Improving Medication Improving Medication Management Support for Management Support for

Older Adults: A Pilot Older Adults: A Pilot StudyStudy

Susan L. Lakey, PharmDSusan L. Lakey, PharmDActing Assistant ProfessorActing Assistant ProfessorUniversity of Washington University of Washington Department of PharmacyDepartment of Pharmacy

April 14, 2008April 14, 2008

BackgroundBackgroundAdherenceAdherence Estimated rate of adherence to medication regimens Estimated rate of adherence to medication regimens

is only 50%.is only 50%. Impact of non-adherence:Impact of non-adherence:

10% of hospital admissions 10% of hospital admissions 23% of nursing home admissions23% of nursing home admissions Estimated yearly cost in U.S. of $100 billionEstimated yearly cost in U.S. of $100 billion

Medication Management CapacityMedication Management Capacity The cognitive and functional ability to take The cognitive and functional ability to take

medications as prescribed. medications as prescribed. Necessary for adherence in persons who self-Necessary for adherence in persons who self-

administer medications. administer medications. Might be addressed by use of supportive Might be addressed by use of supportive

interventions:interventions: medication support devicesmedication support devices human supporthuman support provider interactionprovider interaction

Pilot Study ObjectivesPilot Study Objectives

1.1. Evaluate medication management capacity Evaluate medication management capacity among independent-living older adults in a among independent-living older adults in a continuing care retirement community continuing care retirement community (CCRC).(CCRC).

2.2. Through the use of a survey, evaluate Through the use of a survey, evaluate knowledge about and preferences for knowledge about and preferences for strategies to reduce medication strategies to reduce medication mismanagement risk.mismanagement risk.

3.3. Determine whether knowledge and Determine whether knowledge and preferences are associated with demographic preferences are associated with demographic variables, cognitive status, medication variables, cognitive status, medication management capacity, and medication management capacity, and medication regimen complexity. regimen complexity.

MethodsMethods

DemographicsDemographics Medication regimenMedication regimen Survey assessing knowledge and Survey assessing knowledge and

preferences for strategies to preferences for strategies to improve medication managementimprove medication management

Risk for medication Risk for medication mismanagementmismanagement

Drug Regimen Drug Regimen Unassisted Grading Unassisted Grading Scale (DRUGS)Scale (DRUGS)

Mini-CogMini-Cog Self-report of Self-report of

medication medication management difficultiesmanagement difficulties

Cross-sectional studyCross-sectional study Independent-living residents in a Independent-living residents in a

continuing care retirement community continuing care retirement community (CCRC) in Seattle, Washington(CCRC) in Seattle, Washington

In-person interviews for data collectionIn-person interviews for data collection

Statistical AnalysisStatistical Analysis

Descriptive statistics to report Descriptive statistics to report medication mismanagement risk.medication mismanagement risk.

Descriptive statistics to report Descriptive statistics to report knowledge and preferences for knowledge and preferences for medication management supports. medication management supports.

Medication management tool users Medication management tool users and non-users will be compared at and non-users will be compared at baseline using two-tailed t-tests and baseline using two-tailed t-tests and chi squared tests as appropriate.chi squared tests as appropriate.

Summary of SampleSummary of Sample Total of 89 participantsTotal of 89 participants Average age 85.6 (+/- 5.2) yearsAverage age 85.6 (+/- 5.2) years 71 (79.8%) female71 (79.8%) female 88 (98.9%) white88 (98.9%) white Average 15.6 (+/- 2.7) years educationAverage 15.6 (+/- 2.7) years education Average 4.1 (+/- 2.5) prescription Average 4.1 (+/- 2.5) prescription

medicationsmedications Medications taken an average of 1.8 (+/- Medications taken an average of 1.8 (+/-

1.0) times a day1.0) times a day

Medication Medication Mismanagement RiskMismanagement Risk

8 (9.0%) self-reported difficulty 8 (9.0%) self-reported difficulty taking medications as prescribedtaking medications as prescribed

15 (16.8%) with possible cognitive 15 (16.8%) with possible cognitive impairment (<3 on Mini-Cog)impairment (<3 on Mini-Cog)

