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Trial Lecture – time and place
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Adjudication committee
- First opponent: Professor Nele Van Den Noortgate, Ghent University
- Second opponent: Researcher Christine Gulla, NORCE
- Third member and chair of the evaluation committee: Professor Knut Stavem, University of Oslo
Chair of the Defence
Associate Professor Mari Nerhus, University of Oslo
Principal Supervisor
Post doc Rita Romskaug, Oslo University Hospital
Summary
Municipal in-patient acute care (MipAC) units were introduced in Norway to help meet the challenges of an ageing population by reducing pressure on hospitals. These units admit mainly older adults who need institutional care but not specialist hospital treatment. Although MipAC units have been in place for more than a decade, little has been known about who these patients are, how frail or acutely ill they are, how they perceive their quality of life, and whether interventions such as structured medication reviews can improve their outcomes.
The COOP II study (Cooperation for better treatment of polypharmacy in the community) aimed to gain clinically relevant knowledge about older adults admitted to the Oslo MipAC unit. This thesis presents results from an observational study and a randomized controlled trial (RCT). The observational study examined how frailty and acute illness severity relate to 1-year mortality, and how frailty is associated with both general and oral health-related quality of life (HRQoL). Frailty was measured with the Clinical Frailty Scale (CFS), illness severity with the National Early Warning Score (NEWS2), and HRQoL with the 15D instrument, a single life satisfaction question, and the Oral Health Impact Profile-14 (OHIP-14). The RCT included patients who were using six or more medications and compared a structured, collaborative medication review during MipAC admission with usual care, evaluating its effects on HRQoL and other clinically relevant outcomes 16 weeks after discharge.
The findings show that both higher frailty and higher illness severity were independently associated with increased 1-year mortality among MipAC patients. Among individual NEWS2 components, elevated respiratory rate and hypotension were independently associated with mortality. Increasing frailty was consistently associated with poorer general and oral HRQoL across most dimensions. Collaborative medication reviews conducted during MipAC admission did not improve HRQoL, physical or cognitive function, oral health, health service use, or mortality at 16 weeks. Although more medication changes occurred in the intervention group during admission, pharmacotherapy generally converged between groups during follow-up. Overall, the thesis highlights frailty as a central characteristic of MipAC patients, supports routine frailty assessment to improve prognostic insight and individualized care, and suggests that medication reviews conducted during acute admissions may be insufficient as a stand-alone strategy to improve quality of life in this vulnerable group.
Additional information
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