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Improving Medication Management Support for Older Adults: A Pilot Study. Susan L. Lakey , PharmD Acting Assistant Professor University of Washington Department of Pharmacy April 14, 2008. Background. Adherence Estimated rate of adherence to medication regimens is only 50%.

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improving medication management support for older adults a pilot study

Improving Medication Management Support for Older Adults: A Pilot Study

Susan L. Lakey, PharmD

Acting Assistant Professor

University of Washington

Department of Pharmacy

April 14, 2008

background
Background

Adherence

  • Estimated rate of adherence to medication regimens is only 50%.
  • Impact of non-adherence:
    • 10% of hospital admissions
    • 23% of nursing home admissions
    • Estimated yearly cost in U.S. of $100 billion

Medication Management Capacity

  • The cognitive and functional ability to take medications as prescribed.
  • Necessary for adherence in persons who self-administer medications.
  • Might be addressed by use of supportive interventions:
    • medication support devices
    • human support
    • provider interaction
pilot study objectives
Pilot Study Objectives
  • Evaluate medication management capacity among independent-living older adults in a continuing care retirement community (CCRC).
  • Through the use of a survey, evaluate knowledge about and preferences for strategies to reduce medication mismanagement risk.
  • Determine whether knowledge and preferences are associated with demographic variables, cognitive status, medication management capacity, and medication regimen complexity.
methods
Methods
  • Cross-sectional study
  • Independent-living residents in a continuing care retirement community (CCRC) in Seattle, Washington
  • In-person interviews for data collection
  • Demographics
  • Medication regimen
  • Survey assessing knowledge and preferences for strategies to improve medication management
  • Risk for medication mismanagement
    • Drug Regimen Unassisted Grading Scale (DRUGS)
    • Mini-Cog
    • Self-report of medication management difficulties
statistical analysis
Statistical Analysis
  • Descriptive statistics to report medication mismanagement risk.
  • Descriptive statistics to report knowledge and preferences for medication management supports.
  • Medication management tool users and non-users will be compared at baseline using two-tailed t-tests and chi squared tests as appropriate.
summary of sample
Summary of Sample
  • Total of 89 participants
  • Average age 85.6 (+/- 5.2) years
  • 71 (79.8%) female
  • 88 (98.9%) white
  • Average 15.6 (+/- 2.7) years education
  • Average 4.1 (+/- 2.5) prescription medications
  • Medications taken an average of 1.8 (+/- 1.0) times a day
medication mismanagement risk
Medication Mismanagement Risk

8 (9.0%) self-reported difficulty taking medications as prescribed

15 (16.8%) with possible cognitive impairment (<3 on Mini-Cog)

25 (28.1%) with medication management difficulties (<95% on DRUGS)

39 (43.8%) at risk based on all 3 categories

human support and provider interaction
Human Support and Provider Interaction

Human Support

  • 7/60 (12%) were currently receiving help from a family member
  • 20 (38%) of those not currently receiving family assistance would consider it if needed

Provider Interaction

  • 17 (19%) had asked a provider to simplify their medication regimen
    • 2 (11%) RPH
    • 14 (74%) MD
  • 41 (46%) would be comfortable doing so if needed
conclusions
Conclusions
  • Risk for medication mismanagement was common (44%) in this independent-living sample.
  • Medication management tool use was high (85%), although mainly consisted of medi-set use and easy open medication containers.
  • Medication tool users were less likely to have cognitive impairment and were taking medications more frequently than non-users.