Improving Medication Management Support for Older Adults: A Pilot Study Susan L. Lakey, PharmD Acting Assistant Professor University of Washington Department of Pharmacy April 14, 2008

Background Adherence Estimated rate of adherence to medication regimens is only 50%. Estimated rate of adherence to medication regimens is only 50%. Impact of non-adherence: Impact of non-adherence: 10% of hospital admissions 10% of hospital admissions 23% of nursing home admissions 23% of nursing home admissions Estimated yearly cost in U.S. of $100 billion Estimated yearly cost in U.S. of $100 billion Medication Management Capacity The cognitive and functional ability to take medications as prescribed. The cognitive and functional ability to take medications as prescribed. Necessary for adherence in persons who self-administer medications. Necessary for adherence in persons who self-administer medications. Might be addressed by use of supportive interventions: Might be addressed by use of supportive interventions: medication support devices medication support devices human support human support provider interaction provider interaction

Pilot Study Objectives 1. Evaluate medication management capacity among independent-living older adults in a continuing care retirement community (CCRC). 2. Through the use of a survey, evaluate knowledge about and preferences for strategies to reduce medication mismanagement risk. 3. Determine whether knowledge and preferences are associated with demographic variables, cognitive status, medication management capacity, and medication regimen complexity.

Methods Demographics Demographics Medication regimen Medication regimen Survey assessing knowledge and preferences for strategies to improve medication management Survey assessing knowledge and preferences for strategies to improve medication management Risk for medication mismanagement Drug Regimen Unassisted Grading Scale (DRUGS) Mini-Cog Self-report of medication management difficulties Cross-sectional study Cross-sectional study Independent-living residents in a continuing care retirement community (CCRC) in Seattle, Washington Independent-living residents in a continuing care retirement community (CCRC) in Seattle, Washington In-person interviews for data collection In-person interviews for data collection

Statistical Analysis Descriptive statistics to report medication mismanagement risk. Descriptive statistics to report medication mismanagement risk. Descriptive statistics to report knowledge and preferences for medication management supports. Descriptive statistics to report knowledge and preferences for medication management supports. Medication management tool users and non- users will be compared at baseline using two- tailed t-tests and chi squared tests as appropriate. Medication management tool users and non- users will be compared at baseline using two- tailed t-tests and chi squared tests as appropriate.

Summary of Sample Total of 89 participants Total of 89 participants Average age 85.6 (+/- 5.2) years Average age 85.6 (+/- 5.2) years 71 (79.8%) female 71 (79.8%) female 88 (98.9%) white 88 (98.9%) white Average 15.6 (+/- 2.7) years education Average 15.6 (+/- 2.7) years education Average 4.1 (+/- 2.5) prescription medications Average 4.1 (+/- 2.5) prescription medications Medications taken an average of 1.8 (+/- 1.0) times a day Medications taken an average of 1.8 (+/- 1.0) times a day

Medication Mismanagement Risk 8 (9.0%) self-reported difficulty taking medications as prescribed 8 (9.0%) self-reported difficulty taking medications as prescribed 15 (16.8%) with possible cognitive impairment (<3 on Mini-Cog) 15 (16.8%) with possible cognitive impairment (<3 on Mini-Cog) 25 (28.1%) with medication management difficulties (<95% on DRUGS) 25 (28.1%) with medication management difficulties (<95% on DRUGS) 39 (43.8%) at risk based on all 3 categories 39 (43.8%) at risk based on all 3 categories

Medication Management Tool Use Currently using N (%) Never heard of N (%) Any76 (85.4) Self-filled medi-sets58 (65.2)1 (1.1) Easy-open medicine vials51 (57.3)10 (11.2) A calendar12 (13.5)34 (38.2) Pharmacist filled bubble-packs3 (3.4)54 (60.7) Watches with alarms1 (1.1)59 (66.3) Pharmacist filled medi-sets0 (0)49 (55.1) Medi-sets with timers and alarms0 (0)59 (66.3) Countertop devices0 (0)81 (91.0)

Medication Management Tools Willingness to Use

Human Support and Provider Interaction Human Support 7/60 (12%) were currently receiving help from a family member 7/60 (12%) were currently receiving help from a family member 20 (38%) of those not currently receiving family assistance would consider it if needed 20 (38%) of those not currently receiving family assistance would consider it if needed Provider Interaction 17 (19%) had asked a provider to simplify their medication regimen 2 (11%) RPH 14 (74%) MD 41 (46%) would be comfortable doing so if needed

Demographic Characteristics By Med Tool Use Medication tool users (n = 76) Medication tool non-users (n = 13) p value Age(years), avg (SD) 85.4 (0.6) 86.8 (1.4) 0.37 Gender (female), n (%) 60 (78.9) 11 (84.6) 0.64 Education (years), avg (SD) 15.5 (0.3) 16.3 (0.8) 0.34 Total # meds, avg (SD) 4.3 (0.3) 3.1 (0.7) 0.10 Number times a day meds are taken, avg (SD) 2.0 (0.1) 1.3 (0.2) 0.03

Med Mismanagement Risk By Med Tool Use Medication tool users (n = 76) Medication tool non-users (n = 13) p value Self report med problem, n % 7 (9.2) 1 (7.7) 0.86 Possible cognitive impairment (<3 on Mini-cog), n (%) 10 (13.2) 5 (38.5) 0.02 Medication management difficulties ( <95% on DRUGS), n % 20 (26.3) 5 (38.5) 0.37

Conclusions Risk for medication mismanagement was common (44%) in this independent-living sample. Risk for medication mismanagement was common (44%) in this independent-living sample. Medication management tool use was high (85%), although mainly consisted of medi-set use and easy open medication containers. Medication management tool use was high (85%), although mainly consisted of medi-set use and easy open medication containers. Medication tool users were less likely to have cognitive impairment and were taking medications more frequently than non-users. Medication tool users were less likely to have cognitive impairment and were taking medications more frequently than non-users.