The process of medication management for older adults with dementia

Abstract

kaasalainen s, dolovich l, papaioannou a, holbrook a, lau e, ploeg j, levine m, cosby j & emily a (2011) Journal of Nursing and Healthcare of Chronic Illness 3, 407–418 The process of medication management for older adults with dementia Aim. The purpose of this study was to explore the personal experiences related to medication management of community‐dwelling older adults diagnosed with dementia, their informal caregivers, as well as healthcare professionals who assist them. Background. Older adults who have dementia face many challenges in managing their medications while living in the community. Medication regimens used to treat a variety of conditions in older adults with dementia are usually overseen and coordinated by healthcare professionals such as community nurses, physicians and pharmacists, but often, more supports are needed. However, little research has been conducted to study the barriers and facilitators to medication adherence in this unique population. Methods. Using a grounded theory approach, 57 interviews were completed (10 nurses, 10 pharmacists, 6 physicians, 20 caregivers and 11 patients) in southern Ontario, Canada, in 2007. Findings. The findings indicate that the processes of medication management differ according to the level of dementia. A number of corresponding facilitators and barriers to medication management were identified. Medication management in early stage dementia is characterised by patients’ desire to maintain independence, denial of issues or disease, and a refusal to take medications owing to feeling angry. In late‐stage dementia, older adults often refuse medications owing to delusional or suspicious thinking, which results in caregivers assuming responsibility for managing their medications. Conclusions. Older adults with dementia, their informal caregivers and the healthcare professionals who assist them are faced with the challenges of declining cognitive function and memory while trying to manage medications at home. However, a number of adherence strategies appear to be helpful and should be considered. Relevance to clinical practice. Healthcare professionals struggle with helping older adults who have dementia manage medications safely and therapeutically, often with little resources to draw from. Future work is needed to design, implement and evaluate supportive networks and interventions with the goal of helping older adults with dementia manage their medications better while living in the community.

Managing medications: the role of informal caregivers of older adults and people living with dementia. A review of the literature

“…Subsequently, in a qualitative study conducted by Kaasalainen et al . (), the following strategies were suggested as being useful: establishing medication routines, using dose administration aids, hiding medication in foods, simplifying dosage regimens and using liquid oral medications (where possible) to improve medication compliance.…”

Characterizing Caregiver-Mediated Medication Management in Patients with Memory Loss

“…Additionally, caregivers indicated that they were “on duty” for much of the day. Given these findings along with the frailty of the patients and the number of medications that patients were taking, our caregivers demonstrated that medication management, when patients have memory loss, is burdensome and complicated by the patient’s physical, behavioral, and cognitive problems supporting work by Kaasalainen et al (2011).…”

“…When caregivers trust that patients are taking their medications correctly, they exert little, if any, control over that situation. Similarly, Kaasalainen and colleagues (2011) found that the severity of the patient’s dementia influences medication management. Research is needed to more comprehensively address the complex nature of medication management in patients with cognitive decline and support the theoretical basis for interventions (Banning, 2009).…”

Disability in Instrumental Activities of Daily Living in Elderly Patients with Mild Cognitive Impairment and Alzheimer‘s Disease

“…The discrepancy in domains reported as problematic in the studies may be due to different assessment scales or scoring procedures of IADL. The information of disability in the items shopping, food preparation and responsibility for own medication in our study is interesting since malnutrition and compliance regarding medication are often reported among elderly people with dementia [32,33]. …”