25 (28.1%) with medication 25 (28.1%) with medication management difficulties (<95% on management difficulties (<95% on DRUGS)DRUGS)

39 (43.8%) at risk based on all 3 39 (43.8%) at risk based on all 3 categoriescategories

Medication Management Medication Management Tool UseTool Use

Currently usingN (%)

Never heard of N (%)

Any 76 (85.4)Self-filled medi-sets 58 (65.2) 1 (1.1)Easy-open medicine vials 51 (57.3) 10 (11.2)A calendar 12 (13.5) 34 (38.2)Pharmacist filled bubble-packs 3 (3.4) 54 (60.7)Watches with alarms 1 (1.1) 59 (66.3)Pharmacist filled medi-sets 0 (0) 49 (55.1)Medi-sets with timers and alarms 0 (0) 59 (66.3)Countertop devices 0 (0) 81 (91.0)

Medication Management Medication Management Tools Willingness to UseTools Willingness to Use

Human Support and Human Support and Provider InteractionProvider Interaction

Human SupportHuman Support 7/60 (12%) were 7/60 (12%) were

currently receiving currently receiving help from a family help from a family membermember

20 (38%) of those 20 (38%) of those not currently not currently receiving family receiving family assistance would assistance would consider it if neededconsider it if needed

Provider InteractionProvider Interaction 17 (19%) had asked 17 (19%) had asked

a provider to a provider to simplify their simplify their medication regimenmedication regimen 2 (11%) RPH2 (11%) RPH 14 (74%) MD14 (74%) MD

41 (46%) would be 41 (46%) would be comfortable doing comfortable doing so if neededso if needed

Demographic Characteristics Demographic Characteristics By Med Tool UseBy Med Tool Use

Medication Medication tool userstool users(n = 76)(n = 76)

Medication Medication tool non-tool non-

usersusers(n = 13)(n = 13)

p p valuvalu

ee

Age(years), avg Age(years), avg (SD)(SD)

85.4 (0.6)85.4 (0.6) 86.8 (1.4)86.8 (1.4) 0.370.37

Gender (female), Gender (female), n (%)n (%)

60 (78.9)60 (78.9) 11 (84.6)11 (84.6) 0.640.64

Education (years), Education (years), avg (SD) avg (SD)

15.5 (0.3)15.5 (0.3) 16.3 (0.8)16.3 (0.8) 0.340.34

Total # meds , avg Total # meds , avg (SD)(SD)

4.3 (0.3)4.3 (0.3) 3.1 (0.7)3.1 (0.7) 0.100.10

Number times a Number times a day meds are day meds are taken, avg (SD)taken, avg (SD)

2.0 (0.1)2.0 (0.1) 1.3 (0.2)1.3 (0.2) 0.030.03

Med Mismanagement Risk By Med Mismanagement Risk By Med Tool UseMed Tool Use

Medication Medication tool userstool users(n = 76)(n = 76)

MedicatioMedication tool non-n tool non-

usersusers(n = 13)(n = 13)

p p valuvalu

ee

Self report med Self report med problem, n %problem, n %

7 (9.2)7 (9.2) 1 (7.7)1 (7.7) 0.860.86

Possible cognitive Possible cognitive impairment (<3 on impairment (<3 on Mini-cog), n (%)Mini-cog), n (%)

10 (13.2)10 (13.2) 5 (38.5)5 (38.5) 0.020.02

Medication Medication management management difficulties ( <95% on difficulties ( <95% on DRUGS), n %DRUGS), n %

20 (26.3)20 (26.3) 5 (38.5)5 (38.5) 0.370.37

ConclusionsConclusions Risk for medication mismanagement was Risk for medication mismanagement was

common (44%) in this independent-living common (44%) in this independent-living sample.sample.

Medication management tool use was high Medication management tool use was high (85%), although mainly consisted of medi-(85%), although mainly consisted of medi-set use and easy open medication set use and easy open medication containers.containers.

Medication tool users were less likely to Medication tool users were less likely to have cognitive impairment and were taking have cognitive impairment and were taking medications more frequently than non-medications more frequently than non-users.users.