A multi-centre survey among informal carers who manage medication for older care recipients: problems experienced and development of services

Abstract

The UK Government has highlighted the need to develop appropriate information and support services for informal carers. Previous research that has investigated informal caring has found that managing medication is one aspect of the caring role that presents its own problems; however, these have not been subject to detailed examination. The objective of the present paper was to report the number and type of problems experienced by informal carers when managing medication for older care recipients, and to relate these to measures of coping and health. This was a cross-sectional survey undertaken in one district in each of four randomly selected health authority areas in England. Structured interviews, comprising closed and open questions, with 184 informal carers and 93 associated older care recipients were conducted in participants' own homes. Data were gathered on the number and type of medication-related problems experienced in relation to the informal caring role, and the impact of these from carers' perspectives in terms of coping and health. Sixty-seven per cent of carers reported problems with at least one medication-related activity. Problems were associated with all types of medication-related activities, and experienced by carers providing different levels of care for older people. Four themes were identified from carers' accounts which illustrated a diversity of practical problems and anxieties: maintaining continuous supplies of medication in the home; assisting with administration; making clinical judgements; and communicating with care recipients and health professionals. Carers reporting greater numbers of medication-related problems were more likely to experience higher levels of carer strain (P < 0.001) and poorer mental health status (P < 0.001). The findings of the present study provide insights to inform the development of primary care services to support informal carers in the management of medication for older people.

Consumer perspectives of the Australian Home Medicines Review Program: Benefits and barriers

“…Similar problems have been identified by Smith et al 17 who found that approximately 5% of the carers who participated in their study wanted more information on routine medication details. 17 Whilst the carers in Smith's study reported problems of not being informed about their care recipients' medication changes, they were at the same time aware of the prescribers' dilemma in juggling information disclosure to carers with the care recipients' right to privacy.…”

“…Similar problems have been identified by Smith et al 17 who found that approximately 5% of the carers who participated in their study wanted more information on routine medication details. 17 Whilst the carers in Smith's study reported problems of not being informed about their care recipients' medication changes, they were at the same time aware of the prescribers' dilemma in juggling information disclosure to carers with the care recipients' right to privacy. 17 Other studies found that managing medication contributed to the stress of caring, 18 that carers generally expressed stronger information needs and required different types of information than patients, 19 and that the provision of specific information to carers was vital in the process of developing competency as a carer.…”

“…17 Whilst the carers in Smith's study reported problems of not being informed about their care recipients' medication changes, they were at the same time aware of the prescribers' dilemma in juggling information disclosure to carers with the care recipients' right to privacy. 17 Other studies found that managing medication contributed to the stress of caring, 18 that carers generally expressed stronger information needs and required different types of information than patients, 19 and that the provision of specific information to carers was vital in the process of developing competency as a carer. 20 21 The under met information need of carers has been shown to cause widespread carers' dissatisfaction [22][23][24] and added to the carers' difficulty in defining their caring position in relation to the care recipient and their health care professionals.…”

Medication management concerns of ethnic minority family caregivers of people living with dementia

“…From a family caregiver's perspective, medication management includes maintaining continuous supplies of medications, assisting with administration, making clinical judgements and communicating with health care providers and care recipients (Smith, Francis, Gray, Denham & Graffy 2003). Brodaty and Green (2002) note that this involves being informed about what is prescribed, asking relevant questions of health care professionals, monitoring for medication adherence, watching for medication-related side effects and granting or refusing consent for medications where the care recipient is no longer able to give this.…”

“…While general studies of medication management by family caregivers of older adults are available (Travis, Bethea & Winn 2000;Smith et al 2003;Travis et al 2003;Francis, Smith, Gray & Denham 2006), few studies have focused exclusively on family caregivers of people living with dementia (Cotrell et al 2006, Kaasalainen et al 2011, While et al 2012. In particular, studies of the medication management experience of ethnic minority family …”