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Kean EA, Adeleke OA. Geriatric drug delivery - barriers, current technologies and the road ahead. J Drug Target 2024:1-21. [PMID: 39076049 DOI: 10.1080/1061186x.2024.2386626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Revised: 07/17/2024] [Accepted: 07/25/2024] [Indexed: 07/31/2024]
Abstract
The geriatric population encompasses the largest part of the health care system worldwide. Chronic medical conditions are highly prevalent in the elderly, consequently, due to their complex health needs, there is a significant rate of multi-drug therapy. Despite the high numbers of medications prescribed, geriatric patients face several barriers when it comes to successful drug delivery including alterations in cognitive and physical function. The current review highlights the impact of chronic diseases on the ageing population along with how changes in drug pharmacokinetics could impact drug efficacy and safety. Also discussed are applications of administration routes in the geriatric population and complications that could arise. A focus is placed on the traditional and upcoming drug delivery advancements being employed in seniors with a focus addressing obstacles faced by this patient category. Nanomedicines, three-dimensional printing, long-acting formulations, transdermal systems, orally disintegrating tablets, and shape/taste modification technologies are discussed. Several barriers to drug delivery in the elderly have been identified in literature and directions for future studies should focus on addressing these gaps for geriatric drug formulation development including personalised medicine, insights into novel drug delivery systems like nanomedicines, methods for decreasing pill burden and shape/size modifications.ARTICLE HIGHLIGHTSTypically, senior citizens take more medications than any other patient population, yet most drug delivery technologies are not tailored to address the specific cognitive and physical barriers that these individuals encounter.The safety of drug delivery systems in the elderly patients should be prioritised with considerations on changes in pharmacokinetics with age, use of non-toxic excipients, and selecting drugs with minimal off-target side effects.Several commercialised and upcoming drug delivery technologies have begun to address the current limitations that the ageing population faces.Future research should focus on applying novel strategies like 3D printing, personalised medicine, and long-acting formulations to improve drug delivery to elderly patients.
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Affiliation(s)
- Emma A Kean
- Preclinical Laboratory for Drug Delivery Innovations, College of Pharmacy, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Oluwatoyin A Adeleke
- Preclinical Laboratory for Drug Delivery Innovations, College of Pharmacy, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
- School of Biomedical Engineering, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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Cabrero Castro JE, Wong R, Samper Ternent R, Downer B. Population-level trends in self-reported healthcare utilization among older adults in Mexico with and without cognitive impairment. BMC Geriatr 2024; 24:652. [PMID: 39095702 PMCID: PMC11295330 DOI: 10.1186/s12877-024-05247-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 07/25/2024] [Indexed: 08/04/2024] Open
Abstract
BACKGROUND Older adults with cognitive impairment exhibit different patterns of healthcare utilization compared to their cognitively healthy counterparts. Despite extensive research in high-income countries, similar studies in low- and middle-income countries are lacking. This study aims to investigate the population-level patterns in healthcare utilization among older adults with and without cognitive impairment in Mexico. METHODS Data came from five waves (2001-2018) of the Mexican Health and Aging Study. We used self-reported measures for one or more over-night hospital stays, doctor visits, visits to homeopathic doctors, and dental visits in the past year; seeing a pharmacist in the past year; and being screened for cholesterol, diabetes, and hypertension in the past two years. Cognitive impairment was defined using a modified version of the Cross Cultural Cognitive Examination that assessed verbal memory, visuospatial and visual scanning. Total sample included 5,673 participants with cognitive impairment and 34,497 without cognitive impairment interviewed between 2001 and 2018. Generalized Estimating Equation models that adjusted for time-varying demographic and health characteristics and included an interaction term between time and cognitive status were used. RESULTS For all participants, the risk for one or more overnight hospital stays, doctor visits, and dental visits in the past year, and being screened for diabetes, hypertension, and high cholesterol increased from 2001 to 2012 and leveled off or decreased in 2015 and 2018. Conversely, seeing a homeopathic doctor decreased. Cognitive impairment was associated with higher risk of hospitalization (RR = 1.13, 1.03-1.23) but lower risk of outpatient services (RR = 0.95, 0.93-0.97), cholesterol screening (RR = 0.93, 0.91-0.96), and diabetes screening (RR = 0.95, 0.92-0.97). No significant difference was observed in the use of pharmacists, homeopathic doctors, or folk healers based on cognitive status. Interaction effects indicated participants with cognitive impairment had lower risk for dental visits and hypertension screening but that these trajectories differed over time compared to participants without cognitive impairment. CONCLUSIONS We identified distinct population-level trends in self-reported healthcare utilization and differences according to cognitive status, particularly for elective and screening services. These findings highlight the necessity for policy interventions to ensure older adults with cognitive impairment have their healthcare needs met.
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Affiliation(s)
- José Eduardo Cabrero Castro
- Department of Population Health & Health Disparities, The University of Texas Medical Branch at Galveston, 301 University Boulevard, Galveston, TX, 77555, USA.
| | - Rebeca Wong
- Department of Population Health & Health Disparities, The University of Texas Medical Branch at Galveston, 301 University Boulevard, Galveston, TX, 77555, USA
| | - Rafael Samper Ternent
- Department of Management, Policy & Community Health, UTHealth Houston School of Public Health, 1200 Pressler Street, Houston, TX, USA
| | - Brian Downer
- Department of Population Health & Health Disparities, The University of Texas Medical Branch at Galveston, 301 University Boulevard, Galveston, TX, 77555, USA
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Duodu PA, Okyere J, Simkhada B, Akrong R, Barker C, Gillibrand W, Simkhada P. Exploration of family caregivers' experiences on coping in dementia care in Ghana: a phenomenological study. BMC Psychol 2024; 12:361. [PMID: 38902797 PMCID: PMC11191216 DOI: 10.1186/s40359-024-01862-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 06/18/2024] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND Dementia is an important public health and geriatric concern for sub-Saharan African countries, including Ghana. Evidence shows that persons living with dementia are often supported and cared for by family caregivers in the community. In the execution of these services to the persons living with dementia, family caregivers are overwhelmed and experience heightened stress that results in serious repercussions. Therefore, the aim of this study was to explore family caregivers' experiences on coping in dementia care in Ghana. METHODS Adopting a descriptive phenomenological design, individual face-to-face interviews were conducted among thirty unpaid family caregivers of persons living with dementia in Ghana. Semi-structured interview guides were used. The data analysis process followed Clarke and Braun's framework analysis. RESULTS Six themes were generated from the textual data. These themes were captioned as: (1) empathy and perspective-taking; (2) family support and cohesion; (3) coaxing and pampering of persons living with dementia; (4) humour and positive communication; (5) spiritual support; and (6) ethical/moral consideration in dementia caregiving. CONCLUSION We conclude that unpaid family caregivers of persons living with dementia in Ghana adopt varied strategies to cope with the strains of caregiving. Healthcare facilities that provide services to persons living with dementia could incorporate caregiver preparatory training or education for family caregivers. This training should focus on briefing family caregivers about the potential strains that they are likely to encounter. Also, the training could focus on equipping family caregivers with the knowledge and skills to effectively communicate and care for the persons living with dementia using person-centered approaches. Key stakeholders such as the Ghana Health Service and Alzheimer's Ghana must raise awareness about the dangers of caregivers' violation of the autonomy and freedom of persons living with dementia as they navigate through the challenges of caregiving. Lastly, faith-based institutions need to be considered as key stakeholders in dementia interventions since they could play a critical role.
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Grants
- HHS013-01 Strategic Research Investment Seed Funding, School of Human and Health Sciences, University of Huddersfield, United Kingdom
- HHS013-01 Strategic Research Investment Seed Funding, School of Human and Health Sciences, University of Huddersfield, United Kingdom
- HHS013-01 Strategic Research Investment Seed Funding, School of Human and Health Sciences, University of Huddersfield, United Kingdom
- HHS013-01 Strategic Research Investment Seed Funding, School of Human and Health Sciences, University of Huddersfield, United Kingdom
- HHS013-01 Strategic Research Investment Seed Funding, School of Human and Health Sciences, University of Huddersfield, United Kingdom
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Affiliation(s)
- Precious Adade Duodu
- Department of Nursing, School of Human and Health Sciences, University of Huddersfield, Queensgate, Huddersfield, West Yorkshire, England, UK
| | - Joshua Okyere
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana.
- School of Nursing and Midwifery, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - Bibha Simkhada
- Department of Nursing, School of Human and Health Sciences, University of Huddersfield, Queensgate, Huddersfield, West Yorkshire, England, UK
| | - Ransford Akrong
- Educational Assessment and Research Center, Osu, Accra, Ghana
- School of Human and Health Sciences, University of Huddersfield, Queensgate, Huddersfield, West Yorkshire, England, UK
| | - Caroline Barker
- Department of Nursing, School of Human and Health Sciences, University of Huddersfield, Queensgate, Huddersfield, West Yorkshire, England, UK
| | - Warren Gillibrand
- Department of Nursing, School of Human and Health Sciences, University of Huddersfield, Queensgate, Huddersfield, West Yorkshire, England, UK
| | - Padam Simkhada
- School of Human and Health Sciences, University of Huddersfield, Queensgate, Huddersfield, West Yorkshire, England, UK
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Mahmoudi R, Kamari F, Naghdi Sadeh R, Naseri A, Sadra V. Implications of cognitive and daily living capabilities on early type 2 diabetes management: a preliminary case-control study. Eur J Med Res 2024; 29:337. [PMID: 38890763 PMCID: PMC11186157 DOI: 10.1186/s40001-024-01925-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 06/06/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Adherence to the transition from oral agents to insulin injections in Type 2 Diabetes Mellitus therapy varies among patients and is not uniformly successful, leading to suboptimal glycemic control in certain cases. This study aims to investigate the potential correlation between cognitive and daily functional capabilities and glycemic control in middle-aged to older adults (40-74 years old) diagnosed with Type 2 Diabetes Mellitus for less than 10 years, specifically those who have recently transitioned to insulin injections and have lower education levels within the context of a developing country. METHODS A case-control study was conducted with 30 poorly controlled diabetes mellitus (PCDM) patients recognized by HbA1c levels > 8% compared to 30 fairly controlled diabetes mellitus (FCDM) patients with HbA1c levels ≤ 8%. Basic Montreal Cognitive Assessment (MoCA-B) score of less than 27 was investigated as the exposure among two groups. Additionally, intra- and inter-battery correlations were assessed among MoCA-B and Instrumental Activities of Daily Living (IADL) domains using Pearson's r. RESULTS The primary outcomes showed no crude difference between MoCA-B scores in the two diabetic groups (p-value = 0.82). However, after adjusting for age, education, and IADL scores, cognitive decline in the less-educated younger elderly with high IADL scores demonstrated an unexpected protective effect against PCDM (p-value < 0.0001, OR 95% CI = 0-0.26). In linear regression analysis among MoCA-B and IADL scores, "delayed recall" and "orientation" domains from MoCA-B, and "managing medications" and "using the phone" from IADL were negatively associated with HbA1c levels (p-values of < 0.01, 0.043, 0.015, and 0.023, respectively). Intra- and inter-battery correlations further illustrated a strong association between MoCA-B's "orientation" with IADL's "using the phone" and "managing medications" (p-values < 0.0001). CONCLUSION Superior performance in certain cognitive domains is linked to better glycemic control. Still, since assessing cognitive domains may be timely in clinical routine, a potential rapid approach might be taken by assessing patients' instrumental abilities to use cell phone or manage medications. Future studies including a larger sample size and a broader spectrum of psychosocial factors are needed to elaborate on our findings.
