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Medicineworld.org: Older adults can take medicines more safely

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Older adults can take medicines more safely




Elderly adults may be better able to comply with medicine regimens by working with providers to fill out simple paper tables that track what they take and when they take it. Recent experiments observed that use of a "medtable" may help to prevent medication-related problems. A report appears in the recent issue of Journal of Experimental Psychology: Applied, published by the American Psychological Association.

As they age, people often take several different prescription medications. Yet about half of elderly adults are found to take medicine incorrectly and up to one in three of their hospital admissions is blamed on faulty medicine use. Weak collaboration with health-care providers, along with cognitive problems and lower health literacy, are viewed as contributors.



Older adults can take medicines more safely

Psychology experts at the University of Illinois at Urbana-Champaign led by Daniel Morrow, PhD, observed that when pairs of elderly adults filled out a written matrix listing medications and instructions by days and times to take them, they solved medication-related problems more efficiently and accurately, particularly for the complex medicine schedules increasingly common among elderly adults.

In Experiment 1, 96 participants averaging 69 years in age were randomly assigned to the role of patient or provider. These pairs were randomly assigned to use a pre-designed medtable, a blank piece of paper or no aid. To simulate real life, the scientists varied information about both medicine and patient.

In a complex-medicine condition, the scientists provided information about four medications usually used by elderly adults (for example, for high blood pressure, high cholesterol and osteoporosis), including purpose, number of pills and times per day to take them, dose spacing, and special instructions or warnings. In a simple-medicine condition, there were two medications with fewer constraints on when they could be taken together.

In a complex patient-information condition, patients were described as having a strict daily work routine that only let them take their medicine at lunchtime or after work. In a simple patient-information condition, there were no daily restrictions; patients could adjust wake-up times and meal times.

The "patient-provider" pairs completed four problems, one from each of the four conditions created by combining medicine and patient complexity. The pairs had one minute to review each simple-medicine problem and two minutes to review each complex-medicine problem. The scientists told the pairs to share information verbally but not look at each other's information sheets.

Next, the pairs collaborated on schedules that reflected medicine and patient constraints. To simulate the limited patient contact time in routine primary-care visits, collaborators had up to four minutes to work out simple medicine problems and 10 minutes to work out complex problems. After they agreed on the schedule and filled out the matrices, patients described them to an experimenter (reported schedules were audiotaped for later scoring).

The scientists assessed problem-solving accuracy, completion time and efficiency. Accuracy was reflected by total points awarded for meeting medicine requirements (name, number of pills, times/day, dose spacing, etc.). Problem-solving time started when provider and patient began talking and ended when patients said they were ready to describe the schedule (or until time was up). Efficiency divided solution time by accuracy, indicating the time needed to achieve the same level of accuracy across participants.

In comparison to the no-aid condition, the use of both blank paper and the medtable increased collaborative problem-solving accuracy and efficiency while reducing subjective workload, primarily for the complex medicine problems. Scientists noticed that participants found it hard to use that particular design of the medtable, probably because it was too rigid about meal times.

Experiment 2 included 64 elderly adults who also averaged 69 years old, but used a redesigned medtable and raised the maximum time for complex problems from 10 to 15 minutes. With these changes, the authors observed that the medtable compared with blank paper supported significantly more accurate and efficient collaborative problem-solving. These benefits occurred primarily for the complex-schedule problems.

The medtable and blank paper may have made it easier to solve problems by reducing demands on working memory, with the medtable the more effective of the two because it was designed to support problem-solving processes. The authors said the medtable also may help by integrating provider knowledge of medicine with patient knowledge of daily routines.

The authors see this tool as most suitable for pharmacists or nurses who help chronically ill elderly adults manage complex medicine regimens. They wrote that the medtable may also be suitable when time is less of a barrier, such as when nurses or caregivers work with older patients at home. In the future, electronic medtables could possibly expedite the updating of comprehensive medicine lists. The authors wrote, "It would be important for patients to take home a copy of their medtable schedule to guide adherence".

The research team is investigating medtable use by pharmacists and nurses who work with patients with low health literacy, defined by the U.S. Dept. of Health and Human Services as "The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions".


Posted by: Janet    Source




Did you know?
Elderly adults may be better able to comply with medicine regimens by working with providers to fill out simple paper tables that track what they take and when they take it. Recent experiments observed that use of a "medtable" may help to prevent medication-related problems. A report appears in the recent issue of Journal of Experimental Psychology: Applied, published by the American Psychological Association.

Medicineworld.org: Older adults can take medicines more safely

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