Martins, MM

Pereira, Filipa

Verloo, Henk

English

Repositório Comum

33NURSID2018NOVAS PERSPETIVAS DA ENFERMAGEMROL  Novembro-DezembroÍndiceOptimising medication management for polymedicated home-dwelling older adults with multiple chronic conditions Background and objectives: Current demographic transitions indi-cate that a significant proportion of old (over 65) and very old adults in the future will have crippling chronic diseases or unstable multimorbidity that requires several treatment components involving complex medication regimens. This frail population may experience health-related problems, hospitalisations or readmis-sions due to the acute symptoms of their illnesses, often resulting in medication-re-lated problems (MRPs). Accurate manage-ment of their medication treatment is a real challenge for frail older adults with multiple chronic conditions (OAMCC), especially when living at home. The literature in this area currently focuses on health care professionals’ perspectives, to which patients’ and informal caregivers’ perspectives and experiences are often secondary. Three main objectives will guide this project. The first is to carry out a retrospective analysis of patients’ hospital records, their medication and environment-related factors in order to identify those that increase the risks of hospitalisation, emergency department (ED) visits, readmissions (notably due to MRPs), institutionalisation or early death among polymedicated, home-dwelling OAMCC, whether they are non-frail, frail or dependent. The second objective is to use a prospective qualitative study to explore the skills and strategies developed by the different profiles of home-dwelling OAMCC to manage polymedication within their social contexts and health trajec-tories, despite possible cognitive impair-ments and particularly after a recent hos-pitalisation. The third objective is to better understand the perspectives, roles and coordination of professional caregivers and non-professional/informal caregivers involved in the medication management of home-dwelling OAMCC. Methods: A mixed methods study will address the medication management of polymedicated, home-dwelling OAMCC. This will involve two major phases con-ducted sequentially over time: a quanti-tative data collection phase followed by a qualitative investigative phase. To fulfil the first objective, a quantitative phase will consist of retrospectively exploiting the last five years of electronic patient 50,000) in order to identify the different profiles—made up of medication and environment-related factors—of the poly-medicated, home-dwelling OAMCC at risk of hospitalisation, ED visits, hospital read-mission (notably for MRPs), institutional-isation or early death. To respond to our second and third objectives, a qualitative study will involve: a) obtaining and un-derstanding the medication management practices and experiences of the identi-fied profiles of OAMCC extracted from the hospital data, who will be interviewed at b) collecting and analysing the perspec-tives of the formal and informal caregiv-ers involved in medication management at home in order to cross-reference per-spectives about this important dimension of care at home. Results and discussion: The research results will allow us to then de-velop an innovative, integrated model for supporting this frail population. Concrete, interprofessional recommendations will be established, integrating the retro-spective analysis of the electronic data of hospitalised older patients, the direct perspectives of this population and those of the parties involved in the management of their medication treatment at home. Conclusions: These recommenda-tions will aim to support medication management and prevent potentially harmful consequences, including falls, acute confusion, rehospitalisation and/or institutionalisation, or early death.FILIPA PEREIRA; Scien-tific Collaborator; School of Health Sciences, HES-SO Valais-Wallis; Switzerland; PhD;  filipa.pereira@hevs.chHENK VERLOO; School of Health Sciences, HES-SO Valais-Wallis; Chemin de l’Agasse 5; CH-1951 Sion, Switzerland;   henk.verloo@hevs.chMARIA MANUELA MARTINS; Nursing School of Porto; Abel Salazar Institute of Biomedical Sciences, University of Porto; Rua Dr. António Bernardino de Almeida ; 4200-072 Porto, Portugal; Full Professor; PhD,   mmartins@esenf.ptPALAVRAS-CHAVE:  Polypharmacy; home dwelling older adults; multiples chronic conditions;  medication managementPereira F., Verloo H.,  Martins M.M. Optimising medication management for polymedicated home-dwelling older adults with multiple chronic conditions. Suplemento digital Rev ROL Enferm 2019; 42(11-12)

Optimising medication management for polymedicated home-dwelling older adults with multiple chronic conditions

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Optimising medication management for polymedicated home-dwelling older adults with multiple chronic conditions

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