis on the role of cognitive function in the ongoing conversation. Methods We collected 11 videos of discharge consultations, medication lists, and self-reported demographic information from hospitalised patients ≥65 years at the Geriatric department in a general hospital. Mini Mental State Examination score < 25 was classified as low cognitive function. We used microanalysis of face-to-face dialogue to identify and characterise sequences of interaction focused on and distinguishing the treatment plan activities discussed. In addition to descriptive statistics, we used a paired-sample t-test and Mann-Whitney U test for non-parametric data. Results Patients’ median age was 85 (range: 71–90);7 were females and 4 males. Median of 17 (range: 7 to 23) treatment plan activities were discussed. The proportions of the activities, grouped from a patient perspective, were: 0.40 my medications, 0.21 something the hospital will do for me, 0.18 someone I visit away from home, 0.12 daily routine and 0.09 someone coming to my home. Patients spoke less (mean 190.9 words, SD 133.9) during treatment plan activities compared to other topics (mean 759 words, SD 480.4), (p = .001). Patients used on average 9.2 (SD 3.1) medications; during the conversations, an average of 4.5 (SD 3.3) were discussed, and side effects discussed on average 1.2 (SD 2.1) times. During treatment plan discussions, patients with lower cognitive function were less responsive and spoke less (mean 116.5 words, SD 40.9), compared to patients with normal cognition (mean 233.4 words, SD 152.4), (p = .089). Conclusion Physicians and geriatric patients discuss many activities during discharge conversations, mostly focusing on medication use without stating side effects. Cognitive function might play a role in how older patients respond. These results may be useful for an intervention to improve communication between physicians and older hospitalised patients.

• Siddiqui, Tahreem Ghazal; Cheng, Socheat; Gossop, Michael; Kristoffersen, Espen Saxhaug; Grambaite, Ramune & Lundqvist, Christofer (2020). Association between prescribed central nervous system depressant drugs, comorbidity and cognition among hospitalised older patients: a cross-sectional study. BMJ Open. 10(7). doi: 10.1136/bmjopen-2020-038432. Full text in Research Archive Show summary

  Objectives Central nervous system depressants (CNSDs) such as opioids, benzodiazepine and Z-hypnotics are commonly used. However, CNSDs may influence cognitive function, especially in older hospitalised patients with comorbidities. The aim was to examine the association between CNSD use and cognitive function in older patients. We assessed global and domain specific cognitive function, among hospitalised older patients, including covariates for comorbidity, anxiety and depression. Design Cross-sectional hospital-based study. Settings Data was collected consecutively from inpatients at somatic wards of a general university hospital. Participants Older patients between 65 and 90 years with/without CNSD use for ≥4 weeks. Outcome measures The main outcome was cognitive function assessed by Cognistat. Secondary outcomes were routine clinical tests in the wards (mini-mental state examination (MMSE), trail making test (TMT) A and B, and clock drawing tests). Analyses were bivariate and multiple linear regression, adjusted for age, gender, and education. Covariates were comorbidity, depression and anxiety scores. Results The main result indicated that CNSD users (n=100) had (β=–3.4, 95% CI 6.27 to –0.58, p=0.017) lower Cognistat score than non-users (n=146), adjusted for age, gender, education, anxiety and depression, but not significant when including covariate for comorbidity (β= –2.50 - 5.45; –0.46, p=0.097). Comorbidity was associated with cognitive function (β=−0.77, 95% CI −1.22 to −0.14, p=0.014). Cognistat subdimensions associated with CNSD use were language (p=0.017) and calculation (p=0.003). In clock drawing test, users had lower scores than non-users (β=−0.80, 95% CI 1.24 to −0.36, p=0.004), but no significant difference was found with MMSE and TMT A or B. Z-hypnotics were associated with reduced cognitive function. Conclusion Among older hospitalised patients, global cognition and specific cognitive functions were associated with long-term use of CNSD medication as well as with somatic comorbidity.

