Family involvement in managing medications of older patients across transitions of care: a systematic review

Abstract

Background As older patients’ health care needs become more complex, they often experience challenges with managing medications across transitions of care. Families play a major role in older patients’ lives. To date, there has been no review of the role of families in older people’s medication management at transitions of care. This systematic review aimed to examine family involvement in managing older patients’ medications across transitions of care. Methods Five databases were searched for quantitative, qualitative and mixed methods empirical studies involving families of patients aged 65 years and older: Cumulative Index to Nursing and Allied Health Literature Complete, Medline, the Cochrane Central Register of Controlled Trials, PsycINFO, and EMBASE. All authors participated independently in conducting data selection, extraction and quality assessment using the Mixed Methods Appraisal Tool. A descriptive synthesis and thematic analysis were undertaken of included papers. Results Twenty-three papers were included, comprising 17 qualitative studies, 5 quantitative studies and one mixed methods study. Families participated in information giving and receiving, decision making, managing medication complexity, and supportive interventions in regard to managing medications for older patients across transitions of care. However, health professionals tended not to acknowledge the medication activities performed by families. While families actively engaged with older patients in strategies to ensure safe medication management, communication about medication plans of care across transitions tended to be haphazard and disorganised, and there was a lack of shared decision making between families and health professionals. In managing medication complexity across transitions of care, family members perceived a lack of tailoring of medication plans for patients’ needs, and believed they had to display perseverance to have their views heard by health professionals. Conclusions Greater efforts are needed by health professionals in strengthening involvement of families in medication management at transitions of care, through designated family meetings, clinical bedside handovers, ward rounds, and admission and discharge consultations. Future work is needed on evaluating targeted strategies relating to family members’ contribution to managing medications at transitions of care, with outcomes directed on family understanding of medication changes and their input in preventing and identifying medication-related problems. Electronic supplementary material The online version of this article (10.1186/s12877-019-1102-6) contains supplementary material, which is available to authorized users.

Ludic strategy for promoting engagement of parents and caregivers in the safety of pediatric patients

“…The international policy developed by the WHO highlights the increasing involvement of patients and family members in the health services, acting on the strategies in the search for safety (10) . Other authors also highlight that the patient and the caregiver play a crucial role in providing information, since they are a constant presence in all the transition times of the team (18) . In this context, the authors note that patient involvement is a shared responsibility between the health team and the patient/family, and that the health professional is responsible for creating opportunities for patient participation (14) .…”

Community-dwelling older adults’ awareness of the inappropriate use of proton pump inhibitors

“…This finding implies that older adults need to be more actively engaged in any discussions about medication- and therapy-related decisions. PCPs and nurses should be responsible for fostering productive discussions about all issues related to medication prescription with their patients [ 21 ].…”

“…Elderly patients (polypharmacy patients specifically) may need to take acid suppressing agents on a long-term basis to avoid gastrointestinal complications [ 5 ]. Hence, reducing or stopping treatment may not be appropriate in these patients’ case, and decisions should only be taken after a complete medical review (review of needs, risks, and benefits of PPI therapy) [ 21 ]. The current survey found age, PPI indication, level of comfort to stop or reduce PPIs, and improvement of GERD symptoms to be statistically significant ( P < 0.05) factors affecting the duration of PPI use among community-dwelling older adults in Jordan.…”

Perception of Inappropriate Use of Proton Pump Inhibitors Among Community-Dwelling Older Adults

“…This nding implies that older adults need to be actively engaged in any discussion of medication therapy-related decisions. PCPs and nurses should be responsible for fostering productive discussions about all issues related to medication prescription with their patients [13].…”