Ability of older people with dementia or cognitive impairment to manage medicine regimens: a narrative review

Abstract

Impaired cognition has a significant impact on a person’s ability to manage their medicines. The aim of this paper is to provide a narrative review of contemporary literature on medicines management by people with dementia or cognitive impairment living in the community, methods for assessing their capacity to safely manage medicines, and strategies for supporting independent medicines management. Studies and reviews addressing medicines management by people with dementia or cognitive impairment published between 2003 and 2013 were identified via searches of Medline and other databases. The literature indicates that as cognitive impairment progresses, the ability to plan, organise, and execute medicine management tasks is impaired, leading to increased risk of unintentional non-adherence, medication errors, preventable medication-related hospital admissions and dependence on family carers or community nursing services to assist with medicines management. Impaired functional capacity may not be detected by health professionals in routine clinical encounters. Assessment of patients’ (or carers’) ability to safely manage medicines is not undertaken routinely, and when it is there is variability in the methods used. Self-report and informant report may be helpful, but can be unreliable or prone to bias. Measures of cognitive function are useful, but may lack sensitivity and specificity. Direct observation, using a structured, standardised performance-based tool, may help to determine whether a person is able to manage their medicines and identify barriers to adherence such as inability to open medicine packaging. A range of strategies have been used to support independent medicines management in people with cognitive impairment, but there is little high-quality research underpinning these strategies. Further studies are needed to develop and evaluate approaches to facilitate safe medicines management by older people with cognitive impairment and their carers.

Management of multiple myeloma in older adults: Gaining ground with geriatric assessment

“…Another consideration in weighing therapeutic options is that older adults with cognitive impairment may have greater difficulty adhering to a complex regimen of oral medications unless they have adequate caregiver support to assist with self-administration of medications. 27 …”

Everyday functional ability in HIV and methamphetamine dependence

“…Many studies of everyday functional ability, including those conducted in HIV and substance dependence (Blackstone et al, 2013; Sadek et al, 2007) have used self-report measures that ask the individual to rate how well they perform activities of daily living. We (Henry et al, 2010) and others (Elliott et al, 2015; Karagiozis et al, 1998; Patterson et al, 2001a) have proposed that reliance on self-report is problematic especially during the study of conditions with known cognitive impairment. Performance-based functional measures, such as the UCSD Performance Based Skills Assessment (UPSA-2), are useful in that they divide everyday function into specific components and have high reliability and validity (Patterson et al, 2001a; Patterson et al, 2001b), e.g., comprehension and planning abilities, financial skills, knowledge in use of transportation and managing the household, and the extent to which individuals can internalize and plan to take a complex daily regimen of medications.…”

Cognitive screening during pharmacist medication reviews

“…There are a range of these tools available, and they can provide valuable information about patients' abilities to manage medications at the same time as identifying potential cognitive impairment. 3,4 A systematic review of these tools reported moderate to strong associations between performance on standardised medication management assessments and cognitive function. 3 Some medication management assessment tools were originally designed primarily for the purpose of screening for cognitive impairment, 5 since a decline in ability to manage medications may be an early sign of cognitive decline.…”

“…3 Some medication management assessment tools were originally designed primarily for the purpose of screening for cognitive impairment, 5 since a decline in ability to manage medications may be an early sign of cognitive decline. 4 Standardised medication management assessment tools use either the patient's own medications or a mock medication regimen. They require the patient to perform various tasks such as read medication labels, remove medications from packaging and set out medications for the day.…”

“…Examples include the Drug Regimen Unassisted Grading Scale (DRUGS) and the Medication Management Ability Assessment (MMAA). 3,4 Application of these tools takes an average of 10-15 min, depending on the tool and the patient, 3 which could be feasible during an HMR consultation.…”