Ulster University

Academic Institute

Economic and Social Research Council

Yes

258

Older people are at high risk for Covid-19 and may have been impacted (and psychologically distressed) by the quarantine - entailing disconnection from family, community and usual health, social support and planned treatments. These may be amplified for people in rural areas where services are limited and both transport and digital-based communication services relatively poor. These issues may be more challenging for people living with dementia, generally associated with ageing, functional decline (Melis et al., 2013) and increased prescribing (Browne et al., 2017; Clague et al., 2017). We will develop analysis based on a specific interest with problematic polypharmacy, defined pragmatically as a situation - where specific medication types should not be taken by a patient simultaneously, or where unexpected negative interactions between medications occur. This occurs mainly due to multimorbidity and is recognised as a serious problem for older people which can reduce life expectancy (NICE, 2019). In the UK dementia prevalence is considerable and for those with dementia polypharmacy can increase confusion, cognitive and physical decline and falls, and inappropriate prescribing of antipsychotic medications may arise when agitation and other physical needs are misinterpreted (Pryor & Clarke, 2017). However, evidence is limited. For people with dementia there are concerns about anti-depressant efficacy and anti-psychotic medication for treatment of mood and agitation respectively. Additionally, pain is often problematic and is underdiagnosed in this population (Hanson et al. 2018), while poor pain management (Dening, 2017) can increase discomfort and distress, delirium, sedation and confusion. Aim: to investigate the health impact of the pandemic and lockdown on older people, including those living with dementia. This includes examination of:  Prescribing patterns for psychotropic medication and pain medication across the whole period of interest, with specific focus on comparisons between the pandemic quarantine period and selected pre-Covid periods (see * below);  problematic polypharmacy – again examined as below*;  changes in all-cause/cause-specific mortality over the whole study population, focussing on risks associated with (a) multi-morbidity, (b) the range of contextual data provided with the 2011 Census – this will allow us a preliminary examination (determined by the available mortality downloads) of putative changes that may be accounted for by the pandemic/lockdown; and finally,  changes in dementia mortality over the noted periods* - in relation to multimorbidity; medication use and socio-demographic context (note - assumes we can include later downloads of the mortality data).

This study is of importance to Health and Social Care research because of its focus on population ageing and dementia, and the impact of the pandemic on the selected health outcomes. While numerous studies have demonstrated an association between problematic polypharmacy and risk of adverse drug reactions, morbidity and mortality, none to our knowledge have focused specifically on dementia (despite the potential for such interactions). As part of this study we will examine medications, comorbidities and mortality in that sub-population with dementia, with the comparator drawn from the general population sample. There is a lack of evidence on the effect of multiple drug use on such clinically relevant outcomes as functional and cognitive decline, quality of life, adverse events, and mortality. While most research in this area focuses on disease-oriented approaches which examine for interactions in the clinical data – and not normally addressing any overlapping associated health and social problems - our intention (with the data configuration adopted for this study) is to begin to address these broader issues, with, as noted, special focus on older people living with dementia.

03/08/2021

TRE