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

2. 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

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

4. 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

5. 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.

6. 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

7. Medication Mismanagement Risk 8 (9.0%) self-reported difficulty taking medications as prescribed 15 (16.8%) with possible cognitive impairment (<3 on Mini-Cog) 25 (28.1%) with medication management difficulties (<95% on DRUGS) 39 (43.8%) at risk based on all 3 categories

8. Medication Management Tool Use

9. Medication Management Tools Willingness to Use

10. 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

11. Demographic Characteristics By Med Tool Use

12. Med Mismanagement Risk By Med Tool Use

13. 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.