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Affiliation(s)
- Romina Mahmoudi
- Endocrine Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Farzin Kamari
- Department of Neurophysiology, Institute of Physiology, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Reza Naghdi Sadeh
- Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Amirreza Naseri
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
- Research Center for Evidence-Based Medicine, Iranian EBM Center: A Joanna Briggs Institute Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Vahideh Sadra
- Endocrine Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
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Patel K, Irizarry-Caro JA, Khan A, Holder T, Salako D, Goyal P, Kwak MJ. Definition of Polypharmacy in Heart Failure: A Scoping Review of the Literature. Cardiol Res 2024; 15:75-85. [PMID: 38645827 PMCID: PMC11027783 DOI: 10.14740/cr1636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 03/29/2024] [Indexed: 04/23/2024] Open
Abstract
Patients with heart failure (HF) have a high prevalence of polypharmacy, which can lead to drug interactions, cognitive impairment, and medication non-compliance. However, the definition of polypharmacy in these patients is still inconsistent. The aim of this scoping review was to find the most common definition of polypharmacy in HF patients. We conducted a scoping review searching Medline, Embase, CINAHL, and Cochrane using terms including polypharmacy, HF and deprescribing, which resulted in 7,949 articles. Articles without a definition of polypharmacy in HF patients and articles which included patients < 18 years of age were excluded; only 59 articles were included. Of the 59 articles, 49% (n = 29) were retrospective, 20% (n = 12) were prospective, 10% (n = 6) were cross-sectional, and 27% (n = 16) were review articles. Twenty percent (n = 12) of the articles focused on HF with reduced ejection fraction, 10% (n = 6) focused on HF with preserved ejection fraction and 69% (n = 41) articles either focused on both diagnoses or did not clarify the specific type of HF. The most common cutoff for polypharmacy in HF was five medications (59%, n = 35). There was no consensus regarding the inclusion or exclusion of over-the-counter medications, supplements, or vitamins. Some newer studies used a cutoff of 10 medications (14%, n = 8), and this may be a more practical and meaningful definition for HF patients.
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Affiliation(s)
- Keshav Patel
- Department of Internal Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Jorge A. Irizarry-Caro
- Department of Internal Medicine, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Adil Khan
- Department of Pediatrics, Emory University, Atlanta, GA, USA
| | - Travis Holder
- Houston Academy of Medicine, The Texas Medical Center Library, Houston, TX, USA
| | | | - Parag Goyal
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Min Ji Kwak
- Department of Internal Medicine, Division of Geriatric and Palliative Medicine, The University of Texas Health Science Center at Houston, Houston, TX, USA
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Liu J, Meyer K, Glassner A, Gonzales M, Bartlett Ellis RJ, Park H, Song L, Patel N, Wang J. Thematic Analysis of Alzheimer's Medication Management Discussion in a Non-Moderated Online Forum. West J Nurs Res 2024; 46:307-314. [PMID: 38456477 PMCID: PMC10955786 DOI: 10.1177/01939459241237671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
BACKGROUND Managing medications for Alzheimer's disease and related dementias is challenging for caregivers. Information about caregivers' strategies to manage these challenges is needed to inform intervention development. OBJECTIVE This study aimed to understand caregivers' medication management experiences by analyzing online community discussions. METHODS Posts were extracted from the ALZConnected® Forum using keywords "medication" and "drug" via web scraping. The researchers applied thematic analysis. RESULTS Four major themes emerged: (1) role transition of medication management responsibilities, (2) caregivers' uncertainty about medication purpose and values, (3) conflicts between the care recipients and caregivers, and (4) difficulty accessing and affording medications. CONCLUSIONS The experiences shared on a non-moderated, unstructured online forum indicate that medication management is challenging and overwhelming for caregivers of people living with Alzheimer's disease and related dementias. Since this is a progressive disease with various stages and changing needs, caregivers' strategies vary and are often limited by available resources and support. Health care providers should offer training and support for caregivers to navigate the transfer of medication management responsibilities and changing care needs as the disease progresses.
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Affiliation(s)
- Jia Liu
- School of Nursing, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Kylie Meyer
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Ashlie Glassner
- School of Nursing, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Mitzi Gonzales
- Biggs Institute for Alzheimer’s and Neurodegenerative Diseases, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | | | - Hyejin Park
- College of Nursing, Florida State University, Tallahassee, FL, USA
| | - Lixin Song
- School of Nursing, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Neela Patel
- Department of Family and Community Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Jing Wang
- College of Nursing, Florida State University, Tallahassee, FL, USA
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Lim R, Iflaifel M, Qamariat ZAL, Crowley C, Sharmeen T. Navigating complexity of the medication management system within the home setting-a functional resonance analysis method (FRAM) analysis of people with dementia and their carers' experiences. Age Ageing 2024; 53:afae058. [PMID: 38526026 PMCID: PMC10962015 DOI: 10.1093/ageing/afae058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND There is a strong imperative to support people with dementia to live independently in their homes for as long as possible. A starting point is to understand how they manage medications on a daily basis. AIM To understand how people with dementia and their informal carers manage medications within the home setting to inform the identification of opportunities to improve medication management. METHODS A qualitative study using the Functional Resonance Analysis Method (FRAM). Interview data with people with dementia and informal carers were analysed to (i) Identify and describe key functions, (ii) identify and describe variability in performing key functions, and its potential consequences and (iii) map performance variability to Resilient Healthcare capacities. RESULTS AND DISCUSSION A FRAM model was developed and consisted of 14 interdependent key functions. The interdependent nature of functions, and the different nature and sources of variability in how each key function was performed highlighted the level of complexity of the medication management system within the home setting. The medication system was managed almost entirely by the person with dementia and/or their informal carers. This shows the lack of system-level controls to support the safe functioning of the medication management system in the home setting. CONCLUSION Future work will develop a comprehensive FRAM model that includes the perspectives of health and social care professionals and those from the third sectors to underpin the development of a range of system recommendations to strengthen resilience in the medication management system within the home setting.
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Affiliation(s)
- Rosemary Lim
- Reading School of Pharmacy, University of Reading, Reading, Berkshire, UK
| | - Mais Iflaifel
- Faculty of Life Sciences & Medicine, Department of Pharmacy, King’s College London, London, UK
| | - Zahra A L Qamariat
- Pharmaceutical Affairs, Critical Care, Dammam Medical Complex, Eastern Health Cluster, Dammam, Saudi Arabia
| | - Clare Crowley
- Reading School of Pharmacy, University of Reading, Reading, Berkshire, UK
| | - Taniya Sharmeen
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Watson J, Green MA, Giebel C, Akpan A. Identifying longitudinal healthcare pathways and subsequent mortality for people living with dementia in England: an observational group-based trajectory analysis. BMC Geriatr 2024; 24:150. [PMID: 38350866 PMCID: PMC10865521 DOI: 10.1186/s12877-024-04744-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 01/24/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND The number of people living with dementia (PLWD) continues to increase, particularly those with severe symptomatology. Severe symptoms and greater ill-health result in more acute care need. Early healthcare interventions can prove beneficial. Healthcare use has not been analysed as a holistic set of interlinked events. This study explores different healthcare pathways among PLWD, social or spatial inequalities in healthcare pathways and subsequent mortality risk. METHODS Group-based trajectory models (GBTM) were applied to electronic healthcare records. We generated clusters of PLWD with similar five-year, post-diagnosis trajectories in rates of primary and secondary healthcare use. Potential social and spatial variations in healthcare use clusters were examined. Cox Proportional Hazards used to explore variation in subsequent mortality risk between healthcare use clusters. RESULTS Four healthcare use clusters were identified in both early- (n = 3732) and late-onset (n = 6224) dementia populations. Healthcare use variations were noted; consistent or diminishing healthcare use was associated with lower subsequent mortality risk. Increasing healthcare use was associated with increased mortality risk. Descriptive analyses indicated social and spatial variation in healthcare use cluster membership. CONCLUSION Healthcare pathways can help indicate changing need and variation in need, with differential patterns in initial healthcare use post-diagnosis, producing similar subsequent mortality risk. Care in dementia needs to be more accessible and appropriate, with care catered to specific and changing needs. Better continuity of care and greater awareness of dementia in primary can enhance prospects for PLWD. Research needs to further illuminate holistic care need for PLWD, including health and social care use, inequalities in care, health and outcomes.
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Affiliation(s)
- James Watson
- Department of Primary Care and Mental Health, The University of Liverpool, 1st Floor, Waterhouse Building B, Liverpool, L69 3GF, UK.
| | - Mark A Green
- School of Environmental Sciences, The University of Liverpool, Liverpool, UK
| | - Clarissa Giebel
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
- Applied Research Collaboration North West Coast, Liverpool, UK
| | - Asangaedem Akpan
- Department of Medicine for Older People and Stroke, Liverpool University Hospitals NHS FT, Liverpool, UK
- Healthy Ageing Group, University of Cumbria, Carlisle, UK
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
- Clinical Research Network, North West Coast, Liverpool, UK
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Manzo G, Celi LA, Shabazz Y, Mulcahey R, Flores LJ, Demner-Fushman D. Caregivers Attitude Detection From Clinical Notes. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2024; 2023:1125-1134. [PMID: 38222330 PMCID: PMC10785866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
Caregivers' attitudes impact healthcare quality and disparities. Clinical notes contain highly specialized and ambiguous language that requires extensive domain knowledge to understand, and using negative language does not necessarily imply a negative attitude. This study discusses the challenge of detecting caregivers' attitudes from their clinical notes. To address these challenges, we annotate MIMIC clinical notes and train state-of-the-art language models from the Hugging Face platform. The study focuses on the Neonatal Intensive Care Unit and evaluates models in zero-shot, few-shot, and fully-trained scenarios. Among the chosen models, RoBERTa identifies caregivers' attitudes from clinical notes with an F1-score of 0.75. This approach not only enhances patient satisfaction, but opens up exciting possibilities for detecting and preventing care provider syndromes, such as fatigue, stress, and burnout. The paper concludes by discussing limitations and potential future work.
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Affiliation(s)
- Gaetano Manzo
- Computational Health Research Branch, National Library of Medicine, Bethesda, Maryland, USA
| | - Leo Anthony Celi
- Massachusetts Institute of Technology (MIT), Harvard Medical School, and the Beth Israel Deaconess Medical Center
| | - Yasmeen Shabazz
- Massachusetts Institute of Technology (MIT), Harvard Medical School, and the Beth Israel Deaconess Medical Center
| | - Rory Mulcahey
- Computational Health Research Branch, National Library of Medicine, Bethesda, Maryland, USA
| | - Lorenzo Jaime Flores
- Massachusetts Institute of Technology (MIT), Harvard Medical School, and the Beth Israel Deaconess Medical Center
| | - Dina Demner-Fushman
- Computational Health Research Branch, National Library of Medicine, Bethesda, Maryland, USA
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Anjani QK, Cárcamo-Martínez Á, Wardoyo LAH, Moreno-Castellanos N, Sabri AHB, Larrañeta E, Donnelly RF. MAP-box: a novel, low-cost and easy-to-fabricate 3D-printed box for the storage and transportation of dissolving microneedle array patches. Drug Deliv Transl Res 2024; 14:208-222. [PMID: 37477867 PMCID: PMC10746783 DOI: 10.1007/s13346-023-01393-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2023] [Indexed: 07/22/2023]
Abstract
Research on the use of microarray patches (MAPs) has progressed at an unprecedented rate over the years, leading to the development of many novel drug delivery systems. As the technology approaches patients, there are several key aspects that ought to be addressed in order to facilitate the smooth translation of MAPs from bench to bedside. One integral factor includes the choice of devices and packaging for the storage of MAPs. In the current work, a slide-and-seal box, MAP-box, was developed for the storage of dissolving MAPs, using fused-deposition modelling. The device has been designed to act as a pill-box for MAPs not only to provide protection for MAPs from the environment, but also to improve patient's adherence to treatment. The overall design of the MAP-box was simple, yet offers the capability of sealing and protecting dissolving MAPs up to 30 days. Donepezil HCl was formulated into a dissolvable MAP, which was used to treat dementia related to Alzheimer's disease. This compound was used as a model formulation to evaluate the utility of the 3D printed MAP-box when placed under three storage conditions: 5 °C and ambient humidity, 25 °C and 65% relative humidity and 40 °C and 75% relative humidity. It was shown that the slide-and-seal box was able to confer protection to MAPs for up to 30 days under accelerated stability study conditions as the drug loading, mechanical properties and insertion properties of MAPs remained unaffected when compared to the unpackaged MAPs stored under these same parameters. These preliminary data provide evidence that the MAP-box prototype may be of great utility for the storage of single or multiple MAPs. Nevertheless, future work will be needed to evaluate their patient usability and its application to different types of MAP systems to fully validate the overall robustness of the prototype.
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Affiliation(s)
- Qonita Kurnia Anjani
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, Northern Ireland, UK
| | - Álvaro Cárcamo-Martínez
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, Northern Ireland, UK
- Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach an Der Riss, Germany
| | - Luki Ahmadi Hari Wardoyo
- Fakultas Seni Rupa Dan Desain, Institut Teknologi Bandung, Jl. Ganesa No.10, Bandung, 40132, Indonesia
| | - Natalia Moreno-Castellanos
- Basic Science Department, Faculty of Health, Universidad Industrial de Santander, Bucaramanga, 680001, Colombia
| | - Akmal Hidayat Bin Sabri
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, Northern Ireland, UK
| | - Eneko Larrañeta
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, Northern Ireland, UK
| | - Ryan F Donnelly
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, Northern Ireland, UK.