• Cheng, Socheat; Siddiqui, Tahreem Ghazal; Gossop, Michael; Stavem, Knut; Kristoffersen, Espen Saxhaug & Lundqvist, Christofer (2020). Health-related quality of life in hospitalized older patients with versus without prolonged use of opioid analgesics, benzodiazepines, and z-hypnotics: a cross-sectional study. BMC Geriatrics. 20(425), p. 1–9. doi: 10.1186/s12877-020-01838-8. Full text in Research Archive Show summary

  Background Central nervous system depressant medications (CNSDs) such as opioid analgesics and sedative-hypnotics are commonly prescribed to older patients for the treatment of chronic pain, anxiety and insomnia. Yet, while many studies reported potential harms, it remains unknown whether persistent use of these medications is beneficial for older patients’ self-reported health-related quality of life (HRQoL). The present study clarified this knowledge gap through comparing HRQoL of hospitalized older patients with versus without using CNSD drugs for ≥4 weeks. Moreover, we explored the relationship between such use and HRQoL, adjusting for the effects of polypharmacy, comorbidity burden and other clinically relevant covariates. Methods The study was cross-sectional and included 246 older patients recruited consecutively from somatic departments of a large regional university hospital in Norway. We defined prolonged CNSD use as using opioids, benzodiazepines and/or z-hypnotics for ≥4 weeks. Patients’ self-reported HRQoL were measured with scales of the EuroQol EQ-5D-3L instrument. Data analyses were mainly descriptive statistics and regression models. Results Patients with prolonged use of CNSDs reported lower scores on both EQ-5D index and EQ VAS compared with those without such use (p < 0.001). They had higher odds of having more problems performing usual activities (OR = 3.37, 95% CI: 1.40 to 8.13), pain/discomfort (OR = 2.06, 95% CI: 1.05 to 4.04), and anxiety/depression (OR = 3.77, 95% CI: 1.82 to 7.82). In multivariable regression models, there was no significant association between prolonged CNSD use and HRQoL when including pain as a predictor variable. In models not including pain, CNSD use was strongly associated with HRQoL (adjusted for sociodemographic background, polypharmacy, comorbidity, anxiety and depressive symptoms, regression coefficient − 0.19 (95% CI, − 0.31 to − 0.06). Conclusions Older patients with prolonged CNSD use reported poorer HRQoL. They also had more pain and higher depression scores. Prolonged use of CNSDs was not independently associated with higher HRQoL.

• Cheng, Socheat; Siddiqui, Tahreem Ghazal; Gossop, Michael; Kristoffersen, Espen Saxhaug & Lundqvist, Christofer (2019). Sociodemographic, clinical and pharmacological profiles of medication misuse and dependence in hospitalised older patients in Norway: a prospective cross-sectional study. BMJ Open. 9:e0311483(9), p. 1–9. doi: 10.1136/bmjopen-2019-031483. Full text in Research Archive Show summary

  OBJECTIVES: Timely recognition of medication misuse and dependence is crucial to avoid both adverse drug events and increasing health expenditure. Yet the detection of these disorders in older people remains challenging due to the paucity of evidence on characteristics of patients at risk. This study investigates sociodemographic, pharmacological and clinical characteristics and factors associated with prolonged medication use, misuse and dependence in hospitalised older patients, focusing on three commonly prescribed central nervous system depressants (CNSDs): opioid analgesics, benzodiazepines and z-hypnotics. DESIGN: A prospective, cross-sectional study complying with the Strengthening the Reporting of Observational Studies in Epidemiology guidelines. SETTING: Somatic departments of the Akershus University Hospital, Norway. PARTICIPANTS: 246 patients aged 65-90 were included. OUTCOME MEASURES: Prolonged use was defined as using CNSDs for ≥4 weeks. Misuse and dependence were assessed with the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition criteria for substance abuse and dependence. We used descriptive statistics to report patients' characteristics and logistic regression to demonstrate factors associated with prolonged use, and misuse or dependence. RESULTS: Forty per cent of participants reported using CNSDs for ≥4 weeks. The odds of prolonged use were higher for patients aged 75-84 (OR=2.32, 95% CI 1.16 to 4.65) and ≥85 (OR=3.33, 95% CI 1.25 to 8.87) vs <75 years, for pain intensity (OR=1.02, 95% CI 1.01 to 1.04), and polypharmacy versus no polypharmacy (OR=5.16, 95% CI 2.13 to 12.55). The odds were lower for patients who completed secondary education (OR=0.33, 95% CI 0.13 to 0.83) compared with those with only basic education. Factors associated with misuse or dependence were pain intensity (OR=1.02, 95% CI 1.01 to 1.04) and concurrent use of ≥2 CNSDs (OR=3.99, 95% CI 1.34 to 11.88). CONCLUSION: CNSD overuse is prevalent among hospitalised older patients, despite clear guidelines and recommendations. Our findings underline a need for stronger focus on responsible prescribing, timely detection and prevention of this issue, with special attention towards older patients, those with enhanced pain, polypharmacy and/or concurrent use of several CNSDs.

