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Wang J, Cheng Z, Li Y. Medication Management Difficulty, Medication Nonadherence, and Risk of Hospitalization Among Cognitively Impaired Older Americans: A Nationally Representative Study. J Appl Gerontol 2024:7334648241262940. [PMID: 39025781 DOI: 10.1177/07334648241262940] [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: 07/20/2024] Open
Abstract
Effective disease management in older adults relies on medication adherence to prevent adverse outcomes like hospitalization, particularly among those with cognitive impairment. In this study, we examined the impact of cognitive impairment on medication management, adherence, and hospitalization risk across levels of cognitive function. Analyzing data from 28,558 community-dwelling older adults, we found that those with dementia had the most difficulty managing medications (13.12%), followed by cognitive impairment without dementia (5.80%), and intact cognition (1.96%). Only persons with dementia showed a significant association between medication management difficulty and hospitalization risk (Odds Ratio [OR] = 1.71; 95% Confidence Intervals: 1.08, 2.70; p = .02). Cost-related medication nonadherence was associated with hospitalization risk solely among those with intact cognition (OR = 1.25; 95% CI: 1.07, 1.45; p = .004). Dementia was associated with higher odds of medication management difficulty and subsequently hospitalization risk, underscoring the need for resources to support medication use for this population.
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Affiliation(s)
- Jinjiao Wang
- Elaine Hubbard Center for Nursing Research on Aging, University of Rochester School of Nursing, Rochester, NY, USA
| | - Zijing Cheng
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Yue Li
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
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Shimazaki Y, Kishimoto K, Ishikawa J, Iwakiri R, Araki A, Imai S. Association between Cognitive Impairment Severity and Polypharmacy in Older Patients with Atrial Fibrillation: A Retrospective Study Using Inpatient Data from a Specialised Geriatric Hospital. Geriatrics (Basel) 2024; 9:15. [PMID: 38392102 PMCID: PMC10887641 DOI: 10.3390/geriatrics9010015] [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: 10/04/2023] [Revised: 12/19/2023] [Accepted: 01/17/2024] [Indexed: 02/24/2024] Open
Abstract
This study aimed to investigate the association between cognitive impairment and polypharmacy in patients with atrial fibrillation prone to cognitive decline, and to elucidate if the Dementia Assessment Sheet for Community-based Integrated Care System 21-Items (DASC-21) severity classification indicates drug adjustment. This retrospective cohort study used the DASC-21 and Diagnosis Procedure Combination data at a specialised geriatric hospital with patients hospitalised between April 2019 and March 2022. The association between cognitive severity evaluated using the DASC-21 and polypharmacy was investigated using a multivariate logistic regression model. Data of 1191 inpatients (44.3% aged ≥85 years, 49.0% male) were analysed. Compared with severe cognitive impairment, mild (odds ratio [OR]: 3.33, 95% confidence interval [CI]: 1.29-8.57) and moderate (OR: 2.46, 95% CI: 1.06-5.72) impairments were associated with concurrent use of ≥6 medications. Antithrombotics were related to polypharmacy. The ORs did not change with 6, 8, or 10 medications (2.11 [95% CI: 1.51-2.95, p < 0.001], 2.42 [95% CI: 1.79-3.27, p < 0.001], and 2.01 [95% CI: 1.46-2.77, p < 0.001], respectively). DASC-21 severity was associated with polypharmacy in patients with atrial fibrillation, with a trend toward decreased polypharmacy from moderate to severe. The DASC-21 may serve as an indicator for drug adjustment in clinical practice.
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Affiliation(s)
- Yoshitomo Shimazaki
- Division of Pharmacy, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo 173-0015, Japan
- Depertment of Pharmacoepidemiology, Showa University Graduate School of Pharmacy, 1-8-5, Hatanodai, Shinagawaku, Tokyo 142-8555, Japan
| | - Keiko Kishimoto
- Department of Social Pharmacy, Showa University Graduate School of Pharmacy, 1-8-5, Hatanodai, Shinagawaku, Tokyo 142-8555, Japan
| | - Joji Ishikawa
- Division of Cardiology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo 173-0015, Japan
| | - Rika Iwakiri
- Division of Elderly Care, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo 173-0015, Japan
| | - Atsushi Araki
- Frail Prevention Center, Training Center, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo 173-0015, Japan
| | - Shinobu Imai
- Depertment of Pharmacoepidemiology, Showa University Graduate School of Pharmacy, 1-8-5, Hatanodai, Shinagawaku, Tokyo 142-8555, Japan
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Wang K, Zhao J, Hu J, Liang D, Luo Y. Predicting unmet activities of daily living needs among the oldest old with disabilities in China: a machine learning approach. Front Public Health 2023; 11:1257818. [PMID: 37771828 PMCID: PMC10523409 DOI: 10.3389/fpubh.2023.1257818] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 08/29/2023] [Indexed: 09/30/2023] Open
Abstract
Background The ageing population in China has led to a significant increase in the number of older persons with disabilities. These individuals face substantial challenges in accessing adequate activities of daily living (ADL) assistance. Unmet ADL needs among this population can result in severe health consequences and strain an already burdened care system. This study aims to identify the factors influencing unmet ADL needs of the oldest old (those aged 80 and above) with disabilities using six machine learning methods. Methods Drawing from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) 2017-2018 data, we employed six machine learning methods to predict unmet ADL needs among the oldest old with disabilities. The predictive effects of various factors on unmet ADL needs were explored using Shapley Additive exPlanations (SHAP). Results The Random Forest model showed the highest prediction accuracy among the six machine learning methods tested. SHAP analysis based on the Random Forest model revealed that factors such as household registration, disability class, economic rank, self-rated health, caregiver willingness, perceived control, economic satisfaction, pension, educational attainment, financial support given to children, living arrangement, number of children, and primary caregiver played significant roles in the unmet ADL needs of the oldest old with disabilities. Conclusion Our study highlights the importance of socioeconomic factors (e.g., household registration and economic rank), health status (e.g., disability class and self-rated health), and caregiving relationship factors (e.g., caregiver willingness and perceived control) in reducing unmet ADL needs among the oldest old with disabilities in China. Government interventions aimed at bridging the urban-rural divide, targeting groups with deteriorating health status, and enhancing caregiver skills are essential for ensuring the well-being of this vulnerable population. These findings can inform policy decisions and interventions to better address the unmet ADL needs among the oldest old with disabilities.
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Affiliation(s)
- Kun Wang
- Zhongnan University of Economics and Law (School of Philosophy), Wuhan, Hubei, China
- Nankai University (Zhou Enlai School of Government), Tianjin, China
| | - Jinxu Zhao
- Zhongnan University of Economics and Law (School of Philosophy), Wuhan, Hubei, China
| | - Jie Hu
- Wuhan University (School of Physics and Technology), Wuhan, Hubei, China
| | - Dan Liang
- Tongji Medical College of Huazhong University of Science and Technology (School of Medicine and Health Management), Wuhan, Hubei, China
| | - Yansong Luo
- Zhongnan University of Economics and Law (School of Philosophy), Wuhan, Hubei, China
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Severe Periodontitis Increases the Risk of Oral Frailty: A Six-Year Follow-Up Study from Kashiwa Cohort Study. Geriatrics (Basel) 2023; 8:geriatrics8010025. [PMID: 36826367 PMCID: PMC9956982 DOI: 10.3390/geriatrics8010025] [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: 12/03/2022] [Revised: 01/18/2023] [Accepted: 02/09/2023] [Indexed: 02/15/2023] Open
Abstract
Oral frailty, overlapping a decline in multi-faceted oral functions and often seen in older adults, increases risks of adverse health outcomes, thereby necessitating earlier measures. Tooth loss, a major element of oral frailty, is mainly caused by periodontal disease and is an irreversible event. Therefore, this study aimed to clarify whether advanced periodontal disease increases the risks of "new-onset" oral frailty through a longitudinal analysis based on the 2012 baseline survey of the Kashiwa cohort and the follow-up assessments conducted in 2013, 2014, 2016, and 2018. The participants were disability-free, non-orally frail older adults living in Kashiwa City. Of the 1234 participants (72.2 ± 5.1 years old; 50.8% men) analyzed in this study, oral frailty occurred in 23.1% within the six-year period. The group with Community Periodontal Index (CPI) ≥ 3 at baseline had no significant difference in the risk of oral frailty compared with CPI ≤ 2; however, CPI4 at baseline was related to the increased risk of oral frailty compared with CPI ≤ 3 (an adjusted hazard ratio (95% confidence interval): 1.42 (1.12-1.81). Conclusively, severe periodontitis (CPI4) might be associated with new-onset oral frailty, suggesting that prevention of periodontal disease could contribute to oral frailty prevention.
