Improper intake of medication by elders--insights on contributing factors: a review of the literature

A Self-Administration of Medications Program to Identify and Address Potential Barriers to Adherence in Elderly Patients

BACKGROUND

Inpatient self-administration of medications programs (SAMPs) improve the medication knowledge and adherence of elderly patients after their discharge from the hospital. They may also identify patients who will have difficulties managing their medications after discharge; however, no previous study has evaluated the value of a SAMP for detecting and addressing barriers to adherence.

OBJECTIVE

To evaluate the usefulness of a SAMP for detecting and addressing barriers to adherence in functionally impaired elderly hospital inpatients, and to identify predictors of patient performance in a SAMP.

METHODS

A prospective cohort study was conducted on 2 subacute aged-care wards. Patients who were intending to independently manage their medications after discharge were recruited. Medications were dispensed and labeled with full directions, and the patients were educated about their medications. Each patient was required to request the medications from nursing staff when due, then select and administer them under supervision. Patient performance was documented. Barriers to adherence and interventions used to address these barriers were recorded. Analyses were performed to identify factors associated with failing the SAMP.

RESULTS

Of 62 patients who were recruited, 43 (69.4%) passed the program without requiring interventions to address adherence barriers, 7 (11.3%) passed with an intervention implemented to enable them to remain independent with medication management after discharge, and 12 (19.4%) failed and required full assistance with medication management after discharge. Overall, barriers to medication adherence (eg, inability to open containers, inability to request medications without prompting) were identified for 30.6% of patients. Mini-Mental State Examination scores and patient age were independent predictors of whether a patient would fail the SAMP.

CONCLUSIONS

An inpatient SAMP effectively detected barriers to medication adherence that otherwise may not have been detected and addressed prior to a patient's discharge from the hospital.

Polypharmacy and food-drug interactions among older persons: a review

Polypharmacy is generally defined as the use of 5 or more prescription medications on a regular basis. The average number of prescribed and over-the-counter medications used by community-dwelling older adults per day in the United States is 6 medications, and the number used by institutionalized older persons is 9 medications. Almost all medications affect nutriture, either directly or indirectly, and nutriture affects drug disposition and effect. This review will highlight the issues surrounding polypharmacy, food-drug interactions, and the consequences of these interactions for the older adult.

Factors Associated with Multiple Medication Use in Different Age Groups

Background:

Multiple medicine use among elderly persons is likely to be the result of treatment regimens developed over a long period of time. By learning more about how multiple medication use develops, the quality of prescribing may be improved across the adult lifespan.

Objective:

To describe patterns of multiple medicine use in the general Swedish population and its association with sociodemographic, lifestyle, and health status factors.

Methods:

Data from a cross-sectional population health survey collected during 2001-2005 from 2816 randomly selected Swedish residents (age 30–75 y; response rate 76%) were analyzed. Multiple medicine use was restricted to prescription drugs and defined as the 75th percentile; that is, the 25% of the study group using the highest number of drugs per individual.

Results:

Seventy-one percent of the respondents used some kind of drug, 51.5% used one or more prescription drug, 38.4% used one or more over-the-counter (OTC) medication, and 8.3% used one or more herbal preparation. The cutoff amounts defining multiple medicine use were: 2 or more medications for 30- to 49-year-olds, 3 or more for 50- to 64-year-olds, and 5 or more for 65- to 75-year-olds. No association between use of multiple medicines and use of OTC drugs or herbal preparations was found. When drugs were classified into therapeutic subgroups, 76.3% of those aged 30–49 years, 97.9% of those aged 50–64 years, and 100% of those aged 65–75 years were taking a unique combination of drugs. Multivariate analyses showed that diabetes and poor self-rated health were associated with multiple medicine use in all age cohorts. Female sex and hypertension were associated with multiple medicine use among those aged 30–49 and 50–64 years, current smoking among those aged 50–64 years, and obesity among those aged 65–75 years.

Conclusions:

Multiple medicine use was associated with morbidity and poor self-rated health across all age groups. The vast majority of users of multiple drugs are taking a unique combination of medications.

"I don't know how many of these [medicines] are necessary.." - a focus group study among elderly users of multiple medicines

OBJECTIVE

The growing prevalence of multiple medicine use among elderly challenges health care. The aim was to conduct an exploratory study describing multiple medicine use from the elderly patient's perspective.

METHODS

Twelve focus groups of 29 men and 30 women 65 years of age or older, using five or more medicines were analysed qualitatively.

RESULTS

Initially the participants reported no problems with using multiple medicines; they felt fortunate that medicines existed and kept them alive. However, negative attitudes were also revealed, both similar to those presented in studies on lay experience of medicine-taking and some that appear more specific to users of multiple medicines. The foremost of these was that acceptance of medicines depends on not experiencing adverse effects and worrying whether multiple medicine use is 'good' for the body. Furthermore, participants' perception of their medicines depended on interaction with doctors, i.e. trusting 'good' doctors.

CONCLUSION

The participants revealed co-existing accounts of both immediate gratitude and problems with using multiple medicines. Furthermore, the patient-doctor relationship coloured their attitudes towards their medicines.

PRACTICE IMPLICATIONS

Importance of the patient-doctor relationship for treatment success is highlighted. Moreover, to be able to capture both accounts of the elderly in this study an appropriate consultation length is needed.

Adherence Devices in a Community Sample: How are Pillboxes Used?

Background:

Calendar-packaging devices such as pillboxes (dosettes) and blister packaging are often recommended to seniors, and are commonly used. However, little is known about how they are used. The goal of this project was to investigate how older adults in the community use calendar-packaging adherence devices.

Methods:

A mail survey of a community sample was used. Analyses addressed 3 research questions. First, the respondents reported on what type of calendar packaging they used. Second, the characteristics of the individuals who used pillboxes and blister packs were compared. Third, the way in which calendar devices were used by these individuals was described.

Results:

Respondents were 135 community-dwelling older adults (mean age ± standard deviation = 73 ± 9 years). The majority of respondents in the survey (75%) used a pillbox at least some of the time, while a smaller number (13%) used blister packs for at least some of their medications. Respondents who used pillboxes were taking more medications than those who did not. Few of the respondents reported using pillboxes in the recommended way. Only 11% of pillbox users used boxes with multiple slots for each day and, while the majority of respondents (93%) filled their pillboxes themselves, most of these individuals (82%) depended solely on their memory for filling the pillbox and only one individual had a second person check the pillbox for errors.

Conclusion:

Although pillboxes are often recommended and are widely used, the types of pillboxes chosen and the ways in which they are used may not be optimal to ensure medication adherence. Can Pharm J 2009;142:28–35.

Nutritional status and delirium in long-term care elderly individuals

Delirium is physiologically plausible in elderly individuals with a poor nutritional status. We explored body composition, serum protein levels, and delirium in a multicenter long-term care study using bioelectrical impedance analysis (BIA). Estimates from the BIA procedure included the body cell mass and fat-free mass (FFM) of nursing home elderly residents (N = 312). Increased delirium was identified in men and women who were leaner and had lower FFM. Clinical surveillance for delirium in frail elderly individuals with low serum albumin levels and polypharmacy is recommended because of their increased likelihood of having drug toxicities for medications with protein-binding properties.