• Cheng, Socheat; Siddiqui, Tahreem Ghazal; Gossop, Michael; Kristoffersen, Espen Saxhaug & LUNDQVIST, CHRISTOFER (2019). The Severity of Dependence Scale detects medication misuse and dependence among hospitalized older patients. BMC Geriatrics. 19(1), p. 1–8. doi: 10.1186/s12877-019-1182-3. Full text in Research Archive Show summary

  Background In older patients, timely recognition and treatment of medication misuse and dependence are crucial to secure medication safety and to avoid increasing health expenditure. Nonetheless, the detection of this condition remains challenging due to the paucity of screening instruments validated for older people. This study assesses diagnostic accuracy, reliability, validity and the factor structure of the Severity of Dependence Scale (SDS) in detecting medication misuse and dependence among hospitalized older patients, focusing on prescribed central nervous system depressants (CNSDs): opioid analgesics, benzodiazepines and z-hypnotics. Methods 246 adults aged 65–90 were recruited consecutively from somatic departments of the Akershus University Hospital, Norway. Among these, 100 patients were identified as prolonged users of CNSDs. Diagnostic accuracy and validity of the SDS were assessed using DSM-IV criteria for substance abuse and dependence as the reference standard. We also performed an exploratory factor analysis and assessment of internal consistency using Cronbach’s alpha. Results The area under the ROC curve was 0.86 (95%CI = 0.79–0.93; p < 0.001). A score of 5.5 was determined as the optimal cutoff for detecting CNSD misuse and dependence among older patients. Cronbach’s alpha obtained was satisfactory (α = 0.73). There was a significant positive correlation between the SDS score and DSM-IV criteria for substance abuse and dependence (Pearson’s correlation coefficient = 0.61, p < 0.001). The uni-dimensionality of the SDS was documented. Conclusions The SDS is reliable, valid and capable of detecting medication misuse and dependence among hospitalized older patients, with good diagnostic performance. The scale thus holds promise for use in both clinical and research contexts. Trial registration ClinicalTrials.gov Identifier: NCT03162081. Registered 3 May 2017.

