Assessing feasibility of a novel approach to effective medication self-management for older persons

The fact that nearly one-half of patients take medications differently than as prescribed, combined with the predisposition of older persons to adverse events, suggests a need for new strategies supporting medication self-management for older persons. This pilot study describes the development, acceptability and feasibility of a novel toolkit approach focusing on a systematic 4-step process for ensuring medication appropriateness. A preliminary qualitative assessment of the toolkit's acceptability and feasibility was carried out using a convenience sample of 39 residents aged 62-97 years in two senior living facilities convened in focus groups. A facilitator guided participants through discussions of the 4-step process. All participants indicated they perceive that the toolkit's systematic 4-step process can help older persons successfully self-manage medications. The most common medication use challenges cited by participants were related to effectiveness (35%), followed by intended medical use (27%), safety (23%), and ability to take medications (15%). This preliminary investigation suggests that older adults resonate with use of this 4-step process to confidently self-manage medications and find it feasible and acceptable to use in assessing the appropriateness of their medications. More research is needed to establish the reliability and validity of this toolkit with more diverse populations of older adults.

A Multisite Qualitative Analysis of Perceived Roles in Medication Safety: Older Adults' Perspectives

Older adults and caregivers play an essential role in medication safety; however, self-perception of their and health professionals' roles in medication safety is not well-understood. The objective of our study was to identify the roles of patients, providers, and pharmacists in medication safety from the perspective of older adults. Semi-structured qualitative interviews were held with 28 community-dwelling older adults over 65 years who took five or more prescription medications daily. Results suggest that older adults' self-perceptions of their role in medication safety varied widely. Older adults perceived that self-learning about their medications and securing them are critical to avoiding medication-related harm. Primary care providers were perceived as coordinators between older adults and specialists. Older adults expected pharmacists to inform them of any changes in the characteristics of medications to ensure medications were taken correctly. Our findings provide an in-depth analysis of older adults' perceptions and expectations of their providers' specific roles in medication safety. Educating providers and pharmacists about the role expectations of this population with complex needs can ultimately improve medication safety.

Medication Management Frameworks in the Context of Self-Management: A Scoping Review

PURPOSE

Many individuals take multiple prescribed and unprescribed medications, also known as polypharmacy, which can be problematic. Improving medication self-management is important; however, most medication management frameworks focus on adherence and limit the integration of the core components of self-management. Therefore, the objective of this scoping review was to identify what is reported in the literature on medication management frameworks or models within the context of self-management.

METHODS

Electronic databases (Medline, Embase, CINAHL and Cochrane Library) and grey literature (healthcare and government organization websites) were searched for articles that described a framework or model developed or adapted for medication management, included components of self-management and was published from January 2000 to January 2020. During the screening of titles and abstracts, 5668 articles were reviewed, 5242 were excluded and 426 were then assessed at the full-text level. Thirty-nine articles met the eligibility criteria and were included in the review.

RESULTS

About half of the frameworks were newly developed (n=20), while the other half were adapted from, or applied, a previous model or framework (n=19). The majority of frameworks focused on medication adherence and most of the self-management domains were categorized as medical management, followed by emotional and role management.

CONCLUSION

Medication self-management is a complex process and often impacts multiple areas of an individual's life. It is important for future frameworks to incorporate a comprehensive, holistic conceptualization of self-management that is inclusive of the three self-management domains - medical, emotional and role management.

