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Baby B, McKinnon A, Patterson K, Patel H, Sharma R, Carter C, Griffin R, Burns C, Chang F, Guilcher SJ, Lee L, Fadaleh SA, Patel T. Tools to measure barriers to medication management capacity in older adults: a scoping review. BMC Geriatr 2024; 24:285. [PMID: 38532328 PMCID: PMC10967066 DOI: 10.1186/s12877-024-04893-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 03/13/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND Medication management capacity is a crucial component of medication adherence, particularly among older adults. Various factors, including physical abilities, cognitive functions, sensory capabilities, motivational, and environmental factors, influence older adults' ability to manage medications. It is, therefore, crucial to identify appropriate tools that allow clinicians to determine which factors may impact medication management capacity and, consequently, nonadherence to medications. PURPOSE 1)To identify tools that measure physical, cognitive, sensory (vision, hearing, touch), motivational, and environmental barriers to medication self-management in older adults, and 2) to understand the extent to which these tools assess various barriers. METHODS The scoping review was conducted using Arksey and O'Malley's scoping review framework and the PRISMA Extension for Scoping Reviews checklist. In June 2022, the relevant literature was identified by searching PubMed (MEDLINE), Ovid Embase, Ovid IPA, EBSCOhost CINAHL, APA PsycINFO, and Scopus. RESULTS AND DISCUSSION In total, 7235 studies were identified. Following the removal of duplicates, 4607 articles were screened by title and abstract, of which 4253 did not meet the inclusion criteria. Three reviewers reviewed the full texts of the remaining 354 articles; among them, 41 articles, 4 theses and 1 conference abstract met the inclusion criteria. From the included studies, 44 tools were identified that measured a combination of physical, cognitive, sensory, motivational, and environmental barriers (n=19) or only cognition (n=13), vision (n=5), environmental factors (n=3), auditory (n=1), and motivational factors (n=1). The review also examined the psychometric properties of the identified tools and found that most of them had reported validity and reliability data. Several tools have demonstrated promise in assessing a combination of barriers with validity and reliability. These tools include the Self-Medication Assessment Tool (SMAT), ManageMed Screening (MMS), Self-Medication Risk Assessment Tool (RAT), HOME-Rx revised, and Medication Management Ability Assessment (MMAA). CONCLUSION This scoping review identified 44 validated tools to measure various challenges that older adults encounter with medication management. However, no tool measures all five barriers (physical, cognitive, sensory, motivational, and environmental) to medication-taking at home. Therefore, utilizing a combination of tools would be most appropriate to measure these different aspects comprehensively. Further research is needed to develop a new comprehensive tool that simultaneously measures various barriers to medication self-management.
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Affiliation(s)
- Bincy Baby
- School of Pharmacy, University of Waterloo, Waterloo, ON, Canada
| | | | | | - Hawa Patel
- School of Pharmacy, University of Waterloo, Waterloo, ON, Canada
| | - Rishabh Sharma
- School of Pharmacy, University of Waterloo, Waterloo, ON, Canada
| | - Caitlin Carter
- School of Pharmacy, University of Waterloo, Waterloo, ON, Canada
| | - Ryan Griffin
- National Research Council Canada, Ottawa, ON, Canada
| | - Catherine Burns
- Faculty of Engineering, University of Waterloo, Waterloo, ON, Canada
| | - Feng Chang
- School of Pharmacy, University of Waterloo, Waterloo, ON, Canada
| | - Sara Jt Guilcher
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Linda Lee
- Department of Family Medicine, McMaster University, Hamilton, Canada
| | - Sara Abu Fadaleh
- School of Pharmacy, University of Waterloo, Waterloo, ON, Canada
| | - Tejal Patel
- School of Pharmacy, University of Waterloo, Waterloo, ON, Canada.
