Medication management by community-dwelling older people: an observational study

Abstract

Title: Medication management by community-dwelling older people: an observational study. Background: Several factors, such as self-treatment, impaired cognitive status, and living alone, contribute to problems in medication management which can lead to drug-related problems (DRPs). As frequent users of medication, community-dwelling older people are at risk of developing DRPs. Aim and research questions: To explore medication management skills in community-dwelling older people. Two questions were central in this study. First, what are the medication management skills of community-dwelling older people and how are they related to cognition, self-management skills and demographic variables? Second, to what extent do observations of potential DRPs by home health care staff correspond to the potential DRPs experienced by community-dwelling older people? Method: An observational study, with a cross-sectional design. A random sample of home care clients was recruited from one organization. Participants were ≥75 years old and chronically used five or more medications. The medication management skills, cognition, and the self-management skills were measured respectively using the Medication Management Score (MMS), the Clock Drawing Test (CDT), and the Self-Management Ability Scale. The potential DRPs observed by staff were measured using the Home Observation of Medication related problems by homecare Employees instrument. To verify the existence of potential DRPs observed by the staff, the participants were interviewed about which potential DRPs they experienced. Results: Of 106 eligible clients, 33 participated. Seventy percent scored ≥1 point(s) on the MMS. A lower score for the CDT showed poor medication management skills (rs = -.397; p .025). There was good agreement (κ .653) between potential DRPs related to medication management problems as observed by the staff and reported during the interview. Conclusion: The community-dwelling older people appeared to have good medication management skills which are negatively influenced by cognitive impairment. Home care staff is able to identify potential DRPs related to medication management problems. Recommendations: Further research should focus on how identification of potential DRPs can lead to safer medication management.