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DiBello JR, Lu Y, Swartz J, Bortnichak EA, Liaw KL, Zhong W, Liu X. Patterns of use of symptomatic treatments for Alzheimer's disease dementia (AD). BMC Neurol 2023; 23:400. [PMID: 37946118 PMCID: PMC10634008 DOI: 10.1186/s12883-023-03447-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 10/23/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Symptomatic treatment for Alzheimer's disease (AD) dementia could temporarily slow symptom worsening and improve the quality of life for both AD dementia patients and their caregivers. A comprehensive evaluation of symptomatic treatment patterns using recent data for newly diagnosed AD dementia has not been performed and compared across different countries. METHODS The drug name, time to the first therapy, duration, discontinuation or switches were described in newly diagnosed AD dementia patients in two databases (a major U.S. health plan [US] and UK-Clinical Practice Research Datalink [CPRD GOLD]). This analysis included patients with newly diagnosed AD dementia in 2018-2019, who initiated symptomatic AD drug therapy, with ≥ 1 year baseline period and ≥ 1 year of follow-up. RESULTS Over median follow-ups of 698 and 645 days, 63% and 65% of AD dementia patients used symptomatic treatments, with 34% and 77% newly initiating therapy, constituting analytic samples of 7637 patients in the US database and 4470 patients in the CPRD, respectively. The median time to the first therapy was 14 days for US and 49 days for CPRD; donepezil ranked the as most frequently used (69% vs 61%), followed by memantine (19% vs 28%) in the US database and CPRD, respectively. Median time on first therapy was 213 and 334 days, and 30% and 12% of patients proceeded to a second treatment in the US and CPRD databases, respectively. CONCLUSION Approximately two thirds of newly diagnosed AD dementia patients utilized approved symptomatic treatment. Time on first therapy was relatively short (< 1 year) and the majority did not move to a second therapy, highlighting the need for better adherence and persistence to existing AD symptomatic therapies and the need for additional therapies to alleviate the significant burden of AD dementia.
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Affiliation(s)
- Julia R DiBello
- Epidemiology, Biostatistics and Research Decision Sciences, Merck & Co., Inc., 770 Sumneytown Pike, West Point, PA, 19486, USA
| | - Yifei Lu
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jina Swartz
- Exciva EXCIVA GmbH, Hauptstrasse 25, 69117, Heidelberg, Germany
| | - Edward A Bortnichak
- Epidemiology, Biostatistics and Research Decision Sciences, Merck & Co., Inc., 770 Sumneytown Pike, West Point, PA, 19486, USA
| | - Kai-Li Liaw
- Epidemiology, Biostatistics and Research Decision Sciences, Merck & Co., Inc., 770 Sumneytown Pike, West Point, PA, 19486, USA
| | - Wenjun Zhong
- Epidemiology, Biostatistics and Research Decision Sciences, Merck & Co., Inc., 770 Sumneytown Pike, West Point, PA, 19486, USA
| | - Xinyue Liu
- Epidemiology, Biostatistics and Research Decision Sciences, Merck & Co., Inc., 770 Sumneytown Pike, West Point, PA, 19486, USA.
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Nguyen ATN, Fisher RG, Valentine MJ, Kayastha A, Pham HM, Phu AT, Meimon SA, Newsome-Cuby TR, Parry CA, Kirila CE. Serotonergic Medication Error: A Case Report of Serotonin Syndrome. Cureus 2023; 15:e48161. [PMID: 38046758 PMCID: PMC10693256 DOI: 10.7759/cureus.48161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2023] [Indexed: 12/05/2023] Open
Abstract
Serotonin syndrome (SS) describes a life-threatening clinical condition that can develop within hours or days after taking serotonergic medication(s). Medication adverse reactions, overdose, or drug interactions can cause this syndrome. Patients often present with symptoms of hyperthermia, muscle rigidity, hyperreflexia, and clonus. Symptoms range broadly in severity, often influenced by polypharmacy and age. In this report, SS was diagnosed in an elderly patient who presented with diffuse urticaria and exacerbated tremor. These complaints were thought to be associated with Parkinson's disease due to a strong family history. Clinicians are encouraged to consider SS in their differential diagnosis when dealing with elderly patients with multiple medications, psychiatric diagnoses, conditions managed by other providers, and/or a strong family history of neurodegenerative diseases.
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Affiliation(s)
- Anh Thu N Nguyen
- College of Osteopathic Medicine, Kansas City University, Kansas City, USA
| | - Riley G Fisher
- College of Life Sciences, Brigham Young University, Provo, USA
| | | | - Ankur Kayastha
- College of Osteopathic Medicine, Kansas City University, Kansas City, USA
| | - Hanh M Pham
- College of Osteopathic Medicine, Kansas City University, Kansas City, USA
- Public Health, University of Nebraska Medical Center, Omaha, USA
| | - Alexander T Phu
- College of Osteopathic Medicine, Kansas City University, Kansas City, USA
| | - Saif A Meimon
- College of Osteopathic Medicine, Kansas City University, Kansas City, USA
| | | | - Conor A Parry
- College of Osteopathic Medicine, Kansas City University, Kansas City, USA
| | - Carol E Kirila
- College of Osteopathic Medicine, Kansas City University, Kansas City, USA
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Yu Y, Hunter SC, Xiao L, Meyer C, Chapman M, Tan KP, Chen L, McKechnie S, Ratcliffe J, Ullah S, Kitson A, Andrade AQ, Whitehead C. Exploring the role of a facilitator in supporting family carers when embedding the iSupport for Dementia programme in care services: A qualitative study. J Clin Nurs 2023; 32:7358-7371. [PMID: 37477168 PMCID: PMC10947559 DOI: 10.1111/jocn.16836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 07/02/2023] [Accepted: 07/10/2023] [Indexed: 07/22/2023]
Abstract
AIMS To explore stakeholders' perceptions of a facilitator's role in supporting carers when embedding iSupport for Dementia psychoeducation program, in care services. METHODS A qualitative descriptive study design was applied. Data were collected from workshops and interviews with carers of people living with dementia (PLWD)and with health and social care professionals from two tertiary hospitals and two community aged care organisations across three Australian states between October 2021 and March 2022. A thematic analysis was used to analyse data. The COREQ guideline was followed to report our findings. RESULTS A total of 30 family carers and 45 health and social care professionals participated in the study. Three main themes and seven subthemes were identified from the data. We described the main themes as (1) the facilitator's role at the time of dementia diagnosis, (2) the facilitator's role throughout the everyday dementia care journey and (3) the facilitator's role during transition moments. CONCLUSIONS Caring for family members with dementia is demanding and stressful for carers. Embedding a facilitator-enabled iSupport for Dementia program in hospital and community aged care settings has the potential to mitigate sources of stress associated with care recipient factors, carer factors and care service factors, and improve the health and well-being of carers and those for whom they care. RELEVANCE TO CLINICAL PRACTICE Our findings will inform the establishment of iSupport facilitators appointed by dementia care providers in hospital and community care settings and help determine their roles and responsibilities in delivering the iSupport program. Our findings relate to nurse-led and coordinated dementia care in hospital and community aged care settings. PATIENT OR PUBLIC CONTRIBUTION This study was co-designed with stakeholders from two aged care organisations and two tertiary hospitals. The study participants were staff employed by these organisations and carers of PLWD who were service users.
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Affiliation(s)
- Ying Yu
- College of Nursing and Health SciencesFlinders UniversityBedford ParkSouth AustraliaAustralia
- Caring Future InstitutesFlinders UniversityBedford ParkSouth AustraliaAustralia
| | - Sarah C. Hunter
- College of Nursing and Health SciencesFlinders UniversityBedford ParkSouth AustraliaAustralia
- Caring Future InstitutesFlinders UniversityBedford ParkSouth AustraliaAustralia
| | - Lily Xiao
- College of Nursing and Health SciencesFlinders UniversityBedford ParkSouth AustraliaAustralia
- Caring Future InstitutesFlinders UniversityBedford ParkSouth AustraliaAustralia
| | - Claudia Meyer
- College of Nursing and Health SciencesFlinders UniversityBedford ParkSouth AustraliaAustralia
- Bolton Clarke Research InstituteMelbourneVictoriaAustralia
- Rehabilitation, Ageing and Independent Living Research CentreMonash UniversityClaytonVictoriaAustralia
- Centre for Health Communication and ParticipationLa Trobe UniversityMelbourneVictoriaAustralia
| | - Michael Chapman
- Australian National UniversityCanberraAustralian Capital TerritoryAustralia
- Department of Palliative CareCanberra Health ServicesGarranAustralian Capital TerritoryAustralia
| | - Kai Ping Tan
- Department of Palliative CareCanberra Health ServicesGarranAustralian Capital TerritoryAustralia
| | - Langduo Chen
- College of Nursing and Health SciencesFlinders UniversityBedford ParkSouth AustraliaAustralia
- Southern Adelaide Local Health NetworkAdelaideSouth AustraliaAustralia
| | - Sue McKechnie
- Community ServicesResthaven IncorporatedBartley Crescent WayvilleSouth AustraliaAustralia
| | - Julie Ratcliffe
- College of Nursing and Health SciencesFlinders UniversityBedford ParkSouth AustraliaAustralia
- Caring Future InstitutesFlinders UniversityBedford ParkSouth AustraliaAustralia
| | - Shahid Ullah
- College of Medicine and Public HealthFlinders UniversityBedford ParkSouth AustraliaAustralia
| | - Alison Kitson
- College of Nursing and Health SciencesFlinders UniversityBedford ParkSouth AustraliaAustralia
- Caring Future InstitutesFlinders UniversityBedford ParkSouth AustraliaAustralia
| | - Andre Q. Andrade
- Clinical and Medical Sciences, Quality Use of Medicines and Pharmacy Research CentreUniversity of South AustraliaAdelaideSouth AustraliaAustralia
| | - Craig Whitehead
- Southern Adelaide Local Health NetworkAdelaideSouth AustraliaAustralia
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Tarhan N, Arslan M. Psychometric assessment of pharmacists' counseling in dementia. PATIENT EDUCATION AND COUNSELING 2023; 115:107903. [PMID: 37506523 DOI: 10.1016/j.pec.2023.107903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 06/07/2023] [Accepted: 07/15/2023] [Indexed: 07/30/2023]
Abstract
OBJECTIVE This study aimed to explore pharmacists' counseling for dementia by developing a measurement tool based on the Theory of Planned Behavior. METHODS A survey was applied online to community pharmacists; in total, 190 community pharmacists participated in the study. Exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and Mann-Whitney U test were performed. RESULTS A six-factor structure was obtained from the EFA, and the CFA confirmed the structure. These factors explained 71.294% of the total variance. The Cronbach's alpha coefficients for the factors ranged from 0.728 to 0.913. In addition, the pharmacists rated themselves as having positive attitudes and intentions toward counseling for dementia. Differences in these factors were found between the groups based on their participation in vocational training on dementia. CONCLUSION The developed measurement tool had a satisfactory construct and convergent and discriminant validities and reliabilities. PRACTICE IMPLICATIONS The developed measurement tool can be used to investigate pharmacists' self-reported counseling for dementia and can also be applied to the counseling behavior of pharmacists in various health conditions.