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Rahman MM, Rosenberg M, Flores G, Parsell N, Akter S, Alam MA, Rahman MM, Edejer T. A systematic review and meta-analysis of unmet needs for healthcare and long-term care among older people. HEALTH ECONOMICS REVIEW 2022; 12:60. [PMID: 36482044 PMCID: PMC9733388 DOI: 10.1186/s13561-022-00398-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 09/19/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND The absolute number of older individuals needing medical care and long-term care (LTC) is increasing globally due to the growing ageing population. However, it is uncertain who and what proportion of the population has access to care. Therefore, a systematic review and meta-analysis of the prevalence and reasons for unmet needs for healthcare and long-term care among older people, 65 years old and above, across countries was conducted. METHODS An information specialist performed a comprehensive search of four major databases (PubMed, EMBASE, Web of Science, and CINAHL) from inception to June 2020 without restrictions on language and date. We did random-effects meta-analysis to obtain pooled prevalence. We stratified the meta-analysis by reasons for unmet need categorized by barrier dimension (availability, accessibility, affordability, and acceptability), survey year, geographic location, and socio-demographic characteristics of the older individual. RESULTS After screening 3912 articles, we included 101 studies published between 1996 and 2020. Of the 101 studies, 87 studies reported unmet healthcare needs and 14 studies reported unmet LTC needs. Overall, 10.4% (95% CI, 7.3-13.9) of the older population had unmet needs for healthcare. The common reasons for unmet healthcare needs were cost of treatment, lack of health facilities, lack of/conflicting time, health problem not viewed as serious, and mistrust/fear of provider. A significant variation in pooled prevalence of unmet healthcare needs due to cost was found by gender (male [10.9, 95% CI, 8.9-13.1] vs female [14.4, 95% CI, 11.8-17.3]), educational level (primary or less [13.3, 95% CI, 9.6-17.6] vs higher [7.5, 95% CI, 5.9-9.3]), self-reported health (poor [23.2, 95% CI, 18.8-27.8] vs good [4.4, 95% CI, 3.4-5.5]), insurance status (insured [9.0, 95% CI, 7.5-10.6] vs uninsured [27.7, 95% CI, 24.0-31.5]), and economic status of population (poorest [28.2, 95% CI, 14.1-44.9] vs richest [7.1, 95% CI, 3.8-11.3]). One in four (25.1, 95% CI, 17.1-34.2) older people had unmet needs in LTC. Rural residents had a higher prevalence of unmet needs in LTC compared to their urban counterparts. CONCLUSION With the population ageing globally, it is necessary to improve access to health care and LTC for older people. Ensuring affordability of health services, reducing geographical barriers, and improving acceptability, will be critical in reducing unmet need. Unmet needs for healthcare were concentrated in population with no education, poor economic group, outpatient health facility user, and uninsured group. With education and economic-based inequalities at the forefront, all countries should focus on improving access to health services by reducing the burden related to healthcare costs.
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Affiliation(s)
- Md Mizanur Rahman
- Hitotsubashi Institute for Advanced Study, Hitotsubashi University, Tokyo, Japan.
| | - Megumi Rosenberg
- Centre for Health Development, World Health Organization, Kobe, Japan
| | - Gabriela Flores
- Department of Health Systems Governance and Financing, World Health Organization, Geneva, Switzerland
| | - Nadia Parsell
- Hitotsubashi Institute for Advanced Study, Hitotsubashi University, Tokyo, Japan
| | - Shamima Akter
- Hitotsubashi Institute for Advanced Study, Hitotsubashi University, Tokyo, Japan
| | - Md Ashraful Alam
- Department of Computational Diagnostic Radiology and Preventive Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | | | - Tessa Edejer
- Department of Health Systems Governance and Financing, World Health Organization, Geneva, Switzerland
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Spiers GF, Kunonga TP, Stow D, Hall A, Kingston A, Williams O, Beyer F, Bower P, Craig D, Todd C, Hanratty B. Factors associated with unmet need for support to maintain independence in later life: a systematic review of quantitative and qualitative evidence. Age Ageing 2022; 51:6776175. [PMID: 36309974 PMCID: PMC9618284 DOI: 10.1093/ageing/afac228] [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: 05/26/2022] [Revised: 07/11/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND populations are considered to have an 'unmet need' when they could benefit from, but do not get, the necessary support. Policy efforts to achieve equitable access to long-term care require an understanding of patterns of unmet need. A systematic review was conducted to identify factors associated with unmet need for support to maintain independence in later life. METHODS seven bibliographic databases and four non-bibliographic evidence sources were searched. Quantitative observational studies and qualitative systematic reviews were included if they reported factors associated with unmet need for support to maintain independence in populations aged 50+, in high-income countries. No limits to publication date were imposed. Studies were quality assessed and a narrative synthesis used, supported by forest plots to visualise data. FINDINGS forty-three quantitative studies and 10 qualitative systematic reviews were included. Evidence across multiple studies suggests that being male, younger age, living alone, having lower levels of income, poor self-rated health, more functional limitations and greater severity of depression were linked to unmet need. Other factors that were reported in single studies were also identified. In the qualitative reviews, care eligibility criteria, the quality, adequacy and absence of care, and cultural and language barriers were implicated in unmet need. CONCLUSIONS this review identifies which groups of older people may be most at risk of not accessing the support they need to maintain independence. Ongoing monitoring of unmet need is critical to support policy efforts to achieve equal ageing and equitable access to care.
