Medication management among home-dwelling older patients with chronic diseases: Possible roles for community pharmacists

• Published in: The Journal of nutrition, health & aging health & aging, 2012-08, Vol.16 (8), p.721-726
• Main Authors: Mehuys, Els, Dupond, L, Petrovic, M, Christiaens, T, Van Bortel, L, Adriaens, E, De Bolle, L, Van Tongelen, I, Remon, J. -P, Boussery, K
• Format: Article
• Language: English
• Subjects: Activities of Daily Living; Aged; Aged, 80 and over; Aging; Aging - psychology; Belgium - epidemiology; benzodiazepines; Biological and medical sciences; central nervous system diseases; chronic diseases; Chronic illnesses; Cognitive Dysfunction - epidemiology; Cognitive Dysfunction - psychology; Cross-Sectional Studies; deglutition; Drug Interactions; Drug stores; drug therapy; drugs; elderly; Feasibility Studies; Feeding. Feeding behavior; Female; Fundamental and applied biological sciences. Psychology; Geriatrics/Gerontology; Humans; Male; Medication Adherence; Medication Therapy Management; Medicine; Medicine & Public Health; Needs Assessment; Neurosciences; Nutrition; observational studies; Older people; patients; Pharmaceuticals; Pharmacies; Pharmacists; Polypharmacy; Prescription drugs; Primary Care Medicine; Professional Role; Psychotropic Drugs - administration & dosage; Psychotropic Drugs - adverse effects; Psychotropic Drugs - therapeutic use; Quality of Life Research; questionnaires; screening; Vertebrates: anatomy and physiology, studies on body, several organs or systems; vision; Workforce
• ISSN: 1279-7707; 1760-4788
• DOI: 10.1007/s12603-012-0028-x

OBJECTIVE: To describe medication management among home-dwelling older adults. These data should allow us to identify potential problems and to indicate target areas for community pharmacist intervention. DESIGN: Cross-sectional observational study. SETTING: Community pharmacies (n=86) in Belgium. PARTICIPANTS: Home-dwelling older adults using at least one chronic medicine (n=338). MEASUREMENTS: Data on drug use were taken from the electronic pharmacy databases, while drug adherence was measured by pill count, self-report and estimation by GP and pharmacist. Drug knowledge and practical drug management capacity were assessed by patient interview and questionnaire, respectively. RESULTS: The study population (n=338) used a median of 5 chronic drugs per patient. Half of our sample (n=169) used psychotropic medication chronically, mainly benzodiazepines. In 100 patients (29.6%) at least one drug-drug interaction of potential clinical significance was observed. The overall mean adherence per patient was very high (98.1%), but 39.6% of individuals was underadherent with at least one medication. Seventy-six % of patients had an acceptable knowledge of the indication for at least 75% of their medication. In nearly 15 % of the study population cognitive impairment was suspected by the Mini-Cog Test. The participants reported several practical problems with drug taking; difficulties with vision (32.0%), blister opening (12.1%), tablet swallowing (14.8%), tablet splitting (29.7% [represents % of patients who have to split tablets]) and distinction between different drug packages (23.4%). CONCLUSION: This study identified the following aspects of medication management by home-dwelling older adults that could be improved by pharmaceutical care sendces; (i) assistance of cognitively impaired patients, (ii) management of practical drug taking problems, (iii) DDI screening, (iv) drug adherence, and (v) chronic benzodiazepine use.