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Affiliation(s)
- Nilay Tarhan
- Department of Pharmacy Management, Izmir Katip Celebi University Faculty of Pharmacy, Izmir, Turkiye.
| | - Miray Arslan
- Department of Pharmacy Management, Van Yuzuncu Yil University Faculty of Pharmacy, Van, Turkiye
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Shabet CL, Bicket MC, Blair E, Hu HM, Langa KM, Kabeto MU, Levine DA, Waljee J. The Association of Cognitive Status and Post-Operative Opioid Prescribing in Older Adults. ANNALS OF SURGERY OPEN 2023; 4:e320. [PMID: 37746626 PMCID: PMC10513135 DOI: 10.1097/as9.0000000000000320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 07/14/2023] [Indexed: 09/26/2023] Open
Abstract
Objective To examine the differences in opioid prescribing by cognitive status following common elective surgical procedures among Medicare beneficiaries. Background Older individuals commonly experience changes in cognition with age. Although opioid prescribing is common after surgery, differences in opioid prescribing after surgery by cognitive status are poorly understood. Methods We conducted a retrospective analysis of patients ≥65 years participating in the Health and Retirement Study (HRS) linked with Medicare claims data who underwent surgeries between January 2007 and November 2016 and had cognitive assessments before the index operation. Cognitive status was defined as normal cognition, mild cognitive impairment (MCI), or dementia. Outcomes assessed were initial perioperative opioid fill rates, refill rates, and high-risk prescriptions fill rates. The total amount of opioids filled during the 30-day postdischarge period was also assessed. Adjusted rates were estimated for patient factors using the Cochran-Armitage test for trend. Results Among the 1874 patients included in the analysis, 68% had normal cognition, 21.3% had MCI, and 10.7% had dementia. Patients with normal cognition (58.1%) and MCI (54.5%) had higher initial preoperative fill rates than patients with dementia (33.5%) (P < 0.001). Overall, patients with dementia had similar opioid refill rates (21%) to patients with normal cognition (24.1%) and MCI (26.5%) (P = 0.322). Although prior opioid exposure did not differ by cognitive status (P = 0.171), among patients with high chronic preoperative use, those with dementia had lower adjusted prescription sizes filled within 30 days following discharge (281 OME) than patients with normal cognition (2147 OME) and MCI (774 OME) (P < 0.001; P = 0.009 respectively). Among opioid-naive patients, patients with dementia also filled smaller prescription sizes (97 OME) compared to patients with normal cognition (205 OME) and patients with MCI (173 OME) (P < 0.001 and P = 0.019, respectively). Conclusions Patients with dementia are less likely to receive postoperative prescriptions, less likely to refill prescriptions, and receive prescriptions of smaller sizes compared to patients with normal cognition or MCI. A cognitive assessment is an additional tool surgeons can use to determine a patient's individualized postoperative pain control plan.
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Affiliation(s)
- Christina L Shabet
- From the Department of Surgery, University of Michigan Medical School, University of Michigan, Ann Arbor
| | - Mark C Bicket
- Department of Anesthesiology, University of Michigan, Ann Arbor
- Michigan Opioid Prescribing Engagement Network (Michigan OPEN), Institute for Healthcare Policy and Innovation, Ann Arbor
| | - Emilie Blair
- Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan, Ann Arbor
| | - Hsou Mei Hu
- Michigan Opioid Prescribing Engagement Network (Michigan OPEN), Institute for Healthcare Policy and Innovation, Ann Arbor
- Department of Surgery, Section of Plastic Surgery, University of Michigan, Ann Arbor
| | - Kenneth M Langa
- Michigan Opioid Prescribing Engagement Network (Michigan OPEN), Institute for Healthcare Policy and Innovation, Ann Arbor
- Department of Internal Medicine, University of Michigan, Ann Arbor
- Institute for Social Research, University of Michigan, Ann Arbor
- VA Center for Clinical Management Research, Ann Arbor
| | | | - Deborah A Levine
- Department of Internal Medicine, University of Michigan, Ann Arbor
| | - Jennifer Waljee
- Department of Surgery, Section of Plastic Surgery, University of Michigan, Ann Arbor
- Center for Health Outcomes and Policy, University of Michigan, Ann Arbor, MI
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Raghunandan R, Howard K, Ilomaki J, Hilmer SN, Gnjidic D, Bell JS. Preferences for deprescribing antihypertensive medications amongst clinicians, carers and people living with dementia: a discrete choice experiment. Age Ageing 2023; 52:afad153. [PMID: 37596920 PMCID: PMC10439526 DOI: 10.1093/ageing/afad153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Indexed: 08/21/2023] Open
Abstract
BACKGROUND Optimal management of hypertension in people with dementia may involve deprescribing antihypertensives. Understanding differing treatment priorities is important to enable patient-centred care. This study explored preferences for antihypertensive deprescribing amongst people living with dementia, carers and clinicians. METHODS Discrete choice experiments (DCEs) are a stated preference survey method, underpinned by economic theory. A DCE was conducted, and respondents completed 12 labelled choice-questions, each presenting a status quo (continuing antihypertensives) and antihypertensive deprescribing option. The questions included six attributes, including pill burden, and event risks for stroke, myocardial infarction, increased blood pressure, cognitive decline, falls. RESULTS Overall, 112 respondents (33 carers, 19 people living with dementia, and 60 clinicians) completed the survey. For people with dementia, lower pill burden increased preferences for deprescribing (odds ratio (OR) 1.95, 95% confidence interval (95% CI) 1.08-3.52). Increased stroke risk (for each additional person out of 100 having a stroke) decreased the likelihood of deprescribing for geriatricians (OR 0.71, 95% CI 0.55-0.92) and non-geriatrician clinicians (OR 0.62, 95% CI 0.45-0.86), and carers (OR 0.71, 95% CI 0.58-0.88). Increased myocardial infarction risk decreased preferences for deprescribing for non-geriatricians (OR 0.81, 95% CI 0.69-0.95) and carers (OR 0.84, 95% CI 0.73-0.98). Avoiding cognitive decline increased preferences for deprescribing for geriatricians (OR 1.17, 95% CI 1.03-1.33) and carers (OR 1.27, 95% CI 1.09-1.48). Avoiding falls increased preferences for deprescribing for clinicians (geriatricians (OR 1.20, 95% CI 1.11-1.29); non-geriatricians (OR 1.16, 95% CI 1.07-1.25)). Other attributes did not significantly influence respondent preferences. CONCLUSIONS Antihypertensive deprescribing preferences differ amongst people with dementia, carers and clinicians. The study emphasises the importance of shared decision-making within the deprescribing process.
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Affiliation(s)
- Rakhee Raghunandan
- Menzies Centre for Health Policy and Economics, School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
| | - Kirsten Howard
- Menzies Centre for Health Policy and Economics, School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
| | - Jenni Ilomaki
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Clayton, VIC, Australia
| | - Sarah N Hilmer
- Kolling Institute of Medical Research, Royal North Shore Hospital and University of Sydney, St Leonards, NSW, Australia
- Departments of Clinical Pharmacology and Aged Care, Royal North Shore Hospital, St Leonards, NSW, Australia
- Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
| | - Danijela Gnjidic
- School of Pharmacy, Faculty of Medicine and Health, and Charles Perkins Centre, University of Sydney, Camperdown, NSW, Australia
| | - J Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Clayton, VIC, Australia
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Thompson Z, Tamplin J, Vieira Sousa T, Carrasco R, Flynn L, Lamb KE, Lampit A, Lautenschlager NT, McMahon K, Waycott J, Vogel AP, Woodward-Kron R, Stretton-Smith PA, Baker FA. Content development and validation for a mobile application designed to train family caregivers in the use of music to support care of people living with dementia. Front Med (Lausanne) 2023; 10:1185818. [PMID: 37250645 PMCID: PMC10213236 DOI: 10.3389/fmed.2023.1185818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 04/27/2023] [Indexed: 05/31/2023] Open
Abstract
Background Music therapy is increasingly recognized as an effective support for people living with dementia. However, with incidences of dementia increasing, and limited availability of music therapists, there is a need for affordable and accessible ways that caregivers can learn to use music-therapy based strategies to support the people they care for. The MATCH project aims to address this by creating a mobile application that can train family caregivers in the use of music to support people living with dementia. Methods This study details the development and validation of training material for the MATCH mobile application. Training modules developed based on existing research were assessed by 10 experienced music therapist clinician-researchers, and seven family caregivers who had previously completed personalized training in music therapy strategies via the HOMESIDE project. Participants reviewed the content and scored each training module based on content (music therapists) and face (caregivers) validity scales. Descriptive statistics were used to calculate scores on the scales, while thematic analysis was used to analyze short-answer feedback. Results Participants scored the content as valid and relevant, however, they provided additional suggestions for improvement via short-answer feedback. Conclusion The content developed for the MATCH application is valid and will be trailed by family caregivers and people living with dementia in a future study.
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Affiliation(s)
- Zara Thompson
- Faculty of Fine Arts and Music, University of Melbourne, Melbourne, VIC, Australia
| | - Jeanette Tamplin
- Faculty of Fine Arts and Music, University of Melbourne, Melbourne, VIC, Australia
| | - Tanara Vieira Sousa
- Faculty of Fine Arts and Music, University of Melbourne, Melbourne, VIC, Australia
| | - Romina Carrasco
- School of Computing and Information System, University of Melbourne, Carlton, VIC, Australia
| | - Libby Flynn
- Faculty of Fine Arts and Music, University of Melbourne, Melbourne, VIC, Australia
| | - Karen E. Lamb
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
| | - Amit Lampit
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia
| | - Nicola T. Lautenschlager
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia
- NorthWestern Mental Health, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Kate McMahon
- Faculty of Fine Arts and Music, University of Melbourne, Melbourne, VIC, Australia
| | - Jenny Waycott
- School of Computing and Information System, University of Melbourne, Carlton, VIC, Australia
| | - Adam P. Vogel
- Center for Neuroscience and Speech, University of Melbourne, Parkville, VIC, Australia
- Division of Translational Genomics of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Germany and Center for Neurology, University Hospital Tübingen, Tübingen, Germany
- Redenlab Inc., Melbourne, VIC, Australia
| | - Robyn Woodward-Kron
- Department of Medical Education, Melbourne Medical School, University of Melbourne, Parkville, VIC, Australia
| | | | - Felicity A. Baker
- Faculty of Fine Arts and Music, University of Melbourne, Melbourne, VIC, Australia
- Norwegian Academy of Music, Oslo, Norway
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Widjaja GJ, Gnjidic D, Clough AJ, Watson K, Hepburn K, Sawan MJ. Availability and evaluation of medication management resources for carers of people with dementia: a scoping review with an environmental scan. Expert Rev Clin Pharmacol 2023; 16:195-205. [PMID: 36787628 DOI: 10.1080/17512433.2023.2181158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
INTRODUCTION There is a need for resources to guide informal carers in medication management for people with dementia. Availability of resources on medication management guidance has yet to be explored. AREAS COVERED A systematic search of MEDLINE, Embase, CINAHL and PsycINFO was performed in May 2022 to identify and evaluate resources for carers of people with dementia that provide guidance in medication management. Google and known repositories were also searched. Readability of text-based resources was examined using the Flesch-Kincaid reading level, the Flesch reading ease and the Gunning-Fog index. Resources were further evaluated using the Patient Education Material Assessment Tool (PEMAT or PEMAT-A/V). EXPERT OPINION Fifteen resources were identified, which largely focused on medication administration with limited discussion of shared decision-making. Current resources do not appear to have included people living with dementia or their carers in their development and did not address high-risk care settings. Codesign of resources with carers and people with dementia would ensure that resources are comprehensive and target their needs. Future research should therefore focus on development of readily available and understandable resources that provide medication management guidance for carers across different health settings, to comprehensively address the multi-faceted nature of dementia.
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Affiliation(s)
- Gabrielle J Widjaja
- School of Pharmacy, Faculty of Medicine and Health, the University of Sydney NSW, Camperdown, Australia
| | - Danijela Gnjidic
- School of Pharmacy, Faculty of Medicine and Health, the University of Sydney NSW, Camperdown, Australia
| | - Alexander J Clough
- School of Pharmacy, Faculty of Medicine and Health, the University of Sydney NSW, Camperdown, Australia
| | - Karen Watson
- Sydney Nursing School, Faculty of Medicine and Health, the University of Sydney NSW, Camperdown, Australia
| | - Kenneth Hepburn
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, United States
| | - Mouna J Sawan
- School of Pharmacy, Faculty of Medicine and Health, the University of Sydney NSW, Camperdown, Australia
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‘Everyone should know what they’re on’: a qualitative study of attitudes towards and use of patient held lists of medicines among patients, carers and healthcare professionals in primary and secondary care settings in Ireland. BMJ Open 2022. [PMCID: PMC9301806 DOI: 10.1136/bmjopen-2022-064484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
ObjectivesManaging multiple medicines can be challenging for patients with multimorbidity, who are at high risk of adverse outcomes, for example, hospitalisation. Patient-held medication lists (PHMLs) can contribute to patient safety and potentially reduce medication errors. The aims of this study are to investigate attitudes towards and use of PHMLs among healthcare professionals (HCPs), patients and carers.DesignQualitative study based on 39 semistructured telephone interviews.SettingPrimary and secondary care settings in Ireland.ParticipantsTwenty-one HCPs and 18 people taking medicines and caregivers.MethodsTelephone interviews were conducted with HCPs, people taking multiple medicines (5+ medicines) and carers of people taking medicines who were purposively sampled via social media, patient groups and research collaborators. Interviews were transcribed and thematically analysed based on the Framework approach, with the Consolidated Framework for Implementation Research and Theoretical Domains Framework.ResultsThree core themes emerged: (1) attitudes to PHML, (2) function and preferred features of PHML and (3) barriers and facilitators to future use of PHML. All participating (patients/carers and HCP) groups considered PHML beneficial for patients and HCPs (eg, empowering for patients and improved adherence). While PHML were used in a variety of situations such as emergencies, concerns about their accuracy were shared across all groups. HCPs and patients differed on the level of detail that should be included in PHML. HCPs’ time constraints, patients’ multiple medicines and cognitive impairments were reported barriers. Key facilitators included access to digital/compact lists and promotion of lists by appropriate HCPs.ConclusionsOur findings provide insight into the factors that influence use of PHML. Lists were used in a variety of settings, but there were concerns about their accuracy. A range of list formats and encouragement from key HCPs could increase the use of PHML.