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Affiliation(s)
| | | | - Daniel Stow
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Alex Hall
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Andrew Kingston
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Oleta Williams
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Fiona Beyer
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Peter Bower
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Dawn Craig
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Chris Todd
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Barbara Hanratty
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Effects of a nurse-led medication self-management intervention on medication adherence and health outcomes in older people with multimorbidity: A randomised controlled trial. Int J Nurs Stud 2022; 134:104314. [DOI: 10.1016/j.ijnurstu.2022.104314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 06/14/2022] [Accepted: 06/16/2022] [Indexed: 11/27/2022]
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Patel T, McDougall A, Ivo J, Carducci J, Pritchard S, Chang F, Faisal S, Lee C. Development and Content Validation of an Instrument to Measure Medication Self-Management in Older Adults. PHARMACY 2021; 9:78. [PMID: 33920490 PMCID: PMC8167785 DOI: 10.3390/pharmacy9020078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/01/2021] [Accepted: 04/08/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND For older adults, the capacity to self-manage medications may be limited by several factors. However, currently available tools do not permit a comprehensive assessment of such limitations. The Domain Specific Limitation in Medication Management Capacity (DSL-MMC) was developed to address this need. This study aimed to establish the face and content validity of the DSL-MMC. METHODS The DSL-MMC tool consisted of 4 domains and 12 sub-domains with 42 items including: 1. physical abilities (vision, dexterity, hearing); 2. cognition (comprehension, memory, executive functioning); 3. medication regimen complexity (dosing regimen, non-oral administration, polypharmacy); and 4. access/caregiver (prescription refill, new prescription, caregiver). Pharmacists assessed each item for relevance, importance, readability, understandability, and representation. Items with content validity index (CVI) scores of <0.80 for relevance were examined for revision or removal. RESULTS Twelve pharmacists participated in the study. CVI scores for relevance and importance of domains were 1.0; of the sub-domains, two were below 0.80. Among the 42 items, 35 (83%) and 30 (71%) maintained CVI scores above 0.80 for relevance and importance, respectively. Five items were removed, three were merged and seven were modified due to low CVI scores and/or feedback. CONCLUSION The DSL-MMC has been validated for content.
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Affiliation(s)
- Tejal Patel
- School of Pharmacy, University of Waterloo, 10 Victorial St S., Kitchener, ON N2G 1C5, Canada; (J.I.); (F.C.); (S.F.)
- Centre for Family Medicine Family Health Team, 10 Victoria St S., Kitchener, ON N2G 1C5, Canada; (A.M.); (J.C.); (S.P.); (C.L.)
- Schlegel—University of Waterloo Research Institute of Aging, 250 Laurelwood Drive, Waterloo, ON N2J 0E2, Canada
| | - Aidan McDougall
- Centre for Family Medicine Family Health Team, 10 Victoria St S., Kitchener, ON N2G 1C5, Canada; (A.M.); (J.C.); (S.P.); (C.L.)
| | - Jessica Ivo
- School of Pharmacy, University of Waterloo, 10 Victorial St S., Kitchener, ON N2G 1C5, Canada; (J.I.); (F.C.); (S.F.)
| | - Jillian Carducci
- Centre for Family Medicine Family Health Team, 10 Victoria St S., Kitchener, ON N2G 1C5, Canada; (A.M.); (J.C.); (S.P.); (C.L.)
| | - Sarah Pritchard
- Centre for Family Medicine Family Health Team, 10 Victoria St S., Kitchener, ON N2G 1C5, Canada; (A.M.); (J.C.); (S.P.); (C.L.)
| | - Feng Chang
- School of Pharmacy, University of Waterloo, 10 Victorial St S., Kitchener, ON N2G 1C5, Canada; (J.I.); (F.C.); (S.F.)
| | - Sadaf Faisal
- School of Pharmacy, University of Waterloo, 10 Victorial St S., Kitchener, ON N2G 1C5, Canada; (J.I.); (F.C.); (S.F.)
| | - Catherine Lee
- Centre for Family Medicine Family Health Team, 10 Victoria St S., Kitchener, ON N2G 1C5, Canada; (A.M.); (J.C.); (S.P.); (C.L.)
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Training persons with early-stage Alzheimer’s disease how to use an electronic medication management device: development of an intervention protocol. BRAIN IMPAIR 2021. [DOI: 10.1017/brimp.2020.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractBackground/Objectives:Medication management is challenging for persons with Alzheimer’s disease (AD) and their caregivers. Electronic medication management devices (eMMDs) are specifically designed to support this task. However, theory-driven interventions for eMMD training with this population are rarely described. This study aimed to develop and assess the appropriateness of an intervention protocol to train persons with early-stage AD how to use an eMMD.Methods:Interviews with three categories of participants [persons with early-stage AD (n = 3), caregivers (n = 3), and clinicians (n = 3)] were conducted to understand medication management needs, perceived usefulness of an eMMD, and to explore training strategies. Subsequently, this knowledge was integrated in an intervention protocol which was validated with the three clinicians. A content analysis led to iterative modifications to maximize the acceptability and coherence of the intervention protocol in a homecare context.Results:The final intervention protocol specifies the expertise required to provide the training intervention and the target population, followed by an extensive presentation of eMMD features. Specific learning strategies tailored to the cognitive profile of persons with AD with step-by-step instructions for clinicians are included. Finally, it presents theoretical information on cognitive impairment in AD and how eMMDs can support them.Conclusions:This intervention protocol with its theoretical and pragmatic foundation is an important starting point to enable persons with early-stage AD to become active users of eMMDs. Next steps should evaluate the immediate and long-term impacts of its implementation on medication management in the daily lives of persons with AD and their caregivers.
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Wu D, Gao X, Xie Z, Xu Z. Understanding the Unmet Needs among Community-Dwelling Disabled Older People from a Linkage Perspective. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020389. [PMID: 33419143 PMCID: PMC7825496 DOI: 10.3390/ijerph18020389] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 12/23/2020] [Accepted: 12/30/2020] [Indexed: 11/16/2022]
Abstract
One of the challenges in response to population aging is to meet needs for elderly care among older people especially for those who want to age in their homes or communities. However, disabled older people have more challenges due to their restricted mobility to access care resources than non-disabled ones. We propose a new framework based on the changing relationship between older people and their environment, in which resource linkage in elderly care utilization is emphasized. We conducted a survey with 139 participants (i.e., older people age 60 years or over with different level of disabilities) in three types of neighborhoods in Beijing, China. By conducting a decision tree analysis under the Person-Environment Link (P-E Link) model, we (1) characterized unmet needs for elderly care (activities of daily living (ADL) and instrumental activities of daily living (IADL) assistance) among community-dwelling disabled older people; (2) found disabled older people had more unmet needs for both ADL and IADL assistance because of a lack in linkages to care resources than non-disabled ones; and (3) characterized the linkages to care resources for better supporting disabled older people to age in place, including family support, social connection, and spatial environment. Our findings help improve the Anderson behavioral model by characterizing enabling environments, which highlights that not only the availability of enabling resources but also linkages to these enabling resources play an important role in meeting needs for care among disabled older people. Our findings can also inform improvements in policy design that are targeted to reduce elderly care inequalities.
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Affiliation(s)
- Danxian Wu
- Key Laboratory of Regional Sustainable Development Modeling, Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing 100101, China
- University of Chinese Academy of Sciences, Beijing 100190, China;
- Correspondence: (D.W.); (X.G.); Tel.: +86-188-1098-1198 (D.W.); +86-136-1124-4369 (X.G.)
| | - Xiaolu Gao
- Key Laboratory of Regional Sustainable Development Modeling, Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing 100101, China
- University of Chinese Academy of Sciences, Beijing 100190, China;
- Correspondence: (D.W.); (X.G.); Tel.: +86-188-1098-1198 (D.W.); +86-136-1124-4369 (X.G.)
| | - Zhifei Xie
- University of Chinese Academy of Sciences, Beijing 100190, China;
- Institute for the History of Nature Science, Chinese Academy of Sciences, Beijing 100101, China
| | - Zening Xu
- China Institute for Urban Governance, Shanghai Jiao Tong University, Shanghai 200030, China;
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Indicators of an Integrated Home Care Model Shaped by the Needs of Patients Discharged from the Emergency Department. Int J Integr Care 2020; 20:16. [PMID: 33335458 PMCID: PMC7716787 DOI: 10.5334/ijic.5480] [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] [Indexed: 11/20/2022] Open
Abstract
Introduction: Developing community care models aims to satisfy the needs of patients’ in-home care comprehensively. This is crucial to decrease adverse events and prevent rehospitalization. Methods: A cross-sectional study was conducted among 200 emergency department patients (EDPs) and 200 general practice patients (GPPs). The modified version of the Camberwell Assessment of Need Short Appraisal Schedule (CANSAS), the Health Behavior Inventory (HBI), the Generalized Self-Efficacy Scale (GSES), the Patient Satisfaction Questionnaire (PSQ), and the Multidimensional Health Locus of Control Scale (MHLCS) were used. Results: The study indicated the higher level of unmet needs in EDPs than in the population of GPPs (p = 0.008). The unmet needs increased risk of hospitalization in both groups: OR = 0.28 [95%CI 0.15–0.52] for EDP and OR = 0.33, [95%CI 0.17–0.62] for GPPs groups. We also found a significant relationship between the low levels of needs satisfaction and social-demographic variables, including health profile and the level of health behavior, generalized self-efficacy, health locus of controls, and healthcare measures in general practice. Discussion and Conclusion: We suggest that the identified factors should be included into the integrated community care model to advance satisfaction of patients’ needs, especially in patients discharged from an emergency department.
