BACKGROUND: Non-adherence to medication regimens is a significant problem in older patients, which can lead to therapeutic failure and the wastage of resources. Common causes include poor patient memory, physical difficulties, unpleasant side effects and a lack of social support. CONCLUSION: Strategies such as careful labelling, self-administration of medicine programmes, simplifying drug regimens and the use of medication compliance devices can help to promote patient adherence. Some of these interventions will work for certain patients, however the authors recommend that a multidisciplinary assessment and a regular review of each patient's ability to adhere to medication should be undertaken.
"As space on medication labels is limited and instructions are generally vague, disjointed, and poorly organized, individuals must rely on making inferences regarding information not explicitly stated (Hayes, 1998; Kendrick & Bayne, 1982; McGraw & Drennan, 2001; Park, Willis, Morrow, Diehl, & Gaines, 1994; Willis et al., 1999). Several studies reveal that both cognitively intact and cognitively impaired individuals have difficulty making inferences from medical information, although those with cognitive impairment make significantly more errors (Hayes, 1998; McGraw & Drennan, 2001; Park et al., 1994; Zwahr, 1999). Kendrick and Bayne (1982), for example, found 29% of their cognitively intact elderly sample demonstrated a different understanding of medication administration than the written label. "
[Show abstract][Hide abstract] ABSTRACT: Studies indicate that executive functioning (EF) is a strong predictor of everyday function. However, assessment can be problematic as no single standardized instrument is known to measure all EF domains simultaneously. Thus, the Pillbox Test was developed as a new measure tapping four EF factors through the real-time assessment of medication management, a complex instrumental activity of daily living. The Pillbox Test showed good criterion-related validity and was effective in differentiating graduated levels of executive dysfunction between a mixed neurological group, medical control group, and healthy community control group. This test also showed good convergent validity as it correlated significantly in expected directions with established EF measures in all four of selected EF domains and the Direct Assessment of Functional Status. Finally, a receiver operator characteristic curve found a sensitivity of 75% and specificity of 87.5%, suggesting that the Pillbox Test is a promising new ecological measure of EF.
"expensive medication regimens; however, additional issues such as social isolation; changes in vision, memory, and manual dexterity; and other physical limitations may increase the burden of therapy (McGraw & Drennan, 2001). "
[Show abstract][Hide abstract] ABSTRACT: This study evaluated older renal transplant recipients' perceptions of electronic medication monitoring and the influence of these perceptions on medication adherence. A sample of 73 older adult renal transplant recipients who used the Medication Event Monitoring System (MEMS(®)) TrackCaps for 12 months provided their perceptions of device use. Participants perceived that the MEMS had a neutral effect on their medication-taking routine (65%), believed the MEMS was practical (56%), and could not describe any instances in which using the MEMS was difficult (56%). No significant difference in medication adherence was found between those who perceived the MEMS's influence negatively/neutrally and those who perceived the MEMS positively (p = 0.22). Medication adherence data from older adult renal transplant recipients can be used regardless of their perceptions of the MEMS's influence on their medication taking without biasing medication adherence data.
"To achieve this is, it will be necessary for health care providers in many different roles to support the initial screening and assessment of how older people manage their medicines in order to identify those at high risk who may then receive an in-depth medicine review from their local Pharmacist or GP as a matter of priority. McGraw and Vari (2001) acknowledge that nonadherence to medication regimes in older people is a significant problem and support recommendations such as careful labelling, self-administration of medicine programmes, as well as simplifying drug regimes and the use of compliance aids. However , they also acknowledge that these interventions will not always work for everyone and support should therefore be continuous through multidisciplinary assessment of how older people are managing their medicines and through regular reviews of ability to adhere to a medicine regime. "
[Show abstract][Hide abstract] ABSTRACT: Objectives
The purpose of the study was to refine and validate the self-medication risk assessment instrument for use as a reliable screening method to identify people who may have difficulty managing their medication safely. Specific objectives of the study were to demonstrate the reliability of the instrument.DesignThe study, using a correlational design, was designed to test inter- and intra-rater reliability of the instrument using a sample of 45 patients and 45 pairs of assessors. Each pair of assessors assessed the same patient on the same day and one of the original assessors returned to reassess the patient approximately one week later.SettingThe data collection took place in Acute medical and Community Rehabilitation settings and via Community Nursing, Pharmacy and Social Care staff in Hull and the East Riding of Yorkshire.Participants45 patients and 45 pairs of assessors from Nursing, Pharmacy and Social Care backgrounds.Main Outcome measuresReliability of the instrument when used by different and same assessors and identification of key risk factors related to self-medication risk assessment.ResultsThe instrument has demonstrated strong inter- and intra-rater reliability for both outcome of assessment findings and risk category. Three key elements of the assessment criteria, mental state, attitude and knowledge about medications and severe visual impairment demonstrated a high level of criterion validity.Conclusion
The self-medication assessment instrument shows promise in terms of reliability but further testing is required to demonstrate its validity and the possible weighting of individual items in the instrument.
Clinical Effectiveness in Nursing 03/2005; 9(1-2):78-83. DOI:10.1016/j.cein.2004.12.003
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