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Kehl-Floberg KE, Marks TS, Edwards DF, Giles GM. Conventional clock drawing tests have low to moderate reliability and validity for detecting subtle cognitive impairments in community-dwelling older adults. Front Aging Neurosci 2023; 15:1210585. [PMID: 37705561 PMCID: PMC10495769 DOI: 10.3389/fnagi.2023.1210585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 08/08/2023] [Indexed: 09/15/2023] Open
Abstract
Background Early identification of subtle cognitive decline in community-dwelling older adults is critical, as mild cognitive impairment contributes to disability and can be a precursor to dementia. The clock drawing test (CDT) is a widely adopted cognitive screening measure for dementia, however, the reliability and validity of paper-and-pencil CDT scoring scales for mild cognitive impairment in community samples of older adults is less well established. We examined the reliability, sensitivity and specificity, and construct validity of two free-drawn clock drawing test scales-the Rouleau System and the Clock Drawing Interpretation Scale (CDIS)-for subtle cognitive decline in community-dwelling older adults. Methods We analyzed Rouleau and CDIS scores of 310 community-dwelling older adults who had MoCA scores of 20 or above. For each scale we computed Cronbach's alpha, receiver operating characteristic curves (ROC) for sensitivity and specificity using the MoCA as the index measure, and item response theory models for difficulty level. Results Our sample was 75% female and 85% Caucasian with a mean education of 16 years. The Rouleau scale had excellent interrater reliability (94%), poor internal consistency [0.37 (0.48)], low sensitivity (0.59) and moderate specificity (0.71) at a score of 9. The CDIS scale had good interrater reliability (88%), moderate internal consistency [0.66 (0.09)], moderate sensitivity (0.78) and low specificity (0.45) at a score of 19. In the item response models, both scales' total scores gave the most information at lower cognitive levels. Conclusion In our community-dwelling sample, the CDIS's psychometric properties were better in most respects than the Rouleau for use as a screening instrument. Both scales provide valuable information to clinicians screening older adults for cognitive change, but should be interpreted in the setting of a global cognitive battery and not as stand-alone instruments.
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Affiliation(s)
- Kristen E. Kehl-Floberg
- Institute for Clinical and Translational Science, University of Wisconsin-Madison, Madison, WI, United States
| | - Timothy S. Marks
- Department of Kinesiology-Occupational Therapy, University of Wisconsin-Madison, Madison, WI, United States
| | - Dorothy F. Edwards
- Institute for Clinical and Translational Science, University of Wisconsin-Madison, Madison, WI, United States
- Department of Kinesiology-Occupational Therapy, University of Wisconsin-Madison, Madison, WI, United States
| | - Gordon M. Giles
- Department of Occupational Therapy, Samuel Merritt University, Oakland, CA, United States
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Zietlow K, Dubin L, Battles A, Vitale C. Guardianship: A medicolegal review for clinicians. J Am Geriatr Soc 2022; 70:3070-3079. [PMID: 35420158 PMCID: PMC9790446 DOI: 10.1111/jgs.17797] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 02/17/2022] [Accepted: 03/11/2022] [Indexed: 12/30/2022]
Abstract
Guardianship may pose an ethical dilemma for physicians, who must balance protecting vulnerable patients from potential safety concerns with respecting their autonomy. Older adults with dementia are particularly susceptible to loss of independence and the ability to participate in medical decision making. To have the capacity for medical decision making, individuals must understand relevant information, appreciate their circumstances, demonstrate reasoning, and express a consistent choice free from coercion. Although capacity assessments are usually task-specific, geriatricians and other specialists may be asked to comment on capacity more globally. These determinations may be used to support a Petition for the Appointment of a Guardian of a Legally Incapacitated Adult, the legal process of pursuing guardianship in probate court. Assigned guardians may be known to the incapacitated individual (e.g., a family member or friend) or may be professional guardians with no prior relationship to the ward. Guardians are encouraged to use substituted decision-making, taking into account the ward's previously expressed values and preferences. Although a number of viable alternatives to guardianship exist, numerous systemic barriers may prevent these from being fully explored. The ongoing need for guardianship should be periodically revisited and reassessed. Data about guardians and wards is shockingly sparse, as there are no centralized databases. Laws and regulations for guardianships vary significantly between states. Physicians can serve as important allies and advocates for patients with cognitive impairment at risk of incapacity, can help preserve their autonomy for as long as possible, and ensure appropriate protections are in place if the patient does lose their decision-making ability.