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Bergmans RS, Mezuk B, Zivin K. Food Insecurity and Geriatric Hospitalization. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16132294. [PMID: 31261648 PMCID: PMC6651817 DOI: 10.3390/ijerph16132294] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 06/26/2019] [Accepted: 06/27/2019] [Indexed: 12/14/2022]
Abstract
Food insecurity (FI) has been associated with hospitalization, although the pathways underlying this relationship are poorly understood, in part due to the potential for a bidirectional relationship. This study aimed to determine associations of FI with concurrent and future hospitalization among older adults; mediation by depression and; whether hospitalization increased risk of FI. Participants came from the 2012 and 2014 waves of the Health and Retirement Study (HRS; n = 13,664). HRS is a prospective cohort representative of U.S. adults over the age of 50. Primary analyses included those who were not hospitalized in 2012 (n = 11,776). Not having enough money to buy necessary food or eating less than desired defined food insecurity. The Composite International Diagnostic Interview Short Form provided depression symptomology. Logistic and linear regression examined concurrent and longitudinal associations of FI in 2012 and 2014 with hospitalization in 2014. Path analysis tested mediation of FI with hospitalization frequency by depression symptomology. Finally, logistic regression examined whether hospitalization in 2012 was longitudinally associated with FI in 2014. FI was not associated with future hospitalization (odds ratio (OR) = 1.1; 95% confidence interval (CI) = 0.9–1.4), however; FI was associated with concurrent hospitalization status (OR = 1.4; 95% CI = 1.1–1.8). Depression symptomology explained 17.4% (95% CI = 2.8–32.0%) the association of FI with concurrent hospitalization frequency. Additionally, hospitalization was associated with becoming food insecure (OR = 1.5; 95% CI = 1.2–2.0). Findings may inform best practices for hospital discharge among older adults.
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Affiliation(s)
- Rachel S Bergmans
- Department of Psychiatry, Medical School, University of Michigan, Ann Arbor, MI 48109, USA.
| | - Briana Mezuk
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
| | - Kara Zivin
- Department of Psychiatry, Medical School, University of Michigan, Ann Arbor, MI 48109, USA
- Department of Veterans Affairs, Health Services Research and Development, Center for Clinical Management Research, Ann Arbor, MI 48109, USA
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Otsu Y, Kai M, Suematsu Y, Kiyomi F, Saku K, Kamimura H, Miura SI. Assessment of inter-rater agreement between physicians and their patients regarding medication adherence in a clinical questionnaire study. Medicine (Baltimore) 2019; 98:e15188. [PMID: 31045761 PMCID: PMC6504264 DOI: 10.1097/md.0000000000015188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 02/26/2019] [Accepted: 03/14/2019] [Indexed: 11/26/2022] Open
Abstract
While it is important to treat lifestyle-related diseases for the primary and secondary prevention of cardiovascular diseases, medication adherence is still poor. Although various causes of poor adherence have been reported, the differences between physicians and their patients regarding the recognition of medication adherence have not been well-investigated.We administered a questionnaire about medication adherence to 300 outpatients and their 23 cardiologists at the Department of Cardiology, Fukuoka University Hospital. The questionnaires for patients and physicians included acceptable total number of drug doses and dosing schedule, forgetting to take the medicine, and dose-reduction or -increase based on self-judgement. The patients were 70.6 ± 12.3 years old and 61.0% (n = 183) were male. Patients reported that it was acceptable to receive 0-5 doses twice daily. The patients were divided into two groups: an agreement group, in which physicians and their patients had the same answer to the question regarding forgetting medication (203 cases; 67.7%), and a disagreement group (97 cases; 32.3%). Overall, the inter-rater agreement between physicians and patients with regard to forgetting medication was significant, but slight (κ coefficient = 0.12). In a multivariate analysis, absence of hypertension [odds ratio (OR): 0.21, 95% confidence interval (CI): 0.09-0.50, P < .001), β-blocker usage (OR: 1.86, 95% CI: 1.11-3.12, P = .02), and biguanide usage (OR: 4.04, 95% CI: 1.43-11.41, P = .01) were independent predictors of disagreement with regard to forgetting medication.The inter-rater agreement between physicians and patients with regard to medication adherence was slight. An increase in inter-rater agreement should improve medication adherence.
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Affiliation(s)
- Yuki Otsu
- Department of Clinical Pharmacology, Faculty of Pharmaceutical Sciences
- Division of Pharmacy
| | - Mamiko Kai
- Department of Clinical Pharmacology, Faculty of Pharmaceutical Sciences
| | | | - Fumiaki Kiyomi
- Academia, Industry and Government Collaborative Research Institute of Translational Medicine for Life Innovation, Fukuoka University, Fukuoka, Japan
| | | | - Hidetoshi Kamimura
- Department of Clinical Pharmacology, Faculty of Pharmaceutical Sciences
- Division of Pharmacy
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Herity LB, Upchurch G, Schenck AP. Senior PharmAssist: Less Hospital Use with Enrollment in an Innovative Community-Based Program. J Am Geriatr Soc 2018; 66:2394-2400. [PMID: 30306540 DOI: 10.1111/jgs.15617] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 08/20/2018] [Accepted: 08/21/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To evaluate changes in acute health services use of Senior PharmAssist participants. DESIGN Retrospective analysis. SETTING Community-based, nonprofit program in Durham County, North Carolina. PARTICIPANTS Adults aged 60 and older with income of 200% of the federal poverty level or less who enrolled in the Senior PharmAssist program (N = 191) between August 1, 2011, and March 15, 2017. INTERVENTION Medication therapy management (MTM), customized community referrals, Medicare insurance counseling, and medication copayment assistance provided by Senior PharmAssist. MEASUREMENTS Primary outcomes were self-reported emergency department (ED) visits and hospital admissions in the previous year, assessed at baseline and every 6 months for up to 2 years. RESULTS Mean number of ED visits declined over time (0.83 visits per year at baseline to 0.53 visits per year at 24 months, P = .002), as did the percentage of participants reporting an ED visit in the past year (49% at baseline to 31% at 24 months, P = .003). Mean hospital admissions also decreased (0.56 admissions per year at baseline to 0.4 admissions per year at 24 months, P = .02). There was no significant change in percentage of participants reporting a hospital admission in the past year (33% at baseline to 25% at 24 months, P = .23). CONCLUSION Older adults who enrolled in a community-based program that helps them manage medications, connect with community resources, and overcome barriers to medication access experienced reductions in acute health services use. J Am Geriatr Soc 66:2394-2400, 2018.
