The Severity of Dependence Scale detects medication misuse and dependence among hospitalized older patients

BMC Geriatrics

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[1] 0000 0000 9637 455X, grid.411279.8, Health Services Research Unit (HØKH), Akershus Univeristy Hospital, PO Box 1000, 1478, Lorenskog, Norway;0000 0000 9637 455X, grid.411279.8, Department of Neurology, Akershus Univeristy Hospital, PO Box 1000, 1478, Lorenskog, Norway;0000 0004 1936 8921, grid.5510.1, Department of General Practice, Institute of Health and Society, University of Oslo, 1130 Blindern, 0318, Oslo, Norway;0000 0000 9637 455X, grid.411279.8, Health Services Research Unit (HØKH), Akershus Univeristy Hospital, PO Box 1000, 1478, Lorenskog, Norway;0000 0004 1936 8921, grid.5510.1, Institute of Clinical Medicine, Campus Ahus, Faculty of Medicine, University of Oslo, PO Box 1000, 1478, Lorenskog, Norway;0000 0000 9637 455X, grid.411279.8, Health Services Research Unit (HØKH), Akershus Univeristy Hospital, PO Box 1000, 1478, Lorenskog, Norway;0000 0004 1936 8921, grid.5510.1, Institute of Clinical Medicine, Campus Ahus, Faculty of Medicine, University of Oslo, PO Box 1000, 1478, Lorenskog, Norway;0000 0000 9637 455X, grid.411279.8, Department of Neurology, Akershus Univeristy Hospital, PO Box 1000, 1478, Lorenskog, Norway;0000 0001 2322 6764, grid.13097.3c, National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, PO Box 48, 4 Windsor Walk, SE5 8AF, London, UK;

关键词: Medication dependence;    SDS;    Diagnostic accuracy;    Validity and reliability;    Old age;   

DOI  :  10.1186/s12877-019-1182-3

来源: publisher

【 摘 要 】

BackgroundIn 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.Methods246 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.ResultsThe 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.ConclusionsThe 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 registrationClinicalTrials.gov Identifier: NCT03162081. Registered 3 May 2017.

【 授权许可】

CC BY