Medication: Management Matters
A Toolkit to Promote Improved Medication Management
for Community Dwelling Older Adults
Age Related Changes
Adults aged 75 and older take an average of 7.9 prescription drugs every day. Twenty five percent of independent community dwelling older adults take a daily average of 3 drugs, and seventy one percent of community dwelling adults who receive help with activities of daily living take 3 to 7 medications each day. Yet, the use of multiple medications increases the risk of medication misuse related to poor health outcomes. Error in drug use among older adults has been shown to increase the frequency of:
· visits to outpatient settings and emergency rooms
· lab workups
· medications and medication side-effects
· recurring illness
· early death
Medication management refers to an individual’s ability to obtain, organize, and follow directions for taking their medication. Older adults are at an increased risk of harm from poor medication management which can result in relocation and potentially threaten a community dwelling elder’s ability to remain in their home. Along with increased risk to the individual, medication misuse increases the cost of health care. It is estimated that the direct and indirect health care cost of inadequate medication adherence alone is $177 billion annually.
Given the serious impact on the quality of life for older adults, and with the current crisis of escalating health care costs, the issue of medication management is of critical interest to anyone with an interest in serving older adults.
There are a variety of programs and resources available for medication administration in assisted care settings. These programs typically train formal care providers how to administer medication within legal parameters and how to document this care provision. For many who assist older adults to remain in their home, medication administration is not their proper or legal role.
There is a need for a cohesive resource of information on medication management for non-medical helping professionals who assist community dwelling older adults.
What is this toolkit?
This toolkit is a collection of evidence based information and electronically available resources selected to:
· Develop your awareness of the importance of medication management and help you understand why and how all professionals and care providers who serve older adults play a critical role in the success of medication management.
· Increase your competence to support strategies for improved medication management for community dwelling older adults and thereby assist them in their capacity to age in place.
Items selected for the toolkit can be adapted for use by care professionals in a variety of settings. Many can be downloaded and copied for use.
Who can use this toolkit?
Anyone who is planning to work with or on behalf of older adults, whether the services they plan to provide are in the home, hospital, doctor’s office, skilled nursing or rehabilitation facility, community program, or even in public policy. Medication management touches every aspect of people’s lives and everyone is a stakeholder in this important issue.
How is this toolkit organized?
Along with this introduction, the toolkit has four main sections, called modules. Each module includes: learning objectives, definitions, activities, self evaluation questions, and additional resources.
· Module one provides an introduction to the basic physiological changes associated with aging that impact medication management in older adults.
· Module two explores the impact of medication adherence on the health and well being of older adults.
· Module three explains the significance of care transitions in the medication management process.
· Module four incorporates information about medication management for adults aging with intellectual or developmental disabilities.
Ready to begin?
While the modules and activities can be utilized individually, to achieve the most benefit from the toolkit start with module one and proceed in order through the other modules.
Icons in each module will help identify activities. Click on the link next to the icon to open an activity.
Read it (it’s important!)
Watch it (the time is listed next to each video clip)
Check it out (helpful tools, tips, & terms)
Geriatric Nursing, 27(3), 174-182. http://dx.doi.org/10.1016/j.gerinurse.2006.03.003
Enhancing prescription medicine adherence: A national action plan (Report). (2007). Retrieved from National Council on Patient Information and Education website: http://www.talkaboutrx.org/index.jsp
Roth, M. T., Esserman, D. A., Ivey, J. L., & Weinberger, M. (2009). Racial disparities in the quality of medication use in older adults: Baseline findings from a longitudinal study. Journal of General Internal Medicine, 25(3), 228-234. http://dx.doi.org/ 10.1007/s11606-009-180-9
Roth, M. T., Weinberger, M., & Campbell, W. H. (2009). Measuring quality of medication use in older adults. Journal of the American Geriatrics Society, 57, 1096-1102. http://dx.doi.org/ 10.1111/j.1532-5415.2009.02243.x
Schlenk, E. A., Dunbar-Jacob, J., & Engberg, S. (2004). Medication non-adherence among older adults: A review of strategies and interventions for improvement. Journal of Gerontological Nursing, 33-43.
Steinman, M.A., & Hanlon, J.T. (2010). Managing medications in clinically complex elders: “There’s got to be a happy medium”. Journal of the American Medical Association, 304(14), 1592-1601. http://dx.doi.org/10.1001/jama.2010.1482
Gerontology graduate project developed by:
Felicia Juntunen, BSW, MA
California State University, Sacramento
Activities of daily living (ADLs):
Bathing, dressings, toileting, transferring, feeding
The degree to which a patient follows a prescribed regimen
Age in place:
Enabling people to stay in their homes/ preferred place of residence and programs as they age
Assisted care setting:
A housing option for older adults who do not have severe medical issues but do need assistance with some ADLs.
Residing in one’s own home, either with or without assistance.
The ability to obtain, organize, and follow directions for taking medication