Poster Presentations


P-19: Assessment of Limitations by Instruments that Measure Capacity to Manage Medications in Older Adults

Dr. Tejal Patel

Jessica Ivo*, BSc (c),
Maheen Farooqi, BSc (c),
Tejal Patel, BScPharm, PharmD

University Of Waterloo
School of Pharmacy

Topic: Geriatrics

Background/Purpose
An older adult’s capacity to manage medications is dependent on both cognitive and functional ability to self-administer medications as indicated.  Inability to do so increases the risk of adverse health outcomes such as adverse drug events, under- or over- treatment of medical conditions with resulting increase in emergency department visits and hospitalization.  An older adult’s capacity to appropriately manage medications is dependent on factors such as physical limitations, medication regimen complexity, and cognitive capacity. Several instruments have been developed to assess medication management capacity; however, these instruments address the  factors mentioned above to varying degrees. The goal of this project was to determine the extent to which each published instrument examined limitations in medication management capacity among older adults.

Methods
Firstly, factors involved in medication management capacity among older adults were identified through a literature search and review. These factors were classified into four domains and three sub-domains each: “physical abilities” (vision, dexterity, hearing), “cognition” (comprehension, memory, executive functioning), “medication regimen complexity” (dosing regimen, non-oral administration, polypharmacy), and “access & caregiver” (prescription refill, new prescription, caregiver). Secondly,  instruments that evaluate medication management were identified through a recently published systematic review. Authors of published instruments were contacted to obtain the original instruments for evaluation. Each instrument was examined to determine which of the factors of medication management capacity they assessed. Thirdly, the degree (“definitely”, “probably”, “possibly” and “not” assessed) to which each identified instrument assessed each domain and respective sub-domains was assessed. A series of yes/no questions were created for each sub-domain in order to determine the degree of assessment of each instrument.  The frequency of yes responses were then calculated. A frequency of 80% or greater was coded as “definitely assessed” a frequency of 50-79% was coded as “probably assessed” a frequency of 20-49% was coded as “possibly assessed” and a frequency of 19% or less was coded as “not assessed”.

Results
Of the 10 instruments examined, none definitely assessed all four domains identified to impact medication management. In the domain of physical activity, none of the instruments  assessed vision, 40% probably and 50% possibly assessed dexterity, and 90% possibly assessed hearing. Similarly, in the domain of cognition, 10% definitely and 50% probably assessed comprehension, none assessed memory, and 30% probably and 60% possibly assessed executive functioning.  In the domain medication regimen complexity, 10% of instruments definitely and 80% possibly assessed dosing regimen, 20% definitely assessed non-oral administration, and 40% assessed polypharmacy. Finally, in the domain of access & caregiver, none of the instruments assessed prescription refill, 20% probably assessed new prescription, and 30% definitely assessed caregiver.

Discussion
A comprehensive assessment is required to identify all limitations in medication management capacity and therefore, medication adherence, in older adults. Further research is required to develop and validate an instrument which can assess patient specific limitations in medication management capacity as outlined by the domains and sub-domains identified.

Conclusion
No instrument enables a clinician to examine all the domains of medication management capacity in older adults.