Espejo, Edie

Growdon, Matthew E

Steinman, Michael A

Tang, Belinda

eScholarship - University of California

UCSFUC San Francisco Previously Published WorksTitleCognitive, physical, and sensory deficits that can affect everyday medication use among older adults: A national viewPermalinkhttps://escholarship.org/uc/item/54c515k7AuthorsTang, BelindaEspejo, EdieSteinman, Michael Aet al.Publication Date2024-04-10DOI10.1111/jgs.18922Copyright InformationThis work is made available under the terms of a Creative Commons Attribution License, available at https://creativecommons.org/licenses/by/4.0/ Peer reviewedeScholarship.org Powered by the California Digital LibraryUniversity of CaliforniaTitle: Cognitive, Physical, and Sensory Deficits That Can Affect Everyday Medication Use Among Older Adults: A National ViewAuthors: Belinda Tang BS1,2, Edie Espejo MA3,4, Michael A. Steinman MD3,4, Matthew E. Growdon MD, MPH3,4Affiliations: 1State University of New York (SUNY) Upstate Medical University, Syracuse, NY, US2Medical Student Training in Aging Research (MSTAR) Program 3Division of Geriatrics, University of California-San Francisco, San Francisco, California, US4San Francisco VA Medical Center, San Francisco, California, US Running title: Deficits That Can Affect Medication Use Correspondence: Belinda Tang, 750 East Adams Street, Syracuse, NY 13202Phone: 408-775-9758; Email: tangbe@upstate.edu Manuscript word count: 745, Tables: 1, 1 Figure12345678910111213141516171819Introduction: Age-related changes make medication management more difficult. Older adults face medication management challenges in the domains of cognition (e.g., dementia, which may lead to issues with remembering medication schedules and dosages), physical ability (e.g., hand dexterity and strength, which may include difficulty opening pill bottles), and/or sensory ability (e.g., limited vision, which may present as problems reading medication labels). Challenges across these domains are associated with non-adherence1, medication errors2, and preventable medication-related hospital admissions.3 Fortunately, these repercussions can be mitigated by social and/or institutional supports, such as moving to more supportive forms of housing, as well as safer prescribing and dispensing practices. To understand the scope of these challenges among older adults, we sought to determine the national prevalence of overlapping and compounding cognitive, physical, and sensory impairments that can impact medication management abilities, how these impairments vary across living sites, and by whether one receives help with medication management. Methods: We conducted a cross-sectional study of a nationally representative sample of older adults who reported taking a prescription medication in the last month from the 2015 National Health and Aging Trends Study (NHATS). Key impairments included: cognition (defined as possible/probable dementia using a validated NHATS algorithm4), physical ability in grip strength and dexterity (defined as self-reported difficulty opening a jar), and vision (defined as self-reported blindness or difficulty reading newspaper size font with or without visual aids).5 2021222324252627282930313233343536373839404142Number of impairments was graded (0, 1, or ≥2) and (1) stratified across four living sites that encompassed a spectrum of living arrangements from community to nursing homes and (2) by medication management practices (self-managed or received some/complete help).Results: The unweighted sample included 6,592 individuals, representing over 35 million older adults; 55% were 65 to 74 years, 32% were 75 to 84 years, 13% were ≥85 years, and 56% were female (Table 1). Most (95%) lived in the community (as opposed to residential facilities where medication management supports are commonly provided). Overall, 37% had at least one measured impairment that could affect medication use. Specifically, 16% had possible or probable dementia, 26% were unable to open a jar, and 4% were unable to read newspaper size font with or without visual aids. The percentage of people with ≥1 impairment(s) increased as the living site care level increased (ranging from 35% in the community to 95% in nursing homes).  Overall, 86% of study subjects managed medications by themselves. Among this group,31% had at least one impairment (Figure 1), with inability to open a jar as the most common challenge. Discussion: Cognitive, physical, and sensory impairments that can negatively impact everyday medication use are common, with approximately one-third of older adults nationally reporting having at leastone measured deficit. Of those who managed medications independently, 31% reported having atleast one of the measured impairments. Our findings provide insights into the potential challenges older patients may encounter and supports needed for safe and effective medication 4344454647484950515253545556575859606162636465use. Understanding the challenges of independent medication use is especially important among older adults because they are more at risk for polypharmacy and burdened by complex medication regimens.6 Importantly, our study showed that 35% of older adults living in the community have at least onedeficit that can impact medication safety and adherence. Supporting this population of 33 millionin medication management is especially important because this is a group that may not have built-in supports. Possible solutions include modifications such as blister packs5,7,  building a network of formal (e.g., IHSS) and/or informal (e.g., family) supports8, and changing prescribingpractices to enhance feasibility of use (i.e., use of combination drugs and less-frequent dosing regimens). There are additional factors that can impact a person’s ability to manage medications. We described factors that were most pertinent to the act of taking medicines.9 Limitations to our study include using survey measures that are not validated for medication management, inability to assess other impairments such as finger dexterity that can pose further challenges for medication use, accuracy of proxy responses, and not knowing the