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Affiliation(s)
- Leah B Herity
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina.,Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina.,Virginia Commonwealth University Health System, Richmond, Virginia
| | - Gina Upchurch
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina.,Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina.,Geriatric Workforce Enhancement Program, Duke University, Durham, North Carolina.,Senior PharmAssist, Durham, North Carolina
| | - Anna P Schenck
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
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15
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Chen S, Zheng J, Chen C, Xing Y, Cui Y, Ding Y, Li X. Unmet needs of activities of daily living among a community-based sample of disabled elderly people in Eastern China: a cross-sectional study. BMC Geriatr 2018; 18:160. [PMID: 29996778 PMCID: PMC6042452 DOI: 10.1186/s12877-018-0856-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 07/02/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND China has the largest population of partially or completely disabled elderly people in the world. Although the disabled elderly people try to remain independent in their lives, many still need assistance from others. Failure to obtain sufficient assistance creates a situation of unmet need. Unmet needs of activities of daily living (ADL) for disabled elderly people pose significant risks for hospitalization and mortality and cause an increased economic burden on families and society. This study aimed to identify the prevalence and risk factors of unmet needs among the disabled elderly in China to guide government toward corrective action. METHODS A total of 303 older adults from 15 communities in Nanjing, China were recruited. The Barthel Index (BI) and Functional Activities Questionnaire (FAQ) were used to screen disabled elderly people from the communities. These disabled elderly participants were then investigated in terms of their unmet ADL needs, using an unmet needs assessment form, which had been adapted from the BI and FAQ. Additionally, the Zarit Burden Interview and Family Caregiver Task Inventory were used to survey the main caregivers. Finally, univariate analysis was first used to filter out candidate impact factors, and then, binary logistic regression analysis was used to adjust for cofounders and determine reliable risk factors. RESULTS A total of 93.1% of the disabled elderly people in our study reported at least one unmet need. The prevalence of unmet needs for different ADL tasks ranged from 4.6 to 77.2%. The unmet needs with the highest percentages were using vehicles (77.2%), using stairs (73.1%), working on a hobby (72.1%), social interaction (62.6%) and ambulating (60.1%). The factors influencing unmet needs were related to the degree of disability in instrumental activities of daily living (IADL) (OR = 1.079, p ≤ 0.01), the relationship with caregivers (OR = 1.429, p ≤ 0.05) and the monthly income of caregivers (OR = 0.679, p ≤ 0.05). CONCLUSION Disabled elderly people living in communities had a high percentage of unmet needs for activities of daily life that required going outside the bedroom and involved spiritual aspects. Unmet needs increased with worsening disability status in IADL, more distanced relationships with caregivers and lower incomes of caregivers. Both government and caregivers should take more action to prevent or reduce unmet needs among the elderly.
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Affiliation(s)
- Shen Chen
- School of Nursing, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Nanjing, 211166, People's Republic of China
| | - Jing Zheng
- School of Nursing, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Nanjing, 211166, People's Republic of China
| | - Chen Chen
- School of Nursing, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Nanjing, 211166, People's Republic of China
| | - Ying Xing
- School of Nursing, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Nanjing, 211166, People's Republic of China
| | - Yan Cui
- School of Nursing, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Nanjing, 211166, People's Republic of China.
| | - Yaping Ding
- School of Nursing, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Nanjing, 211166, People's Republic of China
| | - Xiuyun Li
- Nanjing Health Service Center of Mofan West Road, No.3 Dinghuaimen, Nanjing, 210013, China
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Naruse T, Fujisaki-Sakai M, Nagata S. Home Visiting Nurse Service Duration and Factors Related to Institution Admission. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2017. [DOI: 10.1177/1084822316672246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
To empirically measure the quality of home visiting nursing (HVN) agencies in Japan, we longitudinally observed the duration of clients’ HVN use and identified the factors correlated with hospitalization/institutionalization. Medical and long-term care insurance data were analyzed from 1,722 persons with disabilities aged at least 75 years who began using an HVN. At the 12-month follow-up, 67.7% of clients were no longer using the HVN; among these, 48.9% were hospitalized/institutionalized and 23.6% had died. Cox regression analysis showed that risk of hospitalization/institutionalization in HVN agencies depends on client characteristics at service commencement. Measuring the quality of HVN agencies by weighting clients’ characteristics as risk factors for hospitalization and/or institutionalization may be appropriate.
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17
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Elliott RA, Goeman D, Beanland C, Koch S. Ability of older people with dementia or cognitive impairment to manage medicine regimens: a narrative review. ACTA ACUST UNITED AC 2016; 10:213-21. [PMID: 26265487 PMCID: PMC5396255 DOI: 10.2174/1574884710666150812141525] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 08/07/2011] [Indexed: 12/12/2022]
Abstract
Impaired cognition has a significant impact on a person’s ability to manage their medicines. The aim of this paper is to provide a narrative review of contemporary literature on medicines management by people with dementia or cognitive impairment living in the community, methods for assessing their capacity to safely manage medicines, and strategies for supporting independent medicines management. Studies and reviews addressing medicines management by people with dementia or cognitive impairment published between 2003 and 2013 were identified via searches of Medline and other databases. The literature indicates that as cognitive impairment progresses, the ability to plan, organise, and execute medicine management tasks is impaired, leading to increased risk of unintentional non-adherence, medication errors, preventable medication-related hospital admissions and dependence on family carers or community nursing services to assist with medicines management. Impaired functional capacity may not be detected by health professionals in routine clinical encounters. Assessment of patients’ (or carers’) ability to safely manage medicines is not undertaken routinely, and when it is there is variability in the methods used. Self-report and informant report may be helpful, but can be unreliable or prone to bias. Measures of cognitive function are useful, but may lack sensitivity and specificity. Direct observation, using a structured, standardised performance-based tool, may help to determine whether a person is able to manage their medicines and identify barriers to adherence such as inability to open medicine packaging. A range of strategies have been used to support independent medicines management in people with cognitive impairment, but there is little high-quality research underpinning these strategies. Further studies are needed to develop and evaluate approaches to facilitate safe medicines management by older people with cognitive impairment and their carers.
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Affiliation(s)
| | - Dianne Goeman
- Royal District Nursing Service, 31 Alma Rd, St Kilda, Victoria 3182, Australia.
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18
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Anderson RE, Birge SJ. Cognitive Dysfunction, Medication Management, and the Risk of Readmission in Hospital Inpatients. J Am Geriatr Soc 2016; 64:1464-8. [PMID: 27305636 DOI: 10.1111/jgs.14200] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To determine whether cognitive dysfunction, in particular impaired executive function, may be a risk factor for early readmission in older adults independently managing their medications. DESIGN Prospective observational study. SETTING Tertiary hospital. PARTICIPANTS Individuals aged 65 years and older discharged to home from the medicine service of a tertiary hospital (N = 452). MEASUREMENTS Participants underwent a cognitive assessment including the Short Blessed Test (SBT), the executive function component of the Montreal Cognitive Assessment, and the Trail-Making Test Part B (TMT-B). Hospital use and demographic data were obtained. A logistic regression model was used to fit the likelihood of readmission on the basis of participant characteristics, medication management, and cognitive performance. Likelihood of hospital readmission within 30 days was determined. RESULTS For participants managing medications themselves, adjusted 30-day odds of readmission increased 13% on average with each point decrease in SBT score (P = .003) and 9% on average with each 0.01 decrease in TMT-B score (P = .02). For participants who were independent in medication management with more than seven medications, the odds of 30-day readmission increased 16% on average with each point decrease in SBT score (P = .01) and 15% on average with each 0.01 decrease in TMT-B score (P = .03). CONCLUSION Cognitive dysfunction, particularly executive dysfunction, is a risk factor for readmission in individuals managing their own medications. This risk is greater in individuals taking more than seven medications. The interaction of cognitive function, medication management, and number of medications may enhance risk-stratification efforts to identify individuals at risk of early readmission.