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Affiliation(s)
- Kahli Zietlow
- Division of Geriatric and Palliative Medicine, Department of Internal MedicineUniversity of MichiganAnn ArborMichiganUSA,Geriatric Research Education and Clinical CenterVA Ann Arbor Healthcare SystemAnn ArborMichiganUSA
| | - Leslie Dubin
- School of Social WorkUniversity of MichiganAnn ArborMichiganUSA
| | - Alethia Battles
- School of Social WorkUniversity of MichiganAnn ArborMichiganUSA,Office of the Vice President and General CounselUniversity of MichiganAnn ArborMichiganUSA
| | - Caroline Vitale
- Division of Geriatric and Palliative Medicine, Department of Internal MedicineUniversity of MichiganAnn ArborMichiganUSA,Geriatric Research Education and Clinical CenterVA Ann Arbor Healthcare SystemAnn ArborMichiganUSA
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Okuyan B, Ozcan V, Balta E, Durak-Albayrak O, Turker M, Sancar M, Yavuz BB, Uner S, Ozcebe H. The impact of community pharmacists on older adults in Turkey. J Am Pharm Assoc (2003) 2021; 61:e83-e92. [PMID: 34238671 DOI: 10.1016/j.japh.2021.06.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/19/2021] [Accepted: 06/06/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This study aimed to evaluate the impact of theory-based, structured, standardized pharmaceutical care services led by community pharmacists (CPs) on patient-related outcomes in older Turkish adults. PRACTICE DESCRIPTION This prospective, quasi-experimental pilot study was conducted at the national level at community pharmacies in Turkey. After virtual training of CPs, pharmaceutical care services including medicine bag check-up, medication review, patient medicine card, patient education, and counseling services (including motivational interviewing) were delivered to promote medication adherence in older adults. PRACTICE INNOVATION Theory-based, structured, standardized pharmaceutical care services addressing medication adherence problems in older Turkish adults with noncommunicable diseases. EVALUATION METHODS Descriptive data (including demographic and clinical data, medication-related problems by using the DOCUMENT classification, potential inappropriate prescribing by using the Ghent Older People's Prescriptions Community Pharmacy Screening- (GheOP3S) tool, and pharmacy service satisfaction) were presented. Pre- and post-evaluation were compared by using the Wilcoxon test (for continuous variables) and McNemar's or McNemar-Bowker chi-square test (for categorical variables). RESULTS One hundred and thirty-eight medication-related problems were identified among 52 older adults. The medication adherence rate was significantly increased from 51.9% to 75%, and the mean of total quality of life (QoL) score rose significantly from 51.7 to 53.4 (P < 0.05). There was a statistically significant change in the median of necessity-concern differential (baseline: 7 [2.2-10.0] vs. final: 8.0 [5-11]; P < 0.05). At baseline, all patients had at least 1 potential inappropriate prescribing according to the GheOP3S tool, and the rate was 73.1% at the final assessment. CONCLUSION Community pharmacist-led pharmaceutical care services significantly improved patient-related outcomes (such as medication adherence, beliefs about medication, and QoL) in older adults with noncommunicable diseases. No statistically significant change was detected in their lifestyle behaviors (such as physical activity and diet program) or health awareness.