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Teichmann B, Gkioka M, Kruse A, Tsolaki M. Informal Caregivers' Attitude Toward Dementia: The Impact of Dementia Knowledge, Confidence in Dementia Care, and the Behavioral and Psychological Symptoms of the Person with Dementia. A Cross-Sectional Study. J Alzheimers Dis 2022; 88:971-984. [PMID: 35723101 PMCID: PMC9484115 DOI: 10.3233/jad-215731] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Dementia is rapidly increasing worldwide due to demographic aging. More than two-thirds of patients are cared by family members. The quality of care depends on the caregivers' attitude toward dementia influencing patient care decisions. OBJECTIVE The aim of this study is to examine the factors that influence the caregivers' attitude and whether there is an association between participation in a psycho-educational program and attitude. METHODS We performed a cross-sectional study using a structured closed-ended questionnaire to retrieve socio-demographic information from caregivers and the persons with dementia (N = 86). The study included validated scales such as the Dementia Attitude Scale, the Dementia Knowledge Assessment Tool 2, the Positive Aspects of Caregiving, the Zarit Burden Interview, the Confidence in Dementia Scale, and Spielberger's State-Trait Anxiety Inventory, as well as a neuropsychological battery to assess the condition of people with dementia. RESULTS Our final model explains 55.6% of the total variance and shows a significant correlation of five factors with attitude toward dementia: confidence, behavioral and psychological symptoms of dementia, anxiety as a trait, positive aspects of caregiving, and dementia knowledge. The caregivers who participated in a psycho-educational program showed a significantly more positive attitude toward dementia, better dementia knowledge, higher confidence in dementia care, and lower anxiety as a state. CONCLUSION The strong correlation of attitude and knowledge, as well as confidence in dementia care, supports the tripartite model of attitude, which hypothesizes the interrelation of affect, cognition, and behavior.
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Affiliation(s)
- Birgit Teichmann
- Network Aging Research, Heidelberg University, Heidelberg, Germany
| | - Mara Gkioka
- Network Aging Research, Heidelberg University, Heidelberg, Germany.,School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Andreas Kruse
- Institute for Gerontology, Heidelberg University, Heidelberg, Germany
| | - Magda Tsolaki
- Greek Association of Alzheimer's Disease and Related Disorders (GAADRD), Thessaloniki, Greece
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Sawan MJ, Gench M, Bond C, Jeon YH, Hilmer SN, Chen TF, Gnjidic D. Development of a tool to evaluate medication management guidance provided to carers of people living with dementia at hospital discharge: a mixed methods study. BMJ Open 2022; 12:e058237. [PMID: 35501104 PMCID: PMC9062821 DOI: 10.1136/bmjopen-2021-058237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE Medication management guidance for carers of people with dementia at hospital discharge is important to prevent medication-related harm during transitions of care. This study aimed to develop a tool to evaluate medication management guidance provided to carers of people with dementia at hospital discharge. DESIGN The tool was developed using mixed methods involving two stages. Stage 1 involved item generation and content validation. Items were based on a previous qualitative study and systematic review. Content validation involved experts and consumers with knowledge or experience of medication management guidance in the acute care setting, and rating each item on importance and relevance. Stage 2 involved conducting cognitive interviews with carers of people with dementia to pretest the tool. SETTING For stage 1, experts and consumers from Australia, USA and New Zealand were included. For stage 2, carers of people with dementia were recruited across Australia. PARTICIPANTS 18 experts and consumers participated in round 1 of content validation, and 13 experts and consumers completed round 2. Five carers of people with dementia participated in cognitive interviews. RESULTS The final tool contained 30 items capturing information across five domains: (1) provision of medication management guidance at hospital discharge; (2) carer understanding of medication management guidance provided at discharge; (3) carer engagement in discussing the safe use of medications at discharge; (4) carer preparedness to conduct medication management activities after discharge; and (5) co-ordination of medication management guidance after discharge. CONCLUSIONS We developed the first tool to assess medication management guidance provided for carers of people with dementia at hospital discharge. The tool may be useful to inform future research strategies to improve the delivery of medication management guidance at discharge.
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Affiliation(s)
- Mouna J Sawan
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Melissa Gench
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Christine Bond
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Yun-Hee Jeon
- Sydney Nursing School, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Sarah N Hilmer
- Clinical Pharmacology and Aged Care, Kolling Institute of Medical Research, Royal North Shore Hospital and the University of Sydney, St Leonards, New South Wales, Australia
| | - Timothy F Chen
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Danijela Gnjidic
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Camperdown, New South Wales, Australia
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22
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Lau CYE, Wojt I, Jeon YH, Hilmer SN, Tan ECK. Prevalence and Risk Factors for Drug-Related Problems in People With Dementia Living in the Community: A Systematic Review and Meta-Analysis. J Am Med Dir Assoc 2022; 23:980-991.e10. [PMID: 35276086 DOI: 10.1016/j.jamda.2022.01.083] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 01/18/2022] [Accepted: 01/29/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The aims of this systematic review were to identify the prevalence and risk factors associated with of drug-related problems (DRPs) in people living with dementia in the community. DESIGN A systematic review and meta-analysis. SETTING AND PARTICIPANTS People with dementia living in the community. METHODS Six databases (Embase, Medline, PsycINFO, International Pharmaceutical Abstracts, Scopus, and CINAHL) were searched using a combination of keywords and Medical Subject Heading (MeSH) terms with 4 concepts: dementia, older adults, DRPs, and community-dwelling. Primary outcomes were adverse drug reactions (ADRs), adverse drug events (ADEs), and medication errors (MEs). RESULTS There were 22 studies included: 4 cross-sectional studies and 18 cohort studies. The number of participants in these studies ranged from 81 to 21,795. The pooled prevalence for any ADEs, including ADRs, in people living with dementia was 19.0% (95% CI 11.6%-27.7%), whereas the pooled prevalence for specific types of ADEs ranged from 2.6% to 10.2%. Furthermore, the prevalence of MEs ranged from 0.9% to 41.3%. Psychotropic medications, polypharmacy, and inappropriate medications contributed to an increased risk of experiencing DRPs, whereas support with medication management was a protective factor. CONCLUSIONS AND IMPLICATIONS The prevalence of overall DRPs experienced by people with dementia was highly variable in included studies. Awareness that certain medication, patient, and medication management factors are associated with the risk of people with dementia experiencing DRPs may guide clinicians to identify high-risk situations and implement suitable mitigation strategies.
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Affiliation(s)
- Chun Y E Lau
- The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Ilsa Wojt
- The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Yun-Hee Jeon
- The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Sarah N Hilmer
- The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia; Kolling Institute, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Edwin C K Tan
- The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia; Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia.
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23
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Lim RHM, Sharmeen T, Donyai P. How do people with dementia make sense of their medications? An Interpretative Phenomenological Analysis study. Int J Geriatr Psychiatry 2022; 37. [PMID: 35020232 DOI: 10.1002/gps.5673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 12/21/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Managing medication is complex and multifaceted for people with dementia and their family carers. Despite efforts to support medication management, medication errors and medication-related hospital admissions still occur. This study investigated how people with dementia viewed and talked about their different medications and their medication taking. METHODS An interpretative phenomenological analysis (IPA) qualitative research design combining photo elicitation and in-depth interviews was used. People with a diagnosis of mild or moderate dementia took photographs of anything they viewed to be related to medication, with or without the help of family carers, over any two-day period. The photographs were then used as cues for subsequent in-depth interviews, which were analysed using IPA. RESULTS Twelve people with dementia were interviewed. Four themes encapsulated the experiences: (1) Medication as a lifeline, (2) Managing medications dominates daily lives and plans, (3) Struggling with uncertainty about the effectiveness of dementia medication and (4) Sense of 'being' and being in control. People with dementia viewed medication as a lifeline, especially donepezil, giving it preference over other daily medication they were using. Managing medications dominated the daily lives and plans of people with dementia and changed the way they viewed themselves and their life. People with dementia continually struggled with the imperceptible benefits of donepezil on their dementia, but despite such uncertainties, continued to take donepezil. CONCLUSIONS This study provided unique insights into how people with dementia made sense of their medication. Healthcare professionals can use these insights to shape their practice around medication prescribing and advice in dementia. The findings are also useful to researchers looking to develop interventions to support medication management within the home setting.
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Affiliation(s)
- Rosemary H M Lim
- Reading School of Pharmacy, University of Reading, Reading, Berkshire, UK
| | - Taniya Sharmeen
- Reading School of Pharmacy, University of Reading, Reading, Berkshire, UK
| | - Parastou Donyai
- Reading School of Pharmacy, University of Reading, Reading, Berkshire, UK
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24
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Sawan MJ, Jeon YH, Bond C, Hilmer SN, Chen TF, Wennekers D, Gnjidic D. Caregivers' experiences of medication management advice for people living with dementia at discharge. J Eval Clin Pract 2021; 27:1252-1261. [PMID: 33586327 DOI: 10.1111/jep.13551] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 01/19/2021] [Accepted: 01/23/2021] [Indexed: 01/09/2023]
Abstract
RATIONALE, AIMS, AND OBJECTIVES Caregivers of people living with dementia play an essential role in managing medications across transitions of care. Adequate caregiver medication management guidance at hospital discharge is important to ensure optimal outcomes from medication use. This qualitative study explores the experiences and perspectives of caregivers about the medication management guidance provided at hospital discharge. METHODS A qualitative approach using semi-structured, telephone interviews was conducted with 31 caregivers of people with dementia across Australia. Purposive sampling was used to ensure maximum variation of diverse experiences and perspectives. RESULTS Caregivers' experiences of medication guidance for people with dementia at discharge were described in three themes including: (a) inadequate information about medication management at discharge; (b) limited caregiver engagement in medication management decisions; and (c) difficulties ensuring medication supply post discharge. Most participants indicated they would like to be included in discussions at discharge. However, participation was influenced by caregivers being overwhelmed by discharge processes; proactively seeking information on medication-related harm; and belief in advocacy as part of their caregiver role. Caregivers reported they would like to receive a tailored medication list for people with dementia which included information on medications that may impact on the patient's cognition, and for hospital staff to communicate with both the community pharmacist and primary care physician, to improve co-ordination post transition. DISCUSSION In our study of caregivers of people with dementia, we identified key recommendations to facilitate regular participation of people living with dementia and their caregiver around medication guidance at discharge.
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Affiliation(s)
- Mouna J Sawan
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Yun-Hee Jeon
- Sydney Nursing School, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Christine Bond
- School of Medicine, Medical Sciences and Nutrition, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Sarah N Hilmer
- Clinical Pharmacology and Aged Care, Kolling Institute of Medical Research, Faculty of Medicine and Health, Royal North Shore Hospital and Northern Clinical School, St Leonards, New South Wales, Australia
| | - Timothy F Chen
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Damian Wennekers
- School of Pharmacy, Faculty of Science, Utrecht University, Utrecht, The Netherlands
| | - Danijela Gnjidic
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia.,Charles Perkins Centre, The University of Sydney, Camperdown, New South Wales, Australia
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25
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Gench M, Sawan MJ, Langford A, Gnjidic D. Tools to evaluate medication management for caregivers of people living with dementia: A systematic review. Health Expect 2021; 24:1570-1581. [PMID: 34289214 PMCID: PMC8483200 DOI: 10.1111/hex.13318] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 06/29/2021] [Accepted: 07/06/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Caregivers often undertake medication management for people living with dementia without formal training. There is a need to evaluate caregiver medication management practices for people living with dementia to identify and address the key issues that contribute to caregiver burden. OBJECTIVES This study aimed to identify and summarize approaches that evaluate medication management for caregivers of people living with dementia and appraise caregiver's involvement in aspects of medication management. SEARCH STRATEGY A systematic search was undertaken in five databases: Medline, Embase, PsycINFO, Scopus and International Pharmaceutical Abstracts. Studies written in English that contained tools and surveys that evaluated aspects of medication management for caregivers of PWD were included. RESULTS A total of 10 studies were included. Medication selection was assessed in six studies, supply and monitoring/review was captured in seven studies, with administration assessed in nine studies. Caregivers were commonly involved in decision-making for medication changes (77.1%-86.8%) and in the ordering (55.9%-86.0%) and collection (87.0%-92.4%) of medications. Reported caregiver involvement in medication administration showed a wide range (44%-94.7%) between the studies. Challenges in administration were commonly related to polypharmacy and dosage regimen complexity. CONCLUSIONS Current tools capture specific aspects of medication management, with medication administration the most evaluated aspect of medication management. Future research is needed to develop a tool to holistically evaluate the complexities of medication management for caregivers of people living with dementia to minimize adverse events at transitions of care. PUBLIC CONTRIBUTION From the authors' previous research, caregivers highlighted the need to address key issues in medication management for people living with dementia.
