[Development of a regimen comprehension scale]

Disturbed medication management in older adults with good cognitive health and mild cognitive impairment associated with semantic memory impairment: The Wakuya Project

AIM

For older adults with mild cognitive impairment or mild dementia, maintaining daily lives at home is also ideal for quality of life. However, they have serious problems with medication management. Although the Dementia Assessment Sheet in community-based integrated care system-21 items and the regimen comprehension scale are assessment scales for medication, there have been no reports evaluating both semantic memory and actual performance.

METHODS

A total of 180 older adults aged ≥75 years were entered in the Wakuya Project. They underwent the Clinical Dementia Rating, with two original tests: (i) the original semantic memory task for taking medication including the Dementia Assessment Sheet in community-based integrated care system-21 items; and (ii) the actual performance task related to medication including regimen comprehension scale. Non-demented participants were classified into two groups based on reports from their families; that is, a good management group (n = 66) and a poor management group (n = 42), and the two original tests were analyzed as explanatory variables.

RESULTS

There were no differences between the two groups for the actual performance task related to medication including regimen comprehension scale. The success rates for the actual performance task related to medication including regimen comprehension scale (good management group/poor management group) were: regimen comprehension scale 40.9/23.8, One-Day Calendar 93.9/90.5, Medicine Chest 36.4/23.8 and Sequential Behavior Task 66.7/66.7, respectively. In the original semantic memory task for taking medication including the Dementia Assessment Sheet in community-based integrated care system-21 items, logistic regression analysis showed that only the mechanism of action remained (B -2.38, SE 1.10, Wald 4.69, P-value = 0.03, OR 0.09, 95%CI 0.01-0.80).

CONCLUSION

Our results suggest that disruption of medicine management might also be associated with drug semantic memory impairment between the two groups, with no difference in general cognitive and executive functions. Geriatr Gerontol Int 2023; 23: 319-325.

Case Report: Accessible Digital Musical Instrument Can Be Used for Active Music Therapy in a Person With Severe Dementia and Worsening Behavioral and Psychological Symptoms: A Case Study Over a Year and a Half

Despite the fact that accessible digital musical instruments can take into account the level of cognitive demands, previous studies have been conducted with patients with mild cognitive impairment (MCI), and it is not known whether they can be used by people with moderate to severe dementia or dementia with worsening behavioral and psychological symptoms of dementia (BPSD). The participant was an 88-year-old woman with vascular dementia (VaD) (Mini-Mental State Examination [MMSE] and Neuropsychiatric Inventory [NPI] scores: 8 and 20, respectively). Music therapy (MT) was provided twice a week for 15 min, and MT sessions spanned over 18 months. For the MT, we used the cyber musical instrument with score (Cymis), an accessible digital musical instrument; it could be played using a touch panel and switches. The cognitive function of the participant declined further, with MMSE scores of 4 after 1 year and 0 after 1.5 years. BPSD peaked with the NPI score of 54 at 1 year and declined thereafter, although only apathy remained. Despite these changes, during MT, she was able to play the accessible digital musical instrument and focus on the performance. These results suggest that even patients with severe VaD can play an accessible digital instrument and continue active music therapy even if their BPSD progress with cognitive decline.

Pharmacist medication instructions are associated with continued medication self-management in older adults: a retrospective observational study

Background

Various factors are related to self-management of medication. However, few reports comprehensively examine the factors related to patients, medication levels, and other factors related to the recuperative environment, such as family support. The aim of this study was to investigate factors affecting the continuation of medication self-management among hospitalized older adults receiving convalescent rehabilitation.

Methods

We conducted a retrospective observational study with 274 consecutive patients newly admitted to the convalescent rehabilitation wards at a single hospital in Japan between January 2017 and May 2018. Participants who were assessed for their ability to take their medication using the Japanese Regimen Adherence Capacity Tests, were deemed to be self-manageable, and were able to successfully continue to self-manage their medication from admission to discharge were categorized as the “continuation group,” and those who were not able to continue were categorized as the “non-continuation group.” We analyzed the groups’ demographic data, laboratory data, and Functional Independence Measure. The primary outcome was the continuation of medication self-management from admission to discharge.

Results

After enrollment, 134 patients (median age 82 years; 62.7% women) were included in the final analysis. Some 60.4% of eligible patients were able to maintain medication self-management during their hospitalization. The multiple logistic regression analysis for the continuation of medication self-management during hospitalization after adjusting for confounding factors revealed that pharmacist medication instructions were independently and positively correlated with successful continuation of medication self-management (odds ratio: 1.378; 95% confidence interval 1.085–1.831; p = 0.0076).

Conclusion

Successful continuation of medication self-management is associated with pharmacist medication instructions among hospitalized older adults undergoing rehabilitation.

Trail registration

The Ethics Committee’s registration number is “TGE01216–066”.

Medication management skill and regimen compliance are deteriorated in the elderly even without obvious dementia

We investigated whether regimen comprehension deteriorated in the elderly patients who did not suffer from obvious dementia. Eligible patients were ambulatory elderly patients who did not show any signs of dementia and could visit our outpatient clinic by themselves. 138 patients (age: 43-89, 75 males and 63 females, underlying diseases: hypertension, hyperlipidemia, arrhythmia etc.) were tested with a regimen comprehension scale (RCS: Jpn J Geriat 1997; 34: 209-214). The differences in scores among individuals increased with age. Scores of 5 or less in the RCS were recorded in 10 out of 69 patients aged 65 or more, but no such scores were recorded in younger patients (p < 0.01). The 60 patients who scored less than full marks were classified into two groups, the T-group (tutored by pharmacists), and a Non Tutored group. RCS was tested again in both groups. Only in the T-group (n = 28), did the second scores increase significantly (from 7.2 +/- 0.9 to 8.6 +/- 2.0 (m +/- SD); p < 0.01) after tutorial by pharmacists. Comparing the 7 patients who obtained an RCS score of 5 or less and age- and gender-matched controls who got full marks, there was no difference in the HDS-R test. These results suggest that even in elderly patients who did not show any signs of dementia, the regimen comprehension deteriorated with age, and tutorials in medication protocols were considered to be effective.