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• Bjelkarøy, Maria Torheim; Simonsen, Tone Breines; Benth, Jurate Saltyte; Lundqvist, Christofer & Siddiqui, Tahreem Ghazal (2025). Change in health-related quality of life over time in patients who participated in an intervention aimed at reducing sleeping medications. Full text in Research Archive
• Bjelkarøy, Maria Torheim; Siddiqui, Tahreem Ghazal; Simonsen, Tone Breines; Gjerstad, Johannes & Lundqvist, Anders Christofer (2024). Brief intervention as a general method to address prescription or non-prescription medication misuse. Full text in Research Archive
• Simonsen, Tone Breines; Bjelkarøy, Maria Torheim; Siddiqui, Tahreem Ghazal; Cheng, Socheat & Lundqvist, Anders Christofer (2024). 5-year hospital readmission rates of older patients with or without use of central nervous system depressant medications. Full text in Research Archive
• Bjelkarøy, Maria Torheim; Simonsen, Tone Breines; Siddiqui, Tahreem Ghazal; Halset, Sigrid; Cheng, Socheat & Grambaite, Ramune [Show all 10 contributors for this article] (2022). Brief intervention as a method for reducing use of z-hypnotics in older adult – a feasibility study. Full text in Research Archive
• Bjelkarøy, Maria Torheim; Simonsen, Tone Breines; Siddiqui, Tahreem Ghazal; Halset, Sigrid; Cheng, Socheat & Grambaite, Ramune [Show all 10 contributors for this article] (2022). Brief intervention as a method for reducing use of z-hypnotics in older adult – a feasibility study. Full text in Research Archive
• Bjelkarøy, Maria Torheim; Cheng, Socheat; Siddiqui, Tahreem Ghazal; Benth, Jūratė Šaltytė; Grambaite, Ramune & Kristoffersen, Espen Saxhaug [Show all 7 contributors for this article] (2021). The association between pain and central nervous system depressing medication among hospitalised Norwegian older adults ( - and onwards from there; a pilot RCT). Full text in Research Archive
• Bjelkarøy, Maria Torheim; Siddiqui, Tahreem Ghazal; Cheng, Socheat; Benth, Jurate Saltythè; Simonsen, Tone Breines & Halset, Sigrid [Show all 9 contributors for this article] (2021). Brief intervention as a method for reducing z hypnotics in the older adult a feasibility study. Full text in Research Archive
• Bjelkarøy, Maria Torheim; Cheng, Socheat; Siddiqui, Tahreem Ghazal; Benth, Jurate Saltythè; Grambaite, Ramune & Kristoffersen, Espen Saxhaug [Show all 7 contributors for this article] (2021). Pain and central nervous system depressing medication in hospitalised Norwegian older adults. Full text in Research Archive
• Bjelkarøy, Maria Torheim; Cheng, Socheat; Siddiqui, Tahreem Ghazal; Benth, Jurate Saltythè; Grambaite, Ramune & Kristoffersen, Espen Saxhaug [Show all 7 contributors for this article] (2021). Pain and central nervous system depressing medication in hospitalised Norwegian older adults. Full text in Research Archive
• Siddiqui, Tahreem Ghazal; Cheng, Socheat; Grambaite, Ramune; Marte, Mellingsæter; Pål, Gulbrandsen & Lundqvist, Christofer [Show all 7 contributors for this article] (2020). Discharge conversations between specialist physicians and geriatric patients with polypharmacy. Full text in Research Archive
• Siddiqui, Tahreem Ghazal; Cheng, Socheat; Grambaite, Ramune; Mellingsæter, Marte; Gulbrandsen, Pål & Lundqvist, Christofer [Show all 7 contributors for this article] (2020). Discharge conversation between geriatric patients and specialists physicians. Full text in Research Archive
• Bjelkarøy, Maria Torheim; Cheng, Socheat; Siddiqui, Tahreem Ghazal; Grambaite, Ramune; Kristoffersen, Espen Saxhaug & Lundqvist, Christofer (2020). P.424 Prolonged use of central nervous system depressant medication and cognitive function are associated with experienced pain among older adults. Full text in Research Archive
• Siddiqui, Tahreem Ghazal; Cheng, Socheat; Grambaite, Ramune; Michele, Gossop; Kristoffersen, Espen Saxhaug & Lundqvist, Christofer (2019). Long-term use of central nervous system depressant medications is associated with reduced cognitive function in hospitalised older patients: a cross sectional study. European Journal of Neurology. ISSN 1351-5101. 26. Full text in Research Archive
