Medicines Management by the Older-Aged Living Independently in Different Types of Retirement Villages

Pilot study, in a rental retirement village, of an "AdherenceCheck" on the management of medicines by the older-aged

Background The older-aged living in a low socioeconomic, rental, retirement village have a low adherence to medicines and a poor understanding of their illnesses. MedsChecks are commonly used in Australian pharmacies in an attempt to improve the management of medicines. There is no published evidence that MedsChecks, or similar brief/single, interventions improve the management of medicines in the older-aged. Objective The objective of our study was to determine the effect of an AdherenceCheck, which is similar to a MedsCheck, but is performed in the home of the older-aged, had on the ongoing management of medicines by the older-aged living independently. Both a MedsCheck and an AdherenceCheck involves forming an individual Action Plan. Setting Rental retirement village. Method After interviewing the older-aged in the village about their management of medicines, they were given an AdherenceCheck and an Action Plan. Six months later their management of medicines and the Action Plan were (re-)evaluated. Main outcome measure Present and ongoing adherence to medicines. Results Only 15 of the original 23 participants completed the study. The AdherenceCheck with Action Plan did not significantly change the adherence to medicines of these older-aged living in the rental retirement village. Pre- to post-AdherenceCheck, there was a reduction in the percentage of participants with a good knowledge of their illnesses, and thus a corresponding significant increase in the percentage with no knowledge of their illnesses, and this may have been age related. Only 11 of the 15 participants remembered receiving an Action Plan, as part of the AdherenceCheck, and 7 of these considered that the Action Plan helped them manage their medicines. Conclusion An AdherenceCheck may not improve the management of medicines by the older-aged living in a rental retirement village. As there are no peer-reviewed publications as to whether the commonly used MedsChecks, which have some similarities to the AdherenceCheck, improve the management of medicines, it is suggested that these MedsChecks should also be formally evaluated.

Ongoing poor management of medicines in the older-aged living independently in a rental retirement village

BACKGROUND

In a low socioeconomic status, small, rental retirement village, we have shown the older-aged managed their medicines poorly (Doggrell and Kairuz in J Pharm Pract Res 42:208-212, 2012).

OBJECTIVE

As the number of participants was only 25, and the population in the rental retirement village turns over regularly; our objective was to determine whether the findings were consistent and ongoing.

METHODS

We returned to the rental retirement villages after 1 and 2 years, and reassessed the management of medicines, using the same semi-structured interview method. Main outcome measure The perception of present and ongoing adherence.

RESULTS

Although similar numbers (23-25) participated in the studies in 2011-2013, the actual participants changed with only three being interviewed on three occasions. Nevertheless, the findings over the 3 years were similar: <50 % of the participants were adherent at the time of the study and unlikely to have problems in the next 6-12 months; only 50 % had a good knowledge of their illnesses.

CONCLUSION

The management of medicines by the older-aged living in a low socioeconomic, rental retirement village is poor, and this finding is ongoing and consistent. This supports the need for extra assistance and resources for the older-aged, living in rental retirement villages, to manage their medicines.

Comparative studies of how living circumstances influence medication adherence in ≥65 year olds

BACKGROUND

Resources to help the older aged (≥65 year olds) manage their medicines should probably target those in greatest need. The older-aged have many different types of living circumstances. There are different locations (urban, rural), different types of housing (in the community or in retirement villages), different living arrangements (living alone or with others), and different socioeconomic status (SES) circumstances. However, there has been limited attention to whether these living circumstances affect adherence to medicines in the ≥65 year olds.

AIM OF THE REVIEW

The aim was to determine whether comparative studies, including logistic regression studies, show that living circumstances affect adherence to medicines by the ≥65 year olds.

METHODS

A literature search of Medline, CINAHL and the Internet (Google) was undertaken.

RESULTS

Four comparative studies have not shown differences in adherence to medicines between the ≥65 year olds living in rural and urban locations, but one study shows lower adherence to medicines for osteoporosis in rural areas compared to metropolitan, and another study shows greater adherence to antihypertensive medicines in rural than urban areas. There are no comparative studies of adherence to medicines in the older-aged living in indigenous communities compared to other communities. There is conflicting evidence as to whether living alone, being unmarried, or having a low income/worth is associated with nonadherence. Preliminary studies have suggested that the older-aged living in rental, low SES retirement villages or leasehold, middle SES retirement villages have a lower adherence to medicines than those living in freehold, high SES retirement villages.

CONCLUSIONS

The ≥65 year olds living in rural communities may need extra help with adherence to medicines for osteoporosis. The ≥65 year olds living in rental or leasehold retirement villages may require extra assistance/resources to adhere to their medicines. Further research is needed to clarify whether living under certain living circumstances (e.g. living alone, being unmarried, low income) has an effect on adherence, and to determine whether the ≥65 year olds living in indigenous communities need assistance to be adherent to prescribed medicines.