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Marks TS, Giles GM, Al-Heizan MO, Edwards DF. How Well Does the Brief Interview for Mental Status Identify Risk for Cognition Mediated Functional Impairment in a Community Sample? Arch Rehabil Res Clin Transl 2021; 3:100102. [PMID: 33778475 PMCID: PMC7984985 DOI: 10.1016/j.arrct.2021.100102] [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] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE To determine the adequacy of the Brief Interview for Mental Status (BIMS) compared with other screening tools in identifying individuals with limitations in functional cognition and instrumental activities of daily living (IADL). DESIGN Cross-sectional observational study. SETTING Midsized midwestern city. PARTICIPANTS We assessed a convenience sample of community dwelling individuals (N=197) aged 55 years and older who were living independently. MAIN OUTCOME MEASURES Participant scores on the BIMS, Mini-Cog, Menu Task, and Montreal Cognitive Assessment (MoCA) were compared with the Performance Assessment of Self-Care Skills Checkbook Balancing and Shopping tasks (PCST), which are known to predict impairment in complex IADLs associated with a diagnosis of mild cognitive impairment. Multiple logistic regression analyses controlling for participant demographics, as well as sensitivity and specificity, were computed for each screening measure using the PCST as the criterion measure. RESULTS The Mini-Cog, Menu Task, and MoCA identified 25.89%, 32.49%, and 47.21% more individuals, respectively, as impaired than the BIMS. In multiple logistical regression analyses, the BIMS correctly identified 58% of those impaired on the PCST. However, each of the alternate screening measures correctly identified at least 70% of individuals as impaired on the PCST. CONCLUSIONS In this community sample, the BIMS was insensitive to subtle impairments with the potential to compromise community living, suggesting that the BIMS may be inappropriate for use outside nursing home settings.
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Affiliation(s)
- Timothy S. Marks
- University of Wisconsin–Madison, Department of Kinesiology–Occupational Therapy, Madison, WI
| | - Gordon M. Giles
- Department of Occupational Therapy, Samuel Merritt University, Oakland, CA
- Neurobehavioral Services, Crestwood Behavioral Health, Inc, Sacramento, CA
| | | | - Dorothy F. Edwards
- University of Wisconsin–Madison, Department of Kinesiology–Occupational Therapy, Madison, WI
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Marks TS, Giles GM, Al-Heizan MO, Edwards DF. Can Brief Cognitive or Medication Management Tasks Identify the Potential for Dependence in Instrumental Activities of Daily Living? Front Aging Neurosci 2020; 12:33. [PMID: 32153383 PMCID: PMC7045342 DOI: 10.3389/fnagi.2020.00033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 02/03/2020] [Indexed: 02/04/2023] Open
Abstract
Background and Objectives: The identification of functional performance deficits is critical to the community independence of older adults. We examined whether a combined cognitive and performance-based medication management measure would be able to better classify an individual’s functional cognitive status and potential for instrumental activities of daily living (IADL) impairment than either measure alone. Research Design and Methods: Community-dwelling adults age 55 and older (n = 185) were administered the Mini-Cog, the Medication Transfer Screen-Revised (MTS-R), a combination measure the Medi-Cog-Revised (Medi-Cog-R), the Performance Assessment of Self-Care Skills (PASS) Checkbook Balancing and Shopping tasks (PCST), additional cognitive screening measures, and a self-report daily living scale. Receiver operating characteristic (ROC) curve analyses were computed for the Mini-Cog, MTS-R and the Medi-Cog-R using the PCST performance as the criterion measure. The area under the curve (AUC), sensitivity, and specificity were computed for each measure. Results: The Medi-Cog-R most accurately identified individuals as impaired on the PCST. An AUC statistic of 0.82 for the Medi-Cog-R was greater than either the Mini-Cog (0.75) or the MTS-R (0.73). The Medi-Cog-R demonstrated a sensitivity of 0.71 and a specificity of 0.78 in classifying individuals with impaired IADL as measured by the PCST. Discussion and Implications: The Mini-Cog, the MTS-R, and the Medi-Cog-R all show discriminant validity, but the combined measure demonstrates greater sensitivity and specificity than either component measure alone in identifying IADL impairment. The Medi-Cog-R appears to be a useful screening measure for functional cognition and can be used to prompt further assessment and intervention to promote community independence.