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Affiliation(s)
- Melissa Gench
- School of Pharmacy, Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
| | - Mouna J. Sawan
- School of Pharmacy, Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
| | - Aili Langford
- School of Pharmacy, Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
| | - Danijela Gnjidic
- School of Pharmacy, Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
- Charles Perkins CentreThe University of SydneySydneyNew South WalesAustralia
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26
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Vaismoradi M, Behboudi-Gandevani S, Lorenzl S, Weck C, Paal P. Needs Assessment of Safe Medicines Management for Older People With Cognitive Disorders in Home Care: An Integrative Systematic Review. Front Neurol 2021; 12:694572. [PMID: 34539551 PMCID: PMC8446192 DOI: 10.3389/fneur.2021.694572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 07/21/2021] [Indexed: 11/13/2022] Open
Abstract
Background and Objectives: The global trend of healthcare is to improve the quality and safety of care for older people with cognitive disorders in their own home. There is a need to identify how medicines management for these older people who are cared by their family caregivers can be safeguarded. This integrative systematic review aimed to perform the needs assessment of medicines management for older people with cognitive disorders who receive care from their family caregivers in their own home. Methods: An integrative systematic review of the international literature was conducted to retrieve all original qualitative and quantitative studies that involved the family caregivers of older people with cognitive disorders in medicines management in their own home. MeSH terms and relevant keywords were used to search four online databases of PubMed (including Medline), Scopus, CINAHL, and Web of Science and to retrieve studies published up to March 2021. Data were extracted by two independent researchers, and the review process was informed by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Given that selected studies were heterogeneous in terms of the methodological structure and research outcomes, a meta-analysis could not be performed. Therefore, narrative data analysis and knowledge synthesis were performed to report the review results. Results: The search process led to retrieving 1,241 studies, of which 12 studies were selected for data analysis and knowledge synthesis. They involved 3,890 older people with cognitive disorders and 3,465 family caregivers. Their methodologies varied and included cohort, randomised controlled trial, cross-sectional studies, grounded theory, qualitative framework analysis, and thematic analysis. The pillars that supported safe medicines management with the participation of family caregivers in home care consisted of the interconnection between older people's needs, family caregivers' role, and collaboration of multidisciplinary healthcare professionals. Conclusion: Medicines management for older people with cognitive disorders is complex and multidimensional. This systematic review provides a comprehensive image of the interconnection between factors influencing the safety of medicines management in home care. Considering that home-based medicines management is accompanied with stress and burden in family caregivers, multidisciplinary collaboration between healthcare professionals is essential along with the empowerment of family caregivers through education and support.
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Affiliation(s)
| | | | - Stefan Lorenzl
- Palliative Care, Paracelsus Medical University, Salzburg, Austria.,Department of Neurology, Klinikum Agatharied, Hausham, Germany
| | - Christiane Weck
- Palliative Care, Paracelsus Medical University, Salzburg, Austria.,Department of Neurology, Klinikum Agatharied, Hausham, Germany
| | - Piret Paal
- WHO Collaborating Centre at the Institute for Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria
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27
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Peh KQE, Kwan YH, Goh H, Ramchandani H, Phang JK, Lim ZY, Loh DHF, Østbye T, Blalock DV, Yoon S, Bosworth HB, Low LL, Thumboo J. An Adaptable Framework for Factors Contributing to Medication Adherence: Results from a Systematic Review of 102 Conceptual Frameworks. J Gen Intern Med 2021; 36:2784-2795. [PMID: 33660211 PMCID: PMC8390603 DOI: 10.1007/s11606-021-06648-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 01/28/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To summarize the available conceptual models for factors contributing to medication adherence based on the World Health Organization (WHO)'s five dimensions of medication adherence via a systematic review, identify the patient groups described in available conceptual models, and present an adaptable conceptual model that describes the factors contributing to medication adherence in the identified patient groups. METHODS We searched PubMed®, Embase®, CINAHL®, and PsycINFO® for English language articles published from inception until 31 March 2020. Full-text original publications in English that presented theoretical or conceptual models for factors contributing to medication adherence were included. Studies that presented statistical models were excluded. Two authors independently extracted the data. RESULTS We identified 102 conceptual models, and classified the factors contributing to medication adherence using the WHO's five dimensions of medication adherence, namely patient-related, medication-related, condition-related, healthcare system/healthcare provider-related, and socioeconomic factors. Eight patient groups were identified based on age and disease condition. The most universally addressed factors were patient-related factors. Medication-related, condition-related, healthcare system-related, and socioeconomic factors were represented to various extents depending on the patient group. By systematically examining how the WHO's five dimensions of medication adherence were applied differently across the eight different patient groups, we present a conceptual model that can be adapted to summarize the common factors contributing to medication adherence in different patient groups. CONCLUSION Our conceptual models can be utilized as a guide for clinicians and researchers in identifying the facilitators and barriers to medication adherence and developing future interventions to improve medication adherence. PROTOCOL REGISTRATION PROSPERO Identifier: CRD42020181316.
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Affiliation(s)
| | - Yu Heng Kwan
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, Singapore
| | - Hendra Goh
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Hasna Ramchandani
- Department of Biology, Faculty of Science, National University of Singapore, Singapore, Singapore
| | - Jie Kie Phang
- Department of Rheumatology & Immunology, Singapore General Hospital, Singapore, Singapore
| | - Zhui Ying Lim
- SingHealth Regional Health System, Singapore Health Services, Singapore, Singapore
| | - Dionne Hui Fang Loh
- SingHealth Regional Health System, Singapore Health Services, Singapore, Singapore
| | - Truls Østbye
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Department of Family Medicine and Community Health, Duke University, Durham, NC USA
| | - Dan V. Blalock
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC USA
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC USA
| | - Sungwon Yoon
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Hayden Barry Bosworth
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC USA
- Departments of Population Health Sciences and Psychiatry and Behavioral Sciences, School of Medicine, School of Nursing, Duke University, Durham, NC USA
| | - Lian Leng Low
- SingHealth Duke-NUS Family Medicine Academic Clinical Program, Singapore, Singapore
- Department of Family Medicine and Continuing Care, Singapore General Hospital, Singapore, Singapore
- PULSES Centre Grant, SingHealth Regional Health System, Singapore, Singapore
- Post-Acute and Continuing Care, Outram Community Hospital, Singapore, Singapore
| | - Julian Thumboo
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Department of Rheumatology & Immunology, Singapore General Hospital, Singapore, Singapore
- PULSES Centre Grant, SingHealth Regional Health System, Singapore, Singapore
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28
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An investigation of new medications initiation during ambulatory care visits in patients with dementia. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2021; 3:100058. [PMID: 35480611 PMCID: PMC9030674 DOI: 10.1016/j.rcsop.2021.100058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 06/23/2021] [Accepted: 08/06/2021] [Indexed: 11/21/2022] Open
Abstract
Background Objectives Methods Results Conclusion What was already known?Dementia remains responsible for a large economic burden; research has shown that patients with dementia have increased utilization of ambulatory care visits before and after diagnosis. Prior research in patients with dementia has focused on inappropriate prescribing, adverse drug interactions, and polypharmacy, but little work has been published investigating new medications prescribed at outpatient visits. Opportunities exist for pharmacists to manage medications in the outpatient setting for patients with complex medication regimens.
What the study adds?Though fewer visits for patients with dementia provided new medications compared to visits for patients without dementia, there was no statistically significant difference in odds of a new medication being provided after adjustment for important confounders. Some of the new medications more commonly provided to dementia patients include anticoagulants and antipsychotics that often require close monitoring and dosage adjustments. Pharmacist led services would likely improve the care of the dementia population in an outpatient setting, but further investigation of new medication usage and the utility of pharmacists is needed.
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29
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Brewster GS, Molinari V, McCrae C, Beckstead J, D'Aoust R, Rowe M. Cognitive Function and Sleep in Caregivers of Persons Living with Dementia. West J Nurs Res 2021; 44:260-268. [PMID: 34467789 DOI: 10.1177/01939459211041163] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Poor sleep is prevalent among caregivers of persons living with dementia and increases their risk for cognitive impairment and decline. In this cross-sectional, correlational study, we compared the cognitive function scores of caregivers with poor sleep with the demographically adjusted normed scores of the National Institutes of Health Toolbox Cognition Battery. Caregivers completed a 14-day sleep diary. On average, caregivers (n = 28) were 65.14 (±10.08) years, female, and White. Their average crystallized cognitive function composite score was significantly higher and their average fluid cognitive function composite score was significantly lower than the normative scores. Caregivers performed significantly worse on the processing speed domain measure. Poor sleep may affect how caregivers, including highly educated caregivers, process and respond to information, thus can influence how they safely perform complex caregiving tasks. Health care providers should consistently assess caregivers' sleep and cognitive abilities to promptly identify changes and provide timely interventions.
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Affiliation(s)
- Glenna S Brewster
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Victor Molinari
- School of Aging Studies, University of South Florida, Tampa, FL, USA
| | | | - Jason Beckstead
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Rita D'Aoust
- School of Nursing, Johns Hopkins University, Baltimore, MD, USA
| | - Meredeth Rowe
- College of Nursing, University of South Florida, Tampa, FL, USA
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30
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Rangarajan SK, Suhas S, Reddy MSS, Sreeraj VS, Sivakumar PT, Venkatasubramanian G. Domiciliary tDCS in Geriatric Psychiatric Disorders: Opportunities and Challenges. Indian J Psychol Med 2021; 43:351-356. [PMID: 34385730 PMCID: PMC8327869 DOI: 10.1177/02537176211003666] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Subhashini K Rangarajan
- Dept. of Clinical Neurosciences, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Satish Suhas
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Mukku Shiva Shanker Reddy
- Geriatric Clinic and Services, Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Vanteemar S Sreeraj
- WISER Neuromodulation Programme, Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Palanimuthu Thangaraju Sivakumar
- Geriatric Clinic and Services, Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Ganesan Venkatasubramanian
- WISER Neuromodulation Programme, Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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31
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Barry HE, McGrattan M, Ryan C, Passmore AP, Robinson AL, Molloy GJ, Darcy CM, Buchanan H, Hughes CM. 'I just take them because I know the people that give them to me': A theory-informed interview study of community-dwelling people with dementia and carers' perspectives of medicines management. Int J Geriatr Psychiatry 2021; 36:883-891. [PMID: 33368704 DOI: 10.1002/gps.5488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 10/22/2020] [Accepted: 12/19/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Identify facilitators and barriers to successful medicines management for people with dementia (PwD) in primary care from the perspectives of community-dwelling PwD and carers. METHODS Semi-structured interviews conducted with PwD and carers in Northern Ireland. The 14-domain Theoretical Domains Framework guided data collection and analysis. Interviews explored participants' experiences and perceptions of medicines management. PwD also completed the Beliefs about Medicines Questionnaire indicating their level of agreement with statements about medicines. Qualitative data were analysed using the framework method and content analysis. Quantitative data were analysed descriptively. RESULTS Eighteen PwD and 15 carers were interviewed. PwD believed they were competent with medicines management ('beliefs about capabilities'). Most PwD reported having strategies to prompt them to take their medicines ('memory, attention and decision processes'). Carers played an important role in supporting PwD with medicines management ('social influences') and monitoring adherence ('behavioural regulation') and anticipated having to take on a greater role as patients' cognitive impairment worsened ('beliefs about consequences'). Participants highlighted assistance provided by community pharmacies with medicines acquisition and delivery ('environmental context and resources') and placed great trust in primary healthcare professionals ('social influences'). PwD had positive attitudes towards medication and believed strongly in the necessity of their medicines. CONCLUSIONS This is the first study to use a theoretical approach to explore medicines management for community-dwelling PwD. The findings provide new insights into the critical role of carers in facilitating optimal medicines management and will inform future intervention development, in which carers' needs assessment and involvement will be key.
