Improving Medication Management Support for Older Adults: A Pilot Study

1
Improving Medication Management Support for Older
Adults A Pilot Study

• Susan L. Lakey, PharmD
• Acting Assistant Professor
• University of Washington
• Department of Pharmacy
• April 14, 2008

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Background

• Adherence
• Estimated rate of adherence to medication
  regimens is only 50.
• Impact of non-adherence
• 10 of hospital admissions
• 23 of nursing home admissions
• Estimated yearly cost in U.S. of 100 billion
• Medication Management Capacity
• The cognitive and functional ability to take
  medications as prescribed.
• Necessary for adherence in persons who
  self-administer medications.
• Might be addressed by use of supportive
  interventions
• medication support devices
• human support
• provider interaction

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Pilot Study Objectives

1. Evaluate medication management capacity among
   independent-living older adults in a continuing
   care retirement community (CCRC).
2. Through the use of a survey, evaluate knowledge
   about and preferences for strategies to reduce
   medication mismanagement risk.
3. Determine whether knowledge and preferences are
   associated with demographic variables, cognitive
   status, medication management capacity, and
   medication regimen complexity.

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Methods

• Cross-sectional study
• Independent-living residents in a continuing care
  retirement community (CCRC) in Seattle,
  Washington
• In-person interviews for data collection

• Demographics
• Medication regimen
• Survey assessing knowledge and preferences for
  strategies to improve medication management

• Risk for medication mismanagement
• Drug Regimen Unassisted Grading Scale (DRUGS)
• Mini-Cog
• Self-report of medication management difficulties

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Statistical Analysis

• Descriptive statistics to report medication
  mismanagement risk.
• Descriptive statistics to report knowledge and
  preferences for medication management supports.
• Medication management tool users and non-users
  will be compared at baseline using two-tailed
  t-tests and chi squared tests as appropriate.

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Summary of Sample

• Total of 89 participants
• Average age 85.6 (/- 5.2) years
• 71 (79.8) female
• 88 (98.9) white
• Average 15.6 (/- 2.7) years education
• Average 4.1 (/- 2.5) prescription medications
• Medications taken an average of 1.8 (/- 1.0)
  times a day

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Medication Mismanagement Risk

• 8 (9.0) self-reported difficulty taking
  medications as prescribed
• 15 (16.8) with possible cognitive impairment (lt3
  on Mini-Cog)
• 25 (28.1) with medication management
  difficulties (lt95 on DRUGS)
• 39 (43.8) at risk based on all 3 categories

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Medication Management Tool Use
Currently using N () Never heard of N ()
Any 76 (85.4)
Self-filled medi-sets 58 (65.2) 1 (1.1)
Easy-open medicine vials 51 (57.3) 10 (11.2)
A calendar 12 (13.5) 34 (38.2)
Pharmacist filled bubble-packs 3 (3.4) 54 (60.7)
Watches with alarms 1 (1.1) 59 (66.3)
Pharmacist filled medi-sets 0 (0) 49 (55.1)
Medi-sets with timers and alarms 0 (0) 59 (66.3)
Countertop devices 0 (0) 81 (91.0)
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Medication Management Tools Willingness to Use
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Human Support and Provider Interaction

• Human Support
• 7/60 (12) were currently receiving help from a
  family member
• 20 (38) of those not currently receiving family
  assistance would consider it if needed

• Provider Interaction
• 17 (19) had asked a provider to simplify their
  medication regimen
• 2 (11) RPH
• 14 (74) MD
• 41 (46) would be comfortable doing so if needed

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Demographic Characteristics By Med Tool Use
Medication tool users (n 76) Medication tool non-users (n 13) p value
Age(years), avg (SD) 85.4 (0.6) 86.8 (1.4) 0.37
Gender (female), n () 60 (78.9) 11 (84.6) 0.64
Education (years), avg (SD) 15.5 (0.3) 16.3 (0.8) 0.34
Total meds , avg (SD) 4.3 (0.3) 3.1 (0.7) 0.10
Number times a day meds are taken, avg (SD) 2.0 (0.1) 1.3 (0.2) 0.03
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Med Mismanagement Risk By Med Tool Use
Medication tool users (n 76) Medication tool non-users (n 13) p value
Self report med problem, n 7 (9.2) 1 (7.7) 0.86
Possible cognitive impairment (lt3 on Mini-cog), n () 10 (13.2) 5 (38.5) 0.02
Medication management difficulties ( lt95 on DRUGS), n 20 (26.3) 5 (38.5) 0.37
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Conclusions

• Risk for medication mismanagement was common
  (44) in this independent-living sample.
• Medication management tool use was high (85),
  although mainly consisted of medi-set use and
  easy open medication containers.
• Medication tool users were less likely to have
  cognitive impairment and were taking medications
  more frequently than non-users.