Longitudinal Investigation of Older Adults' Ability to Self‐Manage Complex Drug Regimens

Abstract

OBJECTIVES We sought to investigate older patients' ability to correctly and efficiently dose multidrug regimens over nearly a decade and to explore factors predicting declines in medication self‐management. DESIGN Longitudinal cohort study funded by the National Institute on Aging. SETTING One academic internal medicine clinic and six community health centers. PARTICIPANTS Beginning in 2008, 900 English‐speaking adults, aged 55 to 74 years, were enrolled in the study, completing a baseline (T1) assessment. To date, 303 participants have completed the same assessment 9 years postbaseline (T4). MEASUREMENTS At T1, subjects were given a standardized, seven‐drug regimen and asked to demonstrate how they would take medicine over 24 hours. The number of dosing errors made and times per day that a participant would take medicine were recorded. Health literacy was measured via the Newest Vital Sign, and cognitive decline was measured by the Mini‐Mental State Examination. RESULTS Participants on average made 2.9 dosing errors (SD = 2.5 dosing errors; range = 0‐21 dosing errors) of 21 potential errors at T1 and 5.0 errors (SD = 2.1 errors; range = 1‐18 errors; P < .001) at T4. In a multivariate model, limited literacy (β = .69; 95% confidence interval [CI] = .18‐1.20; P = .01), meaningful cognitive decline (β = 1.72; 95% CI = .70‐2.74; P = .01), number of chronic conditions (β = .21; 95% CI = .07‐.34; P = .01), and number of baseline dosing errors (β = −.76; 95% CI = −.85 to −.67; P < .001) were significant, independent predictors of changes in dosing errors. Most patients overcomplicated their daily medication schedule; no sociodemographic characteristics were predictive of poor regimen organization in multivariate models. In a multivariate model, there were no significant predictors of changes in regimen consolidation over time, except regimen consolidation at T1. CONCLUSIONS Older patients frequently overcomplicated drug regimens and increasingly made more dosing errors over 9 years of follow‐up. Patients with limited literacy, cognitive decline, and multimorbidity were at greatest risk for errors. J Am Geriatr Soc 68:569–575, 2020

Medication Complexity among Disadvantaged African American Seniors in Los Angeles

“…Our study shows that similar to findings by Bailey et al from a nine year follow-up, patients with multiple co-morbidities were at the greatest risk as well as frequently having complex medication regimens [25] with subsequent negative health outcomes [26]. In another study conducted among 200 community-dwelling seniors, almost half of the participants had medication regimens that were complex; the common causes identified included misunderstanding of medication instructions and polypharmacy [27].…”

Sex differences in multimorbidity and polypharmacy trends: A repeated cross-sectional study of older adults in Ontario, Canada

“…The potential for significant expansion in years lived with multimorbidity [1] has important implications for healthcare outcomes and costs [5,10]. As both the number and heterogeneity of co-occurring chronic conditions increases with age [6,7], older adults are more likely to be exposed to complex drug regimens that place them at risk for inappropriate use [11,12], treatment burden [13], nonadherence [14] and adverse drug events [15][16][17][18]. As with multimorbidity, prevalence estimates of polypharmacy (5+ drugs) and hyper-polypharmacy (10+ drugs) among persons aged 65 and older have increased significantly over the past 20 years [12,19] with recent international estimates ranging between 50-66% and 23-27%, respectively [20][21][22][23].…”

<p>Development of the NIH Patient-Reported Outcomes Measurement Information System (PROMIS) Medication Adherence Scale (PMAS)</p>

“…7 In addition, patients often err in taking their medications as prescribed, and dosing errors are very common among older adults especially. 10,11 Moreover, 20-25% of patients never fill their prescriptions, and about 20% take "drug holidays" (ie, consciously not taking their prescribed medication for a period of time) after filling the prescriptions. 6,7,[12][13][14][15] While there may be multiple causes of poor medication adherence, reasons for not being fully adherent to a given regimen can be broadly grouped into: 1) intentional (ie, a conscious decision to not take their prescribed medication; eg, negative perceptions of medication or its side effects); or 2) non-intentional (eg, dosing errors, forgetfulness, carelessness).…”