Elder and caregiver solutions to improve medication adherence

Medication mismanagement is a growing public health concern, especially among elders. Annually, it is a major contributor to emergency hospitalization and nursing home placement. Elders and their caregivers, as healthcare consumers and stakeholders in this issue, are uniquely qualified to inform strategies to improve medication adherence. We conducted a qualitative study to ascertain caregiver and elder perceptions of barriers to medication management and to identify community-derived solutions to improve medication management. Nine focus groups (N = 65, mean age = 71) were conducted with caregivers or elders from five communities. Participants were recruited by key informants utilizing snowball sampling methodology. The following themes were identified in the participant-recommended proposed solutions improving medication adherence: (i) use of personal systems to overcome barriers to medication adherence, (ii) various solutions to address cost concerns, (iii) the need for regular review of medications by doctors or pharmacists to eliminate unnecessary medications, (iv) desire for community-driven support systems, and (v) using medical advocates. Elders and caregivers recognized medication non-adherence as a community-wide issue and were eager to offer solutions they thought would work in their communities. These solutions can lend credibility to strategies currently being developed/utilized and offer innovative recommendations for future interventions.

Adherence and medication management by the elderly

AIMS AND OBJECTIVES

The purpose of this study was to explore the strategies used for medication management by elderly who live at home.

BACKGROUND

Non-adherence to chronic medication is a common problem among the elderly with chronic conditions. Many studies have been developed, but it did not progress in solving this multidisciplinary health care problem. The causes of non-adherence by the elderly are multiple and complex.

DESIGN

Descriptive qualitative design.

METHODS

Data were collected by two focus groups. The content of discussion was analysed from verbatim transcript and identifying categories and sub-categories emerged, leading to the construction of a diagram analysis.

RESULTS

The finding indicated the strategies and the interpretation of people aged 65 or more and with chronic illness, managing their medication. Four content categories emerged: to live with drugs, taking medication, belief about drugs and relationship with health professionals.

CONCLUSION

The study enabled us to identify and understand, by giving a 'voice' to the elderly, that living with drugs is a dynamic and complex process and that taking medication is perceived by older people as a consequence of their ageing, which requires them to include that process in their lives as a habit implying changes in their daily routines. The elderly suggest that the relationship with health professionals is essential in medication management and they reported that the information given by the nurse during consultation is very important.

RELEVANCE TO CLINICAL PRACTICE

The relationship with nurses in particular is an important issue for the older people. Understanding the factors of adherence and helping people are important areas of research in nursing. The quality of this relationship may be the key to increasing adherence in this group of people.

The implementation of a self-administration of medication programmes within Older Persons Mental Health

This paper aims to report on the literature related to self-medication programmes that contributed to the development of an Older Persons Mental Health (OPMH) specific pathway for a self-administration of medication (SAM) programme. The traditional methods used within mental health inpatient environments to administer medication are paternalistic and resonant of the medical approach to care. There is a need to investigate innovative methods in the management of depression in older adults that reflect an individualized, innovative approach to redress the power imbalance for patients. Electronic databases were searched using the search strategy of Hek et al. to identify key themes in the implementation of self-administration programmes. Seven themes emerged from the literature review: the structure of SAM, assessments and risks associated with SAM, patient education, SAM and medication adherence, the patients' perspective, advantages and barriers to SAM, and professional issues. These findings were then used as the foundation for a project to develop an OPMH specific pathway for the implementation of SAM. There is a distinct lack of implementation of SAM programmes across the UK, especially within mental health services. Older Persons Mental Health is ready for the implementation of change in medicines management for older adults. Self-administration of medication can ensure all the principles of NHS plan relating to individualized person-centred care are achieved. Nurses have the opportunity to actively contribute to this process, facilitating and empowering those in their care to be experts within their journey and take control of their illness.

A meta-analysis of self-care behavior research on elders in Thailand: an update

Self-care is essential for elderly individuals to maintain their optimal level of health. This meta-analysis was conducted to summarize research findings relating to self-care among the elderly in Thailand. Twenty studies undertaken from 1990 to 2008 were used and 328 effect sizes were computed. Most studies were unpublished master's theses guided by Orem's self-care deficit theory. Data were collected in these studies by face-to-face interviews. Variables with the largest effect sizes encompassed self-concept, social support, and self-efficacy. Those with medium effect sizes entailed family relationships, overall health beliefs, internal locus of control, health status, and external locus of control. Results from this meta-analysis is useful information for nursing.