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Affiliation(s)
- Ryan E Anderson
- Division of Geriatrics and Nutritional Science, Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri.,Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Stanley J Birge
- Division of Geriatrics and Nutritional Science, Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri
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Whaley C, Reed M, Hsu J, Fung V. Functional Limitations, Medication Support, and Responses to Drug Costs among Medicare Beneficiaries. PLoS One 2015; 10:e0144236. [PMID: 26642195 PMCID: PMC4671661 DOI: 10.1371/journal.pone.0144236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 11/16/2015] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Standard Medicare Part D prescription drug benefits include substantial and complex cost-sharing. Many beneficiaries also have functional limitations that could affect self-care capabilities, including managing medications, but also have varying levels of social support to help with these activities. We examined the associations between drug cost responses, functional limitations, and social support. DATA SOURCES AND STUDY SETTING We conducted telephone interviews in a stratified random sample of community-dwelling Medicare Advantage beneficiaries (N = 1,201, response rate = 70.0%). Participants reported their functional status (i.e., difficulty with activities of daily living) and social support (i.e., receiving help with medications). Drug cost responses included cost-reducing behaviors, cost-related non-adherence, and financial stress. STUDY DESIGN We used multivariate logistic regression to assess associations among functional status, help with medications, and drug cost responses, adjusting for patient characteristics. PRINCIPAL FINDINGS Respondents with multiple limitations who did not receive help with their medications were more likely to report cost-related non-adherence (OR = 3.2, 95% CI: 1.2-8.5) and financial stress (OR = 2.4, 95% CI: 1.3-4.5) compared to subjects with fewer limitations and no help; however, those with multiple limitations and with medication help had similar odds of unfavorable cost responses as those with fewer limitations. CONCLUSION The majority of beneficiaries with functional limitations did not receive help with medications. Support with medication management for beneficiaries who have functional limitations could improve adherence and outcomes.
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Affiliation(s)
- Christopher Whaley
- School of Public Health, U.C. Berkeley, University of California, Berkeley, CA, United States of America
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States of America
- * E-mail:
| | - Mary Reed
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States of America
| | - John Hsu
- Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA, United States of America
- Department of Medicine Harvard Medical School, Boston, MA, United States of America
- Department of Health Care Policy, Department of Health Care Policy, Boston, MA, United States of America
| | - Vicki Fung
- Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA, United States of America
- Department of Medicine Harvard Medical School, Boston, MA, United States of America
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Olson CH, Dey S, Kumar V, Monsen KA, Westra BL. Clustering of elderly patient subgroups to identify medication-related readmission risks. Int J Med Inform 2015; 85:43-52. [PMID: 26526277 DOI: 10.1016/j.ijmedinf.2015.10.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 09/03/2015] [Accepted: 10/15/2015] [Indexed: 10/22/2022]
Abstract
INTRODUCTION High Risk Medication Regimen (HRMR) scores are weakly predictive of hospital readmissions for elderly home health care patients. HRMR is composed of three elements related to drug risks: polypharmacy (number of medications); Potentially Inappropriate Medications (PIM) known to be harmful to the elderly; and the Medication Regimen Complexity Index (MRCI) that weighs drugs by the complexity of their dosing and instructions. In this paper, we hypothesized that HRMR scores are more predictive for demographic subgroups of elderly patients. The study used Outcome and Assessment Information Set (OASIS) variables to identify subgroups of patients for whom the HRMR measures appeared more predictive for hospital readmissions. METHODS OASIS and medication data were reused from a study of 911 patients (355 males, 556 females; mean age 78.9) from 15 Medicare-certified home health care agencies that established the relationship between HRMR and hospital readmissions. Hierarchical agglomerative clustering using the Jaccard distance measure and average-link method identified patient subgroups based on the OASIS data. Receiver operating curve (ROC) analyses evaluated the predictive strength of the HRMR variables for each subgroup. Additional False Discovery Rate (FDR) analyses assessed whether the clustered relationships were chance. RESULTS Clustering of OASIS data for 911 patients identified six subgroups: patients with Good Functional Status (n=382); Females with Moderate to Severe Pain (n=354); patients with poor prognosis needing functional status assistance (n=419); patients with Poor Functional Status (n=287); Males with Adult Children as Caregiver (n=198); adults living alone with spouses as primary caregiver (n=127). ROC results relating these subgroups to HRMR risks were strongest for Males with Adult Children as Caregivers (AUC: polypharmacy, 0.73; PIM, 0.64; MRCI, 0.77). The findings for this subgroup also met the FDR analysis threshold (<=0.20). CONCLUSIONS A risk of medication-related readmissions in elderly men with adult children as caregivers is consistent with research showing problems in medication adherence when seniors are supported by informal caregivers. The results from clustering analysis present a hypothesis for research on HRMR and on the relationship between adult caregivers and their fathers.
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Affiliation(s)
- Catherine H Olson
- Health Informatics, University of Minnesota, 330 Diehl Hall, 505 Essex Street SE Minneapolis, MN 55455, United States.
| | - Sanjoy Dey
- Research Assistant, Computer Science and Engineering University of Minnesota Minneapolis, MN, United States.
| | - Vipin Kumar
- Department Head, Computer Science and Engineering University of Minnesota Minneapolis, MN, United States.
| | - Karen A Monsen
- School of Nursing University of Minnesota Minneapolis, MN, United States.
| | - Bonnie L Westra
- School of Nursing University of Minnesota Minneapolis, MN, United States.
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Nagata S, Ogawa K, Taguchi A, Naruse T, Murashima S, Magilvy JK. Promoting the Use of Visiting Nurse Services for Patients Discharged From Hospital. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2015. [DOI: 10.1177/1084822314547960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A project to encourage the adequate use of visiting nurse services (VNS) after discharge was conducted by “K” City, Japan. Eligible individuals were inpatients of general hospital ready for discharge and assessed as potentially needing VNS, and their out-of-pocket fees for VNS within 1 month following discharge were covered by the city. To clarify this project’s effect, patient/family’s intention to use VNS and the utilization of VNS at each time point were evaluated. Eighty-eight residents used the project. Before initial hospitalization, less than one quarter of users had recognized the necessity of VNS. Many participants (88.6%) continued to use VNS even after the completion of the project period despite having to cover the VNS cost by themselves, indicating that this project had a positive impact on appropriate VNS use.