number and type of medications taken. Our study suggests that deficits in the domains of cognition, physical ability, and/or sensory ability that can negatively impact medication use are common among older adults who take prescription medications. Assessing patients’ cognitive, physical, and sensory abilities to take medicines, social supports, and living situations will help clinicians better prescribe safe 6667686970717273747576777879808182838485868788medications, connect patients to optimal supports, and spark specific interventions to help everyday medication use. 899091DisclosuresFunding/support: This research was funded by The Medical Student Training in Aging Research Program and the National Institute on Aging (T35AG026736). The following authors were supported by the National Institute on Aging (NIA): Dr. Growdon (NIA R03AG078804) and Dr. Steinman (NIA R24AG064025 , K24AG049057 , P30 AG044281). Dr. Growdon was additionally supported by AHRQ K12HS02638.Previous Presentation: This project was accepted in abstract form for the American Geriatrics Society Annual Scientific Meeting in Long Beach, CA (May 5th, 2023) Acknowledgments Conflict of interest statement: Dr. Steinman received personal fees from UpToDate Royalties for authoring a chapter in UpToDate and personal fees from American Geriatrics Society Honoraria for serving as co-chair of the American Geriatrics Society Beers Criteria Guideline Panel outside the submitted work. The authors have no other disclosures to report.Concept and design: Tang, Steinman, Growdon.Acquisition, analysis, or interpretation of data: Tang, Steinman, Growdon.Preparation of the manuscript: Tang.Critical revision of the manuscript for important intellectual content: All authors.Statistical analysis: Tang, Espejo.Obtained funding: Steinman, Growdon.9293949596979899100101102103104105106107108109110111112113Supervision: Steinman, Growdon.Role of the Sponsor: The National Institute on Aging and the National Institutes of Health had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.114115116117118119120Table 1: Cohort CharacteristicsaCharacteristics Unweighted Respondents, No.National Estimate, (%) weighted, Representing N= 35 million older adultsAge65-74 2,397 5575-84 2,667 3285+ 1,528 13Female 3,829 56Race/EthnicityWhite, non-Hispanic 4,622 81Black, non-Hispanic 1,383 8Hispanic 393 7Other 194 4Education (highest attainment)Below high school 1,470 18High school 1,788 27Beyond high school 3,334 56Living arrangementAlone 2,237 30With Spouse or Spouse and Others3,161 56Others Only 1,194 14Reported Health StatusExcellent or Very Good 2,468 43Good 2,315 33Fair or Poor 1,809 24121Number of Chronic Illnesses 0-1 1,373 242-3 3,476 52>3 1,743 24Deficits Among Community Dwelling Older Adults  National Estimate, (%) weighted,Representing N= 33 million older adults0 3614 651 1930 282+ 676 7Deficits Among Older Adults in Independent Living Facility SettingsNational Estimate, (%) weighted,Representing N= 750 thousand older adults0 82 511 58 332+ 26 16Note: a Results are adjusted for weights and survey design to produce nationally representative estimates. Other race/ ethnicity includes people who reported their race/ethnicity as American Indian, Asian, Native Hawaiian, Pacific Islander, Other, Do not know, or More than one race/ethnicity. Independent living facility settings referred to living in the independent living 122123124125126127section (as opposed to the assisted living setting) of a multiunit facility in which services for activities of daily living were available.10 Chronic conditions include health history of myocardial infarction, hypertension, heart disease, lung disease, diabetes, arthritis, osteoporosis, stroke, or cancer.  Data for medication deficits among assisted living facility and nursing home residents are not reported due to small cell sizes. Figure 1:  Prevalence of impairments that can affect everyday medication use among older adults, by medication management practices (self vs. receiving some/complete help). Among older adults as a group, 86% manage medications by themselves (represented by left column). Within this group, 69% had none of the measured impairments, 27% had one impairment, and 4% had two or more impairments; specifically, 10% had dementia, 23% were unable to open a jar, and 3% were unable to read newspaper sized fonts. These measures are survey weighted to provide national estimates.128129130131132133134135136137138139140141References: 1. Wang PS, Avorn J, Brookhart MA, et al. Effects of noncardiovascular comorbidities on antihypertensive use in elderly hypertensives. Hypertension. Aug 2005;46(2):273-9. doi:10.1161/01.HYP.0000172753.96583.e12. Mullen RJ, Curtis LM, O'Conor R, et al. Visual acuity, literacy, and unintentional misuse of nonprescription medications. Am J Health Syst Pharm. May 1 2018;75(9):e213-e220. doi:10.2146/ajhp1703033. Zaidi AS, Peterson GM, Bereznicki LRE, Curtain CM, Salahudeen M. Outcomes of Medication Misadventure Among People With Cognitive Impairment or Dementia: A Systematic Review and Meta-analysis. 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Current Medical Research and Opinion. 2015;31(1):145-160. doi:10.1185/03007995.2014.9789391421431441451461471481491501511521531541551561571581591601611621638. McCann RM, Jackson AJ, Stevenson M, Dempster M, McElnay JC, Cupples ME. Help needed inmedication self-management for people with visual impairment: case-control study. Br J Gen Pract. Aug 2012;62(601):e530-7. doi:10.3399/bjgp12X6535709. Patel T, McDougall A, Ivo J, et al. Development and Content Validation of an Instrument to Measure Medication Self-Management in Older Adults. Pharmacy (Basel). Apr 11 2021;9(2):78. doi:10.3390/pharmacy902007810. Freedman VA, Spillman BC. The residential continuum from home to nursing home: size, characteristics and unmet needs of older adults. J Gerontol B Psychol Sci Soc Sci. Nov 2014;69 Suppl 1:S42-50. doi:10.1093/geronb/gbu120164165166167168169170171172173

Cognitive, physical, and sensory deficits that can affect everyday medication use among older adults: A national view

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