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Affiliation(s)
| | | | - Cristín Ryan
- The School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland
| | - A Peter Passmore
- Centre for Public Health, Queen's University Belfast, Belfast, UK.,Belfast Health & Social Care Trust, Belfast, UK
| | - A Louise Robinson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Gerard J Molloy
- School of Psychology, National University of Ireland, Galway, Ireland
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32
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Sawan MJ, Wennekers D, Sakiris M, Gnjidic D. Interventions at Hospital Discharge to Guide Caregivers in Medication Management for People Living with Dementia: a Systematic Review. J Gen Intern Med 2021; 36:1371-1379. [PMID: 33537953 PMCID: PMC8131426 DOI: 10.1007/s11606-020-06442-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 12/10/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND Hospital discharge has a significant impact on the continuity of care for people living with dementia. Clear guidance on medication management should be provided to caregivers of people living with dementia to ensure appropriate use of medications post-discharge. AIM Identify and appraise the impact of interventions at hospital discharge to guide caregivers in the medication management for people living with dementia. METHOD A systematic search of original studies was performed in Medline, Embase, PsycINFO, and CINAHL. Articles published in English that reported on interventions to guide caregivers in medication management for people living with dementia were included. Two authors independently reviewed titles and abstract. Full-text articles were assessed for eligibility and quality assessment was conducted by two authors. RESULTS A total of five studies were included with a range of interventions that were typically delivered post-discharge by a multidisciplinary team and most targeted administration of medications by caregivers. Overall, three types of discharge interventions were identified including a pre-discharge caregiver educational intervention, a post-discharge multidisciplinary team intervention, and discharge summary documentation intervention at transitions of care. Of these, a pre-discharge caregiver education led to shorter hospital stay (25 days vs. 31 days, p = 0.005). A post-discharge intervention that included follow-up visits resulted in lower use of high-risk medications (19% vs. 40%), and reduction in 30-day re-hospitalization rates (11% vs. 20%). In contrast, in another post-discharge intervention study, no difference in one-month re-hospitalization rates (8.4% vs. 8.0%, p = 0.82) was demonstrated. In another study, a post-discharge hospital educational program provided to caregivers led to significantly reduced caregiver burden (31.7 ± 17.6 (SD) pre-intervention to 27.7 ± 16.9 (SD) post-intervention (p = 0.037)). DISCUSSION Current findings suggest there is a need for well-designed interventions to guide caregivers in all aspects of medication management for people living with dementia, and should include support for caregivers in care coordination.
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Affiliation(s)
- Mouna J Sawan
- School of Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia.
| | - Damian Wennekers
- School of Pharmacy, Faculty of Science, University of Utrecht, Utrecht, The Netherlands
| | - Marissa Sakiris
- School of Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Danijela Gnjidic
- School of Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
- Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia
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Vulnerable Strata to Non-Adherence and Overuse in Treatment for Patients with Cognitive Impairment. Dement Neurocogn Disord 2020; 19:152-160. [PMID: 33377668 PMCID: PMC7781736 DOI: 10.12779/dnd.2020.19.4.152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 11/24/2020] [Accepted: 11/24/2020] [Indexed: 11/27/2022] Open
Abstract
Background and purpose Appropriate medication treatment could enable both cognitively impaired patients and caregivers to hold on their cognitive functioning and quality of life. Thus, medication management and the factors influencing how management for this condition is carried out must be identified. In this study we aimed to evaluate the frequency of medication nonadherence (MNA) or drug overuse for cognitive impairment (DOC) and to extract significant variables, including the demographic and social characteristics, vascular risk factors, and cognitive status, for the diagnosis of MNA and DOC in Korean patients. Methods We investigated patients aged over 50 years between March 2019 and June 2019 via the cognitive enHancement of patIents with acQuired cognitive impairment (HIQ) campaign. MNA was defined as a participant who was classified as having cognitive impairment but did not take any cognition-related drugs, whereas DOC was defined as a participant who had normal cognition but was taking cognition-related drugs. Results We included 10,767 patients. The MNA group consisted of 337 participants, whereas the DOC group comprised 1,107 participants. The factors that could differentiate the MNA group from the normal-behavior group were age, education, sex, and the total Korean version of Mini-Mental State Examination (K-MMSE) score. The factors that could differentiate the DOC group from the normal medication-behavior group were age, sex, residential distinction, experience of a dementia screening test, and the total K-MMSE score. Conclusions The underlying factors contributing to inadequate dementia-medication management must be understood, and intervention or support is needed to enable safe medication management.
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Wojt IR, Cairns R, Tan ECK. Poisoning Exposures in People with Dementia (2014‒2019): A Retrospective Study. J Am Med Dir Assoc 2020; 22:1553-1557.e1. [PMID: 33345812 DOI: 10.1016/j.jamda.2020.11.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 11/09/2020] [Accepted: 11/14/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To describe the most common types of poisoning exposures, implicated substances and underlying sources of medication error in people with dementia. DESIGN Retrospective analysis of call records from the New South Wales (NSW) Poisons Information Center (PIC). SETTING AND PARTICIPANTS People with dementia who had a poisoning exposure reported to the NSW PIC (Australia's largest PIC). METHODS A retrospective study was conducted using data from the NSW PIC from July 2014 to July 2019. All calls pertaining to individuals with a reported diagnosis of dementia (Alzheimer's disease or other) or who were taking an antidementia drug were included. Descriptive analysis was performed to characterize poisoning exposures, substances involved, and sources of error. RESULTS A total of 2726 cases involving individuals with dementia [mean age = 79.5 (standard deviation 11.0) years; 56.2% female] were reported to the NSW PIC after intentional or unintentional poisoning. Therapeutic errors comprised 1692 (62.1%) of all reported cases followed by accidental exposures which contributed 711 (26.1%). The most common therapeutic substances responsible for therapeutic errors were donepezil (137 cases, 8.1%) and paracetamol (87 cases, 5.1%). The greatest proportion of all accidental exposures was attributed to hand sanitizer (46 cases, 6.5%). Over one-half of therapeutic errors (n = 1021, 60.3%) were linked to double dosing or mistiming of medications, and nursing home or carer errors were implicated in 385 cases (22.8%). Calls were most commonly made by family (n = 1187, 43.5%) and handled at home (n =1444, 53.0%). CONCLUSIONS AND IMPLICATIONS Therapeutic errors and accidental poisonings are of concern in people with dementia. Strategies to reduce these potentially preventable adverse events should be further explored.
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Affiliation(s)
- Ilsa R Wojt
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Rose Cairns
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, Sydney, New South Wales, Australia; NSW Poisons Information Center, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Edwin C K Tan
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, Sydney, New South Wales, Australia.
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Sluggett JK, Bell JS, Lang C, Corlis M, Whitehead C, Wesselingh SL, Inacio MC. Variation in Provision of Collaborative Medication Reviews on Entry to Long-Term Care Facilities. J Am Med Dir Assoc 2020; 22:148-155.e1. [PMID: 33288466 DOI: 10.1016/j.jamda.2020.10.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 10/12/2020] [Accepted: 10/14/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Residential medication management reviews (RMMRs) are comprehensive medication reviews conducted by clinical pharmacists and general medical practitioners. RMMRs are the primary government-funded service to optimize medication management in Australian residential aged care facilities (RACFs) and are recommended for all new residents. This study investigated resident characteristics associated with timely RMMR provision within 90 days of RACF entry and national intrafacility variation in timely RMMR provision. DESIGN National retrospective cohort study. SETTING AND PARTICIPANTS Individuals aged ≥65 years who first entered permanent residential aged care in Australia between January 1, 2012, and December 31, 2015, received at least 1 medication in the previous year, and were alive at 90 days post-RACF entry. METHODS Resident characteristics associated with timely RMMR provision were determined using multivariate logistic regression. Crude and risk-adjusted funnel plots were used to examine intrafacility variation in timely RMMR provision. RESULTS Of the 143,676 residents from 2799 RACFs included, 30,883 (21.5%) received an RMMR within 90 days. Resident characteristics associated with timely provision included dementia (adjusted odds ratio [aOR] 1.05, 95% confidence interval [CI] 1.02-1.08), primary language other than English (aOR 1.04, 95% CI 1.01-1.09), number of unique prescriptions dispensed in the previous year (aOR [per additional 5 prescriptions] 1.02, 95% CI 1.01-1.03), need for medication administration assistance (aORs ranged from 1.35 to 1.42, compared with residents self-managing) and facility remoteness (aORs ranged from 0.67 to 0.75 for residents outside major cities). The proportion of new residents receiving a timely RMMR ranged from 0% (n = 303 RACFs) to 100% (n = 4 RACFs). There were 174 RACFs (6.2%) in which ≥50% of new residents received a timely RMMR. CONCLUSIONS AND IMPLICATIONS Although there was some evidence that RMMRs are targeted to individuals with a greater burden of medication use and those living with dementia, considerable variation in provision exists nationally. This flagship medication review service is generally underutilized among residents of Australian RACFs.
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Affiliation(s)
- Janet K Sluggett
- University of South Australia, UniSA Allied Health and Human Performance, Adelaide, South Australia, Australia; Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia; Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia.
| | - J Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Catherine Lang
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Megan Corlis
- University of South Australia, UniSA Allied Health and Human Performance, Adelaide, South Australia, Australia
| | - Craig Whitehead
- Department of Rehabilitation, Aged and Palliative Care, Flinders Medical Centre, Flinders University, Bedford Park, South Australia, Australia
| | - Steve L Wesselingh
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Maria C Inacio
- University of South Australia, UniSA Allied Health and Human Performance, Adelaide, South Australia, Australia; Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
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Lim RH, Shalhoub R, Sridharan BK. The experiences of the community pharmacy team in supporting people with dementia and family carers with medication management during the COVID-19 pandemic. Res Social Adm Pharm 2020; 17:S1551-7411(20)31136-0. [PMID: 34756365 PMCID: PMC7568124 DOI: 10.1016/j.sapharm.2020.10.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 10/13/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND The novel coronavirus COVID-19 pandemic has changed the lives of people across the globe in significant and long-lasting ways. People with dementia were significantly and disproportionally affected at the height of the pandemic in England. Community pharmacies in England continued to operate during the pandemic but had to adjust the way they provided key healthcare services. The impact of these changes on the provision of medication services to people with dementia is underexplored. OBJECTIVE To explore the experiences of the community pharmacy team in supporting people with dementia and their family carers with the management of medications during the COVID-19 pandemic. METHODS An interpretivist/constructivist research paradigm was used; semi-structured one-to-one telephone interviews were conducted with any member of the community pharmacy team who had been involved in providing medication services to people with dementia in England before and during the COVID-19 pandemic. Recruitment took place between July and August 2020. Interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis. RESULTS Fourteen participants were interviewed with equal numbers of qualified pharmacists and non-pharmacist staff. Participants were in their role for an average of 4.5 years. The analysis of interviews generated three themes: 1) key interactions curtailed due to COVID-19 restrictions, 2) utilising resources within and outside of the pharmacy to provide tailored services for people with dementia, and 3) the interplay between professional duty and personal values underpinned decisions to provide medication services. CONCLUSIONS The study provided a unique and important first insights to our understanding of how the community pharmacy team in England supported people with dementia and their family carers during the COVID-19 pandemic. These insights provide opportunities for reflection by individuals, healthcare teams, healthcare organisations, policy makers and the public, in an international context, to enable long-term planning, investment and implementation of strategies beyond the current pandemic.
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Affiliation(s)
- Rosemary Hm Lim
- Reading School of Pharmacy, University of Reading, Reading, Berkshire, UK.
| | - Reem Shalhoub
- Reading School of Pharmacy, University of Reading, Reading, Berkshire, UK
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Barry HE, Hughes CM. Managing medicines in the time of COVID-19: implications for community-dwelling people with dementia. Int J Clin Pharm 2020; 43:275-279. [PMID: 32803555 PMCID: PMC7429133 DOI: 10.1007/s11096-020-01116-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 07/25/2020] [Indexed: 11/25/2022]
Abstract
COVID-19 has changed life beyond recognition for millions of individuals, as countries implement social distancing measures to prevent disease transmission. For certain patient groups, such as community-dwelling older people with dementia (PwD), these restrictions may have far-reaching consequences. Medicines management may be adversely affected and deserves careful thought. PwD face unique challenges with medicines management compared to other older people, often relying upon support from family/carers and primary healthcare professionals. This article considers potential issues that PwD may face with each component of medicines management (prescribing, dispensing, administration, adherence, review), and based on previous research, highlights strategies to support PwD and their carers during this time. Primary healthcare professionals must be attentive to medicines-related needs of community-dwelling PwD, particularly those living alone, both during the pandemic and as restrictions are lifted. Carers of PwD continue to have a critical role to play in medicines management, and also require support.