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Affiliation(s)
| | - Kaoru Ogawa
- Kusatsu Community Comprehensive Support Center, Japan
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22
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Elliott RA, Marriott JL. Review of Instruments used in Clinical Practice to Assess Patients' Ability to Manage Medications. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2015. [DOI: 10.1002/j.2055-2335.2010.tb00723.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Rohan A Elliott
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences; Monash University; Parkville Victoria
| | - Jennifer L Marriott
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences; Monash University; Parkville Victoria
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Nagata S, Taguchi A, Naruse T, Kuwahara Y, Murashima S. Unmet needs for visiting nurse services among older people after hospital discharge and related factors in Japan: Cross-sectional survey. Jpn J Nurs Sci 2013; 10:242-54. [DOI: 10.1111/jjns.12012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Accepted: 01/21/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Satoko Nagata
- Department of Community Health Nursing; Graduate School of Medicine; The University of Tokyo; Tokyo Japan
| | | | - Takashi Naruse
- Department of Community Health Nursing; Graduate School of Medicine; The University of Tokyo; Tokyo Japan
| | - Yuki Kuwahara
- Department of Community Health Nursing; Graduate School of Medicine; The University of Tokyo; Tokyo Japan
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Mager DR, Morrissey Ross M. Medication Management at Home: Enhancing Nurse's Skills and Improving Patient Satisfaction—A Longitudinal Study. J Community Health Nurs 2013; 30:63-71. [DOI: 10.1080/07370016.2013.778720] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Lee VWY, Pang KKW, Hui KC, Kwok JCK, Leung SL, Yu DSF, Lee DTF. Medication adherence: Is it a hidden drug-related problem in hidden elderly? Geriatr Gerontol Int 2013; 13:978-85. [DOI: 10.1111/ggi.12042] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2012] [Indexed: 11/29/2022]
Affiliation(s)
- Vivian WY Lee
- School of Pharmacy; Faculty of Medicine; The Chinese University of Hong Kong; Hong Kong
| | - Kathy KW Pang
- School of Pharmacy; Faculty of Medicine; The Chinese University of Hong Kong; Hong Kong
| | - Ka Chun Hui
- School of Pharmacy; Faculty of Medicine; The Chinese University of Hong Kong; Hong Kong
| | - Jennifer CK Kwok
- School of Pharmacy; Faculty of Medicine; The Chinese University of Hong Kong; Hong Kong
| | - Siu Ling Leung
- School of Pharmacy; Faculty of Medicine; The Chinese University of Hong Kong; Hong Kong
| | - Doris Sau Fung Yu
- The Nethersole School of Nursing; Faculty of Medicine; The Chinese University of Hong Kong; Hong Kong
| | - Diana Tze Fan Lee
- The Nethersole School of Nursing; Faculty of Medicine; The Chinese University of Hong Kong; Hong Kong
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Kuzuya M. [Prescribing for older people--Concerns about underuse of drug and inadequate medication assistance]. Nihon Ronen Igakkai Zasshi 2013; 50:494-497. [PMID: 24047662 DOI: 10.3143/geriatrics.50.494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Thiruchselvam T, Naglie G, Moineddin R, Charles J, Orlando L, Jaglal S, Snow W, Tierney MC. Risk factors for medication nonadherence in older adults with cognitive impairment who live alone. Int J Geriatr Psychiatry 2012; 27:1275-82. [PMID: 22337284 DOI: 10.1002/gps.3778] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Accepted: 01/09/2012] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The aim of this study was to prospectively examine the influence of cognitive, medical, behavioral, and social risk factors on medication nonadherence in community-dwelling older adults with cognitive impairment. METHODS A sample of 339 elderly participants with cognitive impairment, who lived alone and took at least one medication, underwent baseline assessment which included the five subscales of the Dementia Rating Scale (DRS), number of medications, retrospective medication nonadherence, amount of formal and informal assistance, functional impairment, depression, perception of social resources, comorbidity, and alcohol consumption. The outcome was medication nonadherence during the 12-month prospective period as reported by the participants' primary care physicians and caregivers at three-month intervals. RESULTS Fifty-nine participants (17.4%) had, at least, one report of medication nonadherence. Logistic regression analyses indicated for every point increase on the DRS Conceptualization subscale (OR = 1.14; 95% CI = 1.02-1.27), there was a 14% increase in the odds of nonadherence. For every point increase on the DRS Memory subscale (OR = 0.89; 95% CI = 0.81-0.97) and DRS Initiation/Perseveration subscale (OR = 0.93; 95% CI = 0.87-1.00), there was an 11% decrease and 7% decrease in the odds, respectively. Having at least one previous occurrence of medication nonadherence (OR = 2.61; 95% CI = 1.18-5.62) and taking at least four medications (OR = 2.58; 95% CI = 1.31-5.29), both increased the odds by over 2.5-fold. CONCLUSIONS Our unique finding that better conceptualization predicted nonadherence has important implications for healthcare providers' approaches to improve adherence in older adults with cognitive impairment. Replication in future studies is warranted.
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Monsen KA, Swanberg HL, Oancea SC, Westra BL. Exploring the value of clinical data standards to predict hospitalization of home care patients. Appl Clin Inform 2012; 3:419-36. [PMID: 23646088 DOI: 10.4338/aci-2012-05-ra-0016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2012] [Accepted: 11/09/2012] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND There is a critical need to reduce hospitalizations for Medicare patients and electronic health record (EHR) home care data provide new opportunities to evaluate risk of hospitalization for patients. OBJECTIVES The objectives of this study were to 1) develop a measure to predict risk of hospitalization among home care patients, the Hospitalization Risk Score (HRS), and 2) compare it with an existing severity of illness measure, the Charlson Index of Comorbidity (CIC). METHODS A convenience sample of clinical data from 14 home care agencies' EHRs, representing 1,643 home care patient episodes was used for the study. The development of the HRS was based on review of the literature, and expert panel evaluation to construct the HRS. Descriptive statistics and generalized linear models were used for comparative analysis; areas under curve (AUC) values were compared for receiver operating curves (ROC), and cut points predicting hospitalization were evaluated. RESULTS The HRS for this sample ranged from 0 to 5.6, with a median of 1.25. The CIC for this sample ranged from 0 to 9 and with a median of 0. Nearly three fourths of the sample was hospitalized at an HRS of 2, and a CIC of 1. AUC values for ROC were 0.63 for HRS and 0.59 for the CIC. The ROC curves were significantly different (t = -7.59, p <0.003). CONCLUSIONS This preliminary study demonstrates the potential value of the HRS using Omaha System EHR data. There was a statistically significant difference for predicting hospitalization of home care patients with the HRS versus the CIC; however the AUC values for both were low. Continued research is needed to further refine the HRS, determine whether it is more sensitive for particular subgroups of patients, and combine it with additional risk factors in understanding rehospitalization.
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Guiding principles for the care of older adults with multimorbidity: an approach for clinicians: American Geriatrics Society Expert Panel on the Care of Older Adults with Multimorbidity. J Am Geriatr Soc 2012; 60:E1-E25. [PMID: 22994865 DOI: 10.1111/j.1532-5415.2012.04188.x] [Citation(s) in RCA: 452] [Impact Index Per Article: 37.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Depalma G, Xu H, Covinsky KE, Craig BA, Stallard E, Thomas J, Sands LP. Hospital readmission among older adults who return home with unmet need for ADL disability. THE GERONTOLOGIST 2012; 53:454-61. [PMID: 22859438 DOI: 10.1093/geront/gns103] [Citation(s) in RCA: 116] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
PURPOSE This study determined whether returning to the community from a recent hospitalization with unmet activities of daily living (ADL) need was associated with probability of readmission. METHODS A total of 584 respondents to the 1994, 1999, and/or 2004 National Long-Term Care Surveys (NLTCS) who were hospitalized within 90 days prior to the interview and reported ADL disability at the time of the interview were considered for analysis. Medicare claims linked to the NLTCS provided information about hospital episodes, so those enrolled in Health Maintenance Organizations or Veterans Affairs Medical Centers were not included (n = 62), resulting in a total sample size of 522. ADL disability was defined as needing human help or equipment to complete the task. Unmet ADL need was defined as receiving inadequate or no help for one or more ADL disabilities. Disability that began within 90 days of the interview was considered new disability. RESULTS After adjusting for demographic, health, and functioning characteristics, unmet ADL need was associated with increased risk for hospital readmission (HR: 1.37, 95% CI: 1.03-1.82). Risk of readmission was greater for those with unmet need for new disabilities than those with unmet need for disabilities that were present before the index hospitalization (HR: 1.66, 95% CI: 1.01-2.73). IMPLICATIONS Many older patients are discharged from the hospital with ADL disability. Those who report unmet need for new ADL disabilities after they return home from the hospital are particularly vulnerable to readmission. Patients' functional needs after discharge should be carefully evaluated and addressed.
