Self-administration of medicine and older people
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.
Available from: Robin Hilsabeck
- "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. "
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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.
- "Compliance with prescribed medication is a widespread problem , and persons with dementia are a particularly susceptible population. These patients are usually of an advanced age and suffer numerous co-morbidities that demand multiple medications and, in addition, are characterized by memory and cognitive problems . In this sense, the transdermal route of administration constitutes an alternative by which the inconveniences related with oral drug administration can be overcome. "
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ABSTRACT: The transdermal administration of memantine may have advantages with respect to oral therapy when treating advanced stages of Alzheimer's disease. With the ultimate objective of administrating memantine through a transdermal patch, the absorption of the drug across skin was evaluated by means of in vitro permeation studies. The effect of several chemical enhancers was studied in order to enhance percutaneous absorption of the memantine. The iontophoretic transdermal transport of memantine hydrochloride using a current density of 0.5mA/cm(2) was also investigated. Results demonstrated that pre-treatment of the skin with R-(+)-limonene, laurocapram, decenoic acid, or oleic acid produced a statistically significant increment in the transdermal flux of memantine hydrochloride with respect to the control. Iontophoresis exhibited the greatest ability to enhance the flux of drug with respect to the control; nevertheless, the results obtained with R-(+)-limonene indicate that this compound could be of great use as a percutaneous enhancer in a memantine transdermal delivery system. In this study, the relationship between enhancement activity and lipophilicity was also studied. Satisfactory correlations have been obtained between the optimum lipophilicity of the enhancer and n-octanol/water partition coefficients of drugs. This relationship is a very useful tool that could allow to reduce time and to optimize the selection of appropriate enhancers for transdermal formulations.
Available from: Rebecca P Winsett
- "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). "
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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.
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