C-19, dementia, multi-morbidity, medications and mortality in NI
Research type
Research Study
Full title
A longitudinal study investigating the C-19 pandemic, multi-morbidity, medications and mortality in older people and those with dementia in Northern Ireland
IRAS ID
298971
Contact name
Gerard Leavey
Contact email
Sponsor organisation
Ulster University
Duration of Study in the UK
3 years, 3 months, 1 days
Research summary
The C-19 pandemic has impacted health care systems and, moving into its second year, it is crucial to assess the short-to-medium-term consequences of the infection. The proposed study will improve our understanding around multi-morbidity, medication use and mortality for older people and those with dementia. To understand how the mental health of this population has been affected by C-19 and how the subsequent quarantine may have altered health outcomes.
In the United Kingdom, the prevalence of dementia is considerable. Polypharmacy, a common and important problem related to drug use, occurs subsequent to multimorbidity in the elderly. Dementias are often associated with accelerated decline in daily function (Melis et al., 2013) and increasing numbers of prescriptions (Browne et al., 2017; Clague et al., 2017). Evidence indicates significant levels of inappropriate prescribing, referred to as polypharmacy, can increase the risk of confusion, cognitive and physical decline and falls. For example, Inappropriate prescribing of antipsychotic medications may arise when agitation and other physical needs are misinterpreted (Pryor & Clarke, 2017). However, evidence in these areas is limited. Moreover, clinicians and families have concerns about the efficacy of anti-depressant and anti-psychotic medication, for the treatment of mood and agitation respectively, in people with dementia. Additionally, pain is often problematic and is underdiagnosed and undertreated in this population (Hanson et al. 2018) while poor pain management (Dening, 2017) can result in increasing levels of discomfort and distress, delirium, sedation and confusion.
More generally, older people are at high risk for C-19 and have been highly impacted by the quarantine, disconnection from family and community and their usual health and social support and treatment (primary and secondary). Current challenges may be amplified for people in rural areas where public and private services are limited and transport and access to digital-based communication services relatively poor. During C-19, some of our health and community sector partners including Alzheimer’s society and a representative from the Commissioner for Older People for Northern Ireland believe that people with dementia have experienced increased levels of agitation behaviour, distressing both for patients and also their family caregivers, and raising concerns about accelerated physical and mental deterioration for both.
Aim: To investigate the association between multimorbidity, medications and subsequent mortality in older people and those with dementia. To understand how the mental health of this population has been affected by C-19 and how the subsequent quarantine may have altered health outcomes. We will examine change in mortality, including risks associated with comorbidity and place of residence (e.g. Care-homes)
Using data before and after the pandemic we will examine:
Patterns of comorbidity and multimorbidity in older people and those with dementia.
Changes in the mortality of older people.
Trends and patterns of psychotropic medication prescriptions for older people.
The association between dementia, multimorbidity and mortality, accounting for socio-demographic/socio-economic characteristics.
Associations between area (e.g. urban/rural), socioeconomic circumstances and place of death.REC name
HSC REC A
REC reference
21/NI/0095
Date of REC Opinion
30 Jun 2021
REC opinion
Further Information Favourable Opinion