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Affiliation(s)
- Heather E Barry
- Primary Care Research Group, School of Pharmacy, Medical Biology Centre, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, UK.
| | - Carmel M Hughes
- Primary Care Research Group, School of Pharmacy, Medical Biology Centre, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, UK
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Zaidi AS, Peterson GM, Bereznicki LRE, Curtain CM, Salahudeen M. Outcomes of Medication Misadventure Among People With Cognitive Impairment or Dementia: A Systematic Review and Meta-analysis. Ann Pharmacother 2020; 55:530-542. [PMID: 32772854 DOI: 10.1177/1060028020949125] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVE To investigate mortality and hospitalization outcomes associated with medication misadventure (including medication errors [MEs], such as the use of potentially inappropriate medications [PIMs], and adverse drug events [ADEs]) among people with cognitive impairment or dementia. DATA SOURCES Ovid MEDLINE, Ovid EMBASE, Ovid International Pharmaceutical Abstracts, Cumulative Index to Nursing and Allied Health Literature, and Cochrane Central Register of Controlled Trials were searched from inception to December 2019. STUDY SELECTION AND DATA EXTRACTION Relevant studies using any study design were included. Reviewers independently performed critical appraisal and extracted relevant data. DATA SYNTHESIS The systematic review included 10 studies that reported the outcomes of mortality or hospitalization associated with medication misadventure, including PIMs (n=5), ADEs (n=2), a combination of MEs and ADEs (n=2), and drug interactions (n=1). Five studies examining the association between PIMs and mortality/hospitalization were included in the meta-analyses. Exposure to PIMs was not associated with either mortality (odds ratio [OR]=1.36; 95%CI=0.79-2.35) or hospitalization (OR=1.02; 95%CI=0.83-1.26). In contrast, single studies indicated that ADEs with cholinesterase inhibitors were associated with mortality and hospitalization. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE Individuals with cognitive impairment or dementia are at increased risk of medication misadventure; based on relatively limited published data, this does not necessarily translate to increased mortality and hospitalization. CONCLUSIONS Overall, medication misadventure was not associated with mortality or hospitalization in people with cognitive impairment or dementia, noting the limited number of studies, difficulty in controlling potential confounding variables, and that most studies focus on PIMs.
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Affiliation(s)
- Anum Saqib Zaidi
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, Australia
| | - Gregory M Peterson
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, Australia.,Faculty of Health, University of Canberra, Australia
| | - Luke R E Bereznicki
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, Australia
| | - Colin M Curtain
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, Australia
| | - Mohammed Salahudeen
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, Australia
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Evaluation of Carer Strain and Carer Coping with Medications for People with Dementia after Discharge: Results from the SMS Dementia Study. Healthcare (Basel) 2020; 8:healthcare8030248. [PMID: 32751986 PMCID: PMC7551266 DOI: 10.3390/healthcare8030248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 07/28/2020] [Accepted: 07/28/2020] [Indexed: 11/16/2022] Open
Abstract
This study reports carer strain and coping with medications for people with dementia with an unplanned admission to hospital, and it evaluates the impact of a safe medication intervention on carer coping and carer strain. This was a quasi-experimental pre/post-controlled trial that included a survey of carers about managing medications for people with dementia after discharge. For 88 carers who completed surveys, 33% were concerned about managing medications, and 40% reported difficulties with medication management, including resistive behaviours by people with dementia. Dose administration aids were used by 72% of carers; however, only 15% reported receiving a recent home medicines review by a community pharmacist. High carer strain was reported by 74% of carers. Carer comments described many issues that contributed to high carer stress, as well as their engagement in vigilant activities to maintain medication safety. Strategies that can contribute to carers managing medications and reducing their strain include an increased use of dose administration aids, increased provision of home medicines reviews, and increased education of health professionals to provide adequate support and education about managing medications.
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Välimäki T, Mäki-Petäjä-Leinonen A, Vaismoradi M. Abuse in the caregiving relationship between older people with memory disorders and family caregivers: A systematic review. J Adv Nurs 2020. [PMID: 32301130 DOI: 10.1111/jan.14397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 03/03/2020] [Accepted: 03/30/2020] [Indexed: 11/28/2022]
Abstract
AIM To synthesize what is known about elder abuse and relationship factors associated with abuse between caregivers and older people with memory disorders at home. BACKGROUND Concerns about abuse in the caring relationship between older people with memory disorders and family caregivers have increased. Abuse is associated with negative outcomes on older people's health, quality of life, and zest for life. Abuse in the caring relationship manifests in financial exploitation, neglect, mistreatment, and physical issues. DESIGN Systematic review. DATA SOURCES Databases including Scopus, PubMed/Medline, SveMed+ , Cinalh, SonINDEX, and ProQuest were searched using keywords about abuse in the caring relationship between older people with memory disorders and family caregivers at home. Articles published between 2005-2019 were retrieved and underwent data analysis and knowledge synthesis. REVIEW METHODS The review was presented under the categories of the dyadic approach of elder abuse in connection with the role of caregiver (risk) and care recipient (vulnerability) by Fulmer et al. (2005). RESULTS The search process led to 12 quantitative studies, including an intervention, a prospective, nine surveys, and a cross-sectional structural interview. Findings were synthesized and presented under 'personal', 'physical and psychological', and 'social' domains indicating the bilateral roles of caregiver and care recipient leading to abuse. CONCLUSION This review depicted factors influencing abuse in the caring relationship between older people with memory disorders and their family caregivers at home. They included family caregivers' psychological issues, knowledge of memory disorders and modifications, previous caring relationship, social support, number of care recipients, and care recipients' functional level. IMPACT This review identifies what influences elder abuse by family caregivers using the dyadic approach and explains how abuse can be prevented through suggested strategies. The review findings are relevant to multidisciplinary healthcare providers and can guide the provision of support, screening and assessment, educational programs, and legislative initiatives.
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Affiliation(s)
- Tarja Välimäki
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
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Law W, Kwok TCY. Impacts of a multicomponent intervention programme on neuropsychiatric symptoms in people with dementia and psychological health of caregivers: A feasibility pilot study. Int J Geriatr Psychiatry 2019; 34:1765-1775. [PMID: 31390090 DOI: 10.1002/gps.5191] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 08/05/2019] [Indexed: 01/25/2023]
Abstract
OBJECTIVES The objectives of this study are to explore the feasibility of a multicomponent intervention programme and to evaluate its impacts on behavioural and psychological symptoms of dementia (BPSD) and psychological health of caregivers. METHODS Fifty-six community-dwelling people with dementia (PWD) and knee osteoarthritis (OA) and their caregivers were recruited and randomized into the intervention group (IG) or comparison group (CG). Each participant in both groups received an individual physiotherapy session (personalized home exercises and care education) and underwent 8 weeks of a 1-hour-structured group exercise session weekly at a day care centre. They were instructed to follow the prescribed home exercise. The IG received a multicomponent programme, combining knee OA-specific therapeutic exercise with self-management support, while the CG attended the routine group exercise programme. The attendance rate and reasons for non-attendance were recorded for evaluating the feasibility. The Chinese versions of the Revised Scale for Caregiving Self-Efficacy (RSCSE) and the Neuropsychiatric Inventory Questionnaire (NPI-Q) were measured at the baseline and postintervention. RESULTS Fifty-four dyads completed the programme with high attendance rate (94.4%). Compared with the CG, caregivers in the IG significantly improved in three domains of RSCSE scores (P ≤ .005) and caregivers' distress (P = .004) after the intervention. However, no effects were observed in terms of BPSD severity in PWD. No adverse events or falls were reported. CONCLUSION This multicomponent programme is feasible and safe for dementia caregivers and older people with mild-to-moderate dementia and knee OA. The programme has beneficial effects on caregiving self-efficacy and distress of dementia caregivers.
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Affiliation(s)
- Waiyan Law
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Timothy C Y Kwok
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Sha Tin, Hong Kong
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Rees J, Tuijt R, Burton A, Walters K, Cooper C. Supporting self-care of long-term conditions in people with dementia: A systematic review. Int J Nurs Stud 2019; 116:103432. [PMID: 32197788 DOI: 10.1016/j.ijnurstu.2019.103432] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 09/09/2019] [Accepted: 09/13/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Long-term conditions are common in people living with dementia; their self-management is an important determinant of wellbeing. Family carers often support or substitute self-care activities, and act as proxies for self-management, as dementia progresses. OBJECTIVES To conduct the first systematic review of how management of long-term conditions in people with dementia is best enabled and supported, including factors that facilitate or inhibit self-management and management by a proxy. DESIGN Systematic review. DATA SOURCES We systematically searched MEDLINE, PsychINFO, Embase and Allied and Complementary Medicine databases up to November 2018. REVIEW METHODS We identified the long-term conditions most prevalent in people with dementia that require an element of self-management. We then developed our inclusion criteria to identify qualitative and quantitative studies describing the self-management (or self-management assisted by family carers) of long-term conditions in people with dementia. Two authors independently rated study validity using a standardised checklist. We synthesised qualitative and quantitative findings using a data driven convergent synthesis approach. RESULTS We included 12 articles meeting predetermined inclusion criteria: seven qualitative, two case studies, two quantitative and one mixed methods study. We identified four main themes across these studies: (1) dementia symptoms impeding treatment regimens (forgetfulness, decreased understanding, ability to communicate symptoms and behavioural and psychological symptoms); (2) adapting routines to be simpler, (using memory aids and accommodating physical limitations); (3) negotiating self-management support (carer availability and knowledge; balancing needs for safety and empowerment); and (4) interface with professionals, (Routine simplification, condition specific education, and acknowledging carer role). CONCLUSIONS People living with dementia can be supported to manage their own health for as long as possible, through simplifying routines and reminding, but where this can no longer be negotiated, carers take over responsibility for self-management, often due to safety concerns. Empowerment of people with dementia to remain involved in their care reduces the loss experienced by this transition. Communication and partnership between clinicians and carers is critical when supporting people living with a long-term condition and dementia. Care planning for people living with dementia and a long-term condition should include explicit discussion of how these partnerships will work and guidance on strategies carers can use to support people to self-manage long-term conditions.
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Affiliation(s)
- Jessica Rees
- Division of Psychiatry, University College London, London, UK.
| | - Remco Tuijt
- Division of Psychiatry, University College London, London, UK
| | | | - Kate Walters
- Division of Psychiatry, University College London, London, UK
| | - Claudia Cooper
- Division of Psychiatry, University College London, London, UK
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Lim RH, Sharmeen T. Medicines management issues in dementia and coping strategies used by people living with dementia and family carers: A systematic review. Int J Geriatr Psychiatry 2018; 33:1562-1581. [PMID: 30270451 PMCID: PMC6282522 DOI: 10.1002/gps.4985] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 08/06/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Medicines play a key role in the lives of people with dementia, primarily to manage symptoms. Managing medicines is complex for people with dementia and their family carers and can result in multiple problems leading to harm. We conducted a systematic review to identify and model medication issues experienced and coping strategies used by people with dementia and/or family carers. METHODS Eleven general databases and four systematic review databases were searched. Studies were quality assessed using an established framework and thematically analysed. RESULTS Twenty-one articles were included in this study, and four domains affecting medication use were identified: cognitive, medication, social and cultural, and knowledge/educational and communication. People with dementia reported medication issues in all four domains, but few coping strategies were developed. Family carers reported issues and coping strategies related to the medication and knowledge/educational and communication domains. Common issues with regards to knowledge and communication about medicines remain unresolved. The "voices" of people with dementia appeared largely missing from the literature so were in-depth understanding of how, whether, and in which circumstances coping strategies work in managing medicines. CONCLUSIONS Medicines management is a complex set of activities and although current coping strategies exists, these were primarily used by family carers or the person with dementia-carer dyad. Health and social care practitioners and researchers should seek to understand in-depth the "mechanisms of action" of existing coping strategies and actively involve people with dementia as co-producers of knowledge to underpin any further work on medicines management.
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Affiliation(s)
- Rosemary H. Lim
- Reading School of PharmacyUniversity of ReadingReadingBerkshireUK
| | - Taniya Sharmeen
- Reading School of PharmacyUniversity of ReadingReadingBerkshireUK
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