• Cheng, Socheat; Siddiqui, Tahreem Ghazal; Gossop, Michael; Kristoffersen, Espen Saxhaug & Lundqvist, Christofer (2019). Characteristics of at-risk patients and a reliable screening tool for detecting medication dependence among elderly patients. European Journal of Neurology. ISSN 1351-5101. 26. Full text in Research Archive
• Siddiqui, Tahreem Ghazal; Cheng, Socheat; Mellingsæter, Marte; Lundqvist, Christofer; Gulbrandsen, Pål & Gerwing, Jennifer (2019). Communication about medication use between older patients and physicians in secondary care. Full text in Research Archive
• Cheng, Socheat; Siddiqui, Tahreem Ghazal; Gossop, Michael; Kristoffersen, Espen Saxhaug & Lundqvist, Christofer (2019). Characteristics of at-risk patients and a reliable screening tool for detecting medication dependence among elderly patients. Full text in Research Archive
• Siddiqui, Tahreem Ghazal; Cheng, Socheat; Kristoffersen, Espen Saxhaug; Gossop, Michael; Grambaite, Ramune & Lundqvist, Christofer (2019). The association between central nervous system depressant medications and cognitive function in hospitalised older patients: a cross sectional study. Full text in Research Archive
• Siddiqui, Tahreem Ghazal; Cheng, Socheat; Grambaite, Ramune; Michele, Gossop; Kristoffersen, Espen Saxhaug & Lundqvist, Christofer (2019). Long-term use of central nervous system depressant medications is associated with reduced cognitive function in hospitalised older patients: a cross sectional study. Full text in Research Archive
• Siddiqui, Tahreem Ghazal (2019). The association between prescribed central nervous system depressant and cognitive function in older patients. Full text in Research Archive
• Siddiqui, Tahreem Ghazal; Cheng, Socheat; Kristoffersen, Espen Saxhaug; Gossop, Michael; Grambaite, Ramune & Lundqvist, Christofer (2019). Prescribed Central Nervous System Depressants are associated with Cognitive side effects among older patients. Full text in Research Archive
• Siddiqui, Tahreem Ghazal; Cheng, Socheat; Gossop, Michael; Kristoffersen, Espen Saxhaug; Grambaite, Ramune & Lundqvist, Christofer (2019). Prescribed Central Nervous System Depressants are associated with reduced cognition among hospitalised older patients. Full text in Research Archive
• Cheng, Socheat; Siddiqui, Tahreem Ghazal; Gossop, Michael; Kristoffersen, Espen Saxhaug & Lundqvist, Christofer (2019). Disparities in quality of life between elderly patients with and without long-term use of opioids and benzodiazepines. Full text in Research Archive
• Cheng, Socheat; Siddiqui, Tahreem Ghazal; Gossop, Michael; Stavem, Knut; Kristoffersen, Espen Saxhaug & Lundqvist, Christofer (2019). Overuse of opioids and benzidiazepines among elderly patients: Characteristics of at-risk patients and disparities in quality of life. Full text in Research Archive
• Cheng, Socheat; Siddiqui, Tahreem Ghazal; Gossop, Michael; Kristoffersen, Espen Saxhaug & LUNDQVIST, CHRISTOFER (2018). Diagnostic accuracy and usability of the severity dependence scale in detecting medication misuse and dependence in elderly patients. Full text in Research Archive
• Cheng, Socheat; Siddiqui, Tahreem Ghazal; Gossop, Michael; Kristoffersen, Espen Saxhaug & LUNDQVIST, CHRISTOFER (2018). Socio-demographic and pharmacological profile of medication Misuse and dependence in elderly patients. Full text in Research Archive
• Siddiqui, Tahreem Ghazal; Cheng, Socheat; Lundqvist, Christofer & Grambaite, Ramune (2018). Association between cognition and centrally acting medication in elderly patients. Full text in Research Archive
• Siddiqui, Tahreem Ghazal; Cheng, Socheat; Grambaite, Ramune & Lundqvist, Christofer (2018). Medication use and cognitive function in older adults. Full text in Research Archive
• Siddiqui, Tahreem Ghazal; Cheng, Socheat; Grambaite, Ramune & LUNDQVIST, CHRISTOFER (2018). Association between cognition and centrally acting medication in older patients. Full text in Research Archive
• Cheng, Socheat; Siddiqui, Tahreem Ghazal; LUNDQVIST, CHRISTOFER & Kristoffersen, Espen Saxhaug (2017). Medication misuse and dependence in elderly patients - Towards evidence-based interventions. Full text in Research Archive
• Siddiqui, Tahreem Ghazal; Cheng, Socheat; LUNDQVIST, CHRISTOFER & Grambaite, Ramune (2017). Neuropsychological assessment of elderly at risk of cognitive impairment due to central depressant medication. Full text in Research Archive

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