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Affiliation(s)
- Timothy S Marks
- Department of Kinesiology-Occupational Therapy, The University of Wisconsin-Madison, Madison, WI, United States
| | - Gordon M Giles
- Department of Occupational Therapy, Samuel Merritt University, Oakland, CA, United States
| | - Muhammad O Al-Heizan
- Department of Rehabilitation Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Dorothy F Edwards
- Department of Kinesiology-Occupational Therapy, The University of Wisconsin-Madison, Madison, WI, United States
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Lee S, Khare MM, Olson HR, Chen AMH, Law AV. The TEACH trial: Tailored education to assist label comprehension and health literacy. Res Social Adm Pharm 2018; 14:839-845. [PMID: 29937110 DOI: 10.1016/j.sapharm.2018.05.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 04/27/2018] [Accepted: 05/30/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Prior work demonstrated significantly improved prescription label comprehension and functional health literacy (FHL) using an educational intervention and redesigned prescription label. OBJECTIVE The objective of this study was to assess the effectiveness of the educational intervention to improve prescription label understanding using three factors: (1) redesigned prescription label, (2) previously validated MLT and (3) pillbox fill test. METHODS English-speaking patrons ≥55 years old taking ≥2 prescription medications were recruited in this prospective, multisite, randomized, controlled, pre-post study, in California, Illinois, and Ohio. Participants completed the MLT (25 points) as a test of label comprehension and filled a 7 × 4 pillbox (Pillbox test, 35 points) at baseline and 1-month follow-up. The intervention group received tailored education by a student or pharmacist on how to read the label based on their response to the MLT and Pillbox Test. RESULTS Combined data analysis was conducted of the 92 (63.4%) completed follow-ups from all sites. Baseline characteristics were comparable between control and intervention groups. Overall, mean MLT increased in both control and intervention groups (ΔPre-Post: +0.7 point vs. +0.8 point, p < 0.05). Although not statistically significant, pillbox test scores increased by 2.0 points in the intervention group compared to a slight decrease in the control group (-0.8 point, p > 0.05). Significant correlation between MLT and Pillbox scores was observed (r = 0.63, p < 0.05). Subgroup analysis between sites revealed that the CA-site had lower educational background and English proficiency; lower mean MLT and Pillbox Fill pre-scores compared to the IL- and OH-sites, with a statistically significant effect of intervention on MLT and Pillbox post-scores. CONCLUSIONS This study extended earlier findings that focused education using redesigned Rx labels helped improve Rx label comprehension and observed action. Larger studies are needed to determine the impact on patient outcomes. Patients with lower education, English proficiency, and/or FHL may benefit from education that could translate into improved medication use behavior.
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Affiliation(s)
- Sun Lee
- Western University of Health Sciences, College of Pharmacy, Department of Pharmacy Practice and Administration, 309 East Second Street, Pomona, CA, 91766, USA.
| | - Manorama M Khare
- University of Illinois, College of Pharmacy, Rockford, 1601 Parkview Avenue, Rockford, IL, 61107, USA.
| | - Heidi R Olson
- University of Illinois, College of Pharmacy, Rockford, 1601 Parkview Avenue, Rockford, IL, 61107, USA.
| | - Aleda M H Chen
- Cedarville University, School of Pharmacy, 251 North Main Street, Cedarville, OH, 45314, USA.
| | - Anandi V Law
- Western University of Health Sciences, College of Pharmacy, Department of Pharmacy Practice and Administration, 309 East Second Street, Pomona, CA, 91766, USA.
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Anderson K, Willmore C, Doran E, Oki N, Vonnahme J, Gates BJ. Cognitive and Literacy Screening as Predictors of Ability to Fill a Pillbox Using Two Pillbox Assessment Scoring Methods. ACTA ACUST UNITED AC 2014; 29:304-16. [DOI: 10.4140/tcp.n.2014.304] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Strunk AD, Mayer SD. Resistant Hypertension in the Elderly: Optimizing Outcomes While Avoiding Adverse Effects. ACTA ACUST UNITED AC 2013; 28:307-12. [DOI: 10.4140/tcp.n.2013.307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Defanti e Souza FR, da Silva Santana C. A descriptive study about the use of pillboxes by older adults. Health (London) 2013. [DOI: 10.4236/health.2013.512a014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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