Modification of oral dosage forms for the older adult: An Irish prevalence study

Gillicuddy, Aoife Mc; Kelly, Maria; Sweeney, C. Renn Upchurch; Carmichael, Ann; Crean, Abina M.; Sahm, Laura J.

doi:10.1016/j.ijpharm.2016.06.056

Cited by 15 publications

(8 citation statements)

References 44 publications

(63 reference statements)

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“… 31 33 This study further develops the evidence base through the inclusion of nurses working in both acute and long-term care settings and also by investigating modifications to facilitate fractional dosing which have been neglected in qualitative literature thus far. Data from quantitative studies have demonstrated that modifications are prevalent, 15 18 29 46 and alternative formulations are often unavailable or unsatisfactory, 18 47 which confirms the beliefs expressed by nurses about modifications. However, despite this reality, guidance provided to healthcare professionals generally advises that modifications should be avoided.…”

Section: Discussionmentioning

confidence: 64%

“…The topic guide was developed by the authors based on a review of the literature, 34 observations from a prevalence study 18 and the authors’ practical knowledge of the research area. The topic guide was modified following piloting with an experienced geriatric nurse who provided feedback on the content and language.…”

Section: Methodsmentioning

confidence: 99%

“…17 A study undertaken in an Irish nursing home setting that investigated any modification of an ODF for 111 residents found that 35% of residents received at least one modified medication. 18 Modifications have also been widely reported in the literature as being undertaken to facilitate covert administration of medication. 19 20 This practice has recently been the focus of many policy documents in healthcare given the legal and ethical implications of covert administration.…”

Section: Introductionmentioning

confidence: 99%

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Oral medicine modification for older adults: a qualitative study of nurses

et al. 2017

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ObjectiveOral medicines are frequently modified (eg, tablets crushed) for older adults. However, these modifications can have clinical, legal and/or ethical implications. Nurses bear responsibility for medicine administration and hence, perform these modifications. The aim of this study was to investigate the knowledge, attitudes and beliefs of nurses about oral medicine modification for older adults.DesignA qualitative study was conducted using semi-structured, face-to-face interviews with nurses providing care to older adults in acute and long-term care settings. Interviews were audio-recorded, transcribed verbatim and analysed thematically.SettingsSixteen purposively selected care settings; 4 acute-care and 12 long-term care settings were included. Nurses were recruited by convenience sampling at these sites.ParticipantsEighteen nurses participated (83% female, 67% long-term care, 33% acute-care, median age (IQR) 38 years (32.5–52.0)).ResultsThree major themes: modifying—a necessary evil, nurses’ role as patient advocate and modifying—we are working very much as a team and two minor themes: fractional dosing, and covert administration emerged from the data. Nurses viewed oral medicine modifications as being a routine and necessary occurrence in geriatric patient care due to limitations of available formulations and the presence of age-related challenges in drug administration. Nurses’ knowledge of residents’ requirements ensured that they advocate for those with individualised formulation needs, however, nurses rely on pharmacists for information about modifications. Nurses expressed a desire for supports including increased education and ward-specific, pharmacist-developed recommendations on common modifications.ConclusionsThis study has provided useful insights into the views of nurses regarding oral medicine modification for older adults. The unique and varied formulation requirements of older adults must be acknowledged. Increased engagement by healthcare professionals, the pharmaceutical industry, regulatory agencies and policy-makers is required to facilitate the development of age-appropriate formulations. In the interim, practical interventions, informed by the findings of this study, are required.

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Section: Discussionmentioning

confidence: 64%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Oral medicine modification for older adults: a qualitative study of nurses

et al. 2017

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“…The lack of appropriate licensed dosage forms for this population results in dosage forms being routinely modified, with medications affecting the Central Nervous System being the most frequently modified [ 10 ]. While modifications are sometimes necessary to facilitate fractional dosing and to overcome swallowing difficulties, studies and guidelines recommend that modifications are best avoided due to the legal and clinical risks that may arise [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Patient-Centric Medicine Design: Key Characteristics of Oral Solid Dosage Forms that Improve Adherence and Acceptance in Older People

et al. 2020

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Older people represent a very heterogeneous patient population and are the major user group of medication. Age-related changes mean that this population can encounter barriers towards taking medicines orally. The aim of this study was to investigate the characteristics of oral solid dosage forms that contribute to an age appropriate dosage design, with an aim to improve overall medication adherence and acceptance in older people. Fifty-two semistructured interviews were conducted with older people, informal (family) carers, and health and social care professionals. Formulation characteristics impacted three stages of the medication taking process: (1) medication identification and memorability, (2) medication handling and (3) swallowability. Small round tablets (≤7 mm) are least accepted amongst older people and their carers and had a negative impact on all stages. The use of bright, two-coloured preparations and interesting shapes improves identification and further aids memorability of indications and the timing of tablets. Palatability, while useful to enhance swallowability, also has an impact on the visual appeal and memorability of medication. Environmental, patient, medication and disease characteristics also determine preferences for formulation. Developing an age appropriate dosage design for older people, therefore, requires a holistic, patient-centric approach to improve adherence and acceptance.

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“…3,19,20 While modifications may be necessary due to a lack of appropriate licensed formulations, 4,5,19 it is clear from the literature that modifications occur even in situations where alternative formulations are available 3,4,21 and / or in situations where the modification is expressly prohibited by the manufacturers guidelines. 3,4,20,21 Whilst quantitative studies have provided useful evidence on the prevalence of ODF modifications and highlighted concerns, they have not elucidated the factors that influence the decision to modify.…”

Section: Accepted Manuscriptmentioning

confidence: 99%