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Affiliation(s)
- Glen Depalma
- Department of Statistics, Purdue University, West Lafayette, Indiana 47907-2069, USA
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Quail JM, Wolfson C, Lippman A. Unmet need and psychological distress predict emergency department visits in community-dwelling elderly women: a prospective cohort study. BMC Geriatr 2011; 11:86. [PMID: 22182515 PMCID: PMC3297513 DOI: 10.1186/1471-2318-11-86] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Accepted: 12/19/2011] [Indexed: 12/03/2022] Open
Abstract
Background Unmet need to perform activities of daily living (ADL) is associated with increased use of urgent health services by the elderly. However, the reported associations may be confounded by psychological distress. We examine the independent effects of unmet need and psychological distress upon emergency department (ED) visits. Methods We conducted a prospective study of randomly selected community-dwelling adults aged ≥ 75. We report here the results for women only (n = 530). In-person interviews collected data on self-reported unmet need and the 14-item l'Indice de détresse psychologique de Santé Québec psychological distress scale. ED visits were identified from an administrative database. Multivariable logistic regression was used to identify predictors of any ED visit in the 6 months following the baseline interview. Results In multivariable analysis, unmet need in instrumental ADL was associated with subsequent ED visits (odds ratio = 1.57, 95% confidence interval = 1.02-2.41), as was psychological distress (odds rate = 1.30, 95% confidence interval = 1.02-1.67). The magnitude of the association between unmet need and ED visits was overestimated in statistical models that did not adjust for psychological distress. Conclusions Both unmet need and psychological distress were independent predictors of ED visits. Future investigations of unmet need and health services utilization should include psychological distress to control for confounding and improve the internal validity of statistical models.
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Affiliation(s)
- Jacqueline M Quail
- Department of Epidemiology and Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.
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Gallagher R, Warwick M, Chenoweth L, Stein-Parbury J, Milton-Wildey K. Medication knowledge, adherence and predictors among people with heart failure and chronic obstructive pulmonary disease. ACTA ACUST UNITED AC 2011. [DOI: 10.1111/j.1752-9824.2010.01077.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Naruse T, Nagata S, Taguchi A, Murashima S. Classification Tree Model Identifies Home-based Service Needs of Japanese Long-term Care Insurance Consumers. Public Health Nurs 2011; 28:223-32. [DOI: 10.1111/j.1525-1446.2010.00915.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Kuzuya M, Enoki H, Izawa S, Hasegawa J, Suzuki Y, Iguchi A. FACTORS ASSOCIATED WITH NONADHERENCE TO MEDICATION IN COMMUNITY-DWELLING DISABLED OLDER ADULTS IN JAPAN. J Am Geriatr Soc 2010; 58:1007-9. [DOI: 10.1111/j.1532-5415.2010.02837.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Kuzuya M, Hasegawa J, Hirakawa Y, Enoki H, Izawa S, Hirose T, Iguchi A. Impact of informal care levels on discontinuation of living at home in community-dwelling dependent elderly using various community-based services. Arch Gerontol Geriatr 2010; 52:127-32. [PMID: 20346524 DOI: 10.1016/j.archger.2010.02.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2009] [Revised: 02/19/2010] [Accepted: 02/25/2010] [Indexed: 10/19/2022]
Abstract
The aim of the study was to examine the effect of informal care levels on overall discontinuation of living at home, all-cause death, hospital admission, and long-term care placement for community-dwelling older people using various community-based services during a 3-year period. Prospective cohort study of 1582 community-dwelling disabled elderly and paired informal caregivers was conducted. Baseline data included the recipients and caregivers' demographic characteristics, comorbidities, informal care levels (sufficient, moderate, and insufficient care), which were evaluated by trained visiting nurses, and the level of formal community-based service use. Among 1582 participants, 97 died at home, 692 were admitted to hospitals, 318 died during their hospital stay, and 117 were institutionalized in long-term care facilities during 3 years of follow-up. A multivariate Cox hazard model demonstrated that when compared with a sufficient informal care level, an insufficient informal care level was associated with overall discontinuation of living at home, all-cause mortality, hospitalization, and institutionalization during 3 years of follow-up (hazard ratio: 1.65, 95% confidence interval: 1.15-2.36; 1.98, 1.17-3.34; 1.56, 1.04-2.35; 2.93, 1.25-6.86, respectively). The results suggested that informal caregiving is an important factor in the prevention of overall discontinuation of living at home in a population of disabled older people.
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Affiliation(s)
- Masafumi Kuzuya
- Department of Geriatrics, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya 466-8550, Japan.
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Xu H, Weiner M, Paul S, Thomas J, Craig B, Rosenman M, Doebbeling CC, Sands LP. Volume of Home- and Community-Based Medicaid Waiver Services and Risk of Hospital Admissions. J Am Geriatr Soc 2009; 58:109-15. [PMID: 20002513 DOI: 10.1111/j.1532-5415.2009.02614.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Huiping Xu
- Department of Mathematics and Statistics, Mississippi State University, Mississippi State, Mississippi, USA
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Elliott RA, Marriott JL. Standardised assessment of patients' capacity to manage medications: a systematic review of published instruments. BMC Geriatr 2009; 9:27. [PMID: 19594913 PMCID: PMC2719637 DOI: 10.1186/1471-2318-9-27] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2008] [Accepted: 07/13/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Older people are commonly prescribed complex multi-drug regimens while also experiencing declines in the cognitive and physical abilities required for medication management, leading to increased risk of medication errors and need for assisted living. The purpose of this study was to review published instruments designed to assess patients' capacity to self-administer medications. METHODS Searches of Medline, EMBASE, CINAHL, PsycINFO, International Pharmaceutical Abstracts, Health and Psychosocial Instruments, Google, and reference lists of identified publications were conducted to identify English-language articles describing development and validation of instruments designed to assess patients' capacity to self-administer medications. Methodological quality of validation studies was rated independently against published criteria by two reviewers and reliability and validity data were reviewed. RESULTS Thirty-two instruments were identified, of which 14 met pre-defined inclusion criteria. Instruments fell into two categories: those that used patients' own medications as the basis for assessment and those that used a simulated medication regimen. The quality of validation studies was generally low to moderate and few instruments were subjected to reliability testing. Most instruments had some evidence of construct validity, through associations with tests of cognitive function, health literacy, activities of daily living or measures of medication management or adherence. Only one instrument had sensitivity and specificity data with respect to prediction of medication-related outcomes such as adherence to therapy. Only three instruments had validity data from more than one independent research group. CONCLUSION A number of performance-based instruments exist to assess patients' capacity to manage their own medications. These may be useful for identifying physical and cognitive barriers to successful medication management, but further studies are needed to determine whether they are able to accurately and reliably predict medication outcomes.
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Affiliation(s)
- Rohan A Elliott
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria 3052, Australia.
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Kuzuya M, Hirakawa Y. INCREASED CAREGIVER BURDEN ASSOCIATED WITH HEARING IMPAIRMENT BUT NOT VISION IMPAIRMENT IN DISABLED COMMUNITY-DWELLING OLDER PEOPLE IN JAPAN. J Am Geriatr Soc 2009; 57:357-8. [DOI: 10.1111/j.1532-5415.2009.02116.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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