Expanding How to Assess Adherence in Older Adults With Home Medication Management

According to a report by the US Centers for Disease Control and Prevention, use of 1 or more prescription drugs was more common among US adults aged 60 to 79 years compared with those aged 40 to 59 years (83.6% versus 59.5%). Use of 5 or more prescription drugs was also more common among US adults aged 60 to 79 years compared with those aged 40 to 59 years (34.5% versus 14.5%).¹

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More common among our older adult population, polypharmacy is associated multi-drug interactions, drug-disease interactions, and adverse drug events, resulting in potentially avoidable health care utilization. Polypharmacy may result in nonadherence as managing multiple medications is difficult, especially for those living at home. When older adults are discharged from the hospital or obtain medications from the pharmacy, they often develop their own routines and systems for medication management and organization.

A qualitative analysis published in Pharmacy explored how community-dwelling older adults who are 55 years of age or older and prescribed 4 or more medications manage their medications at home. Home medication management was driven by 2 wellbeing goals: maintaining control and avoiding vulnerability.²

The qualitative analysis was part of an intervention study conducted at a community pharmacy. The researchers designed a medication management questionnaire to help pharmacists make recommendations to patients about home medication use. Half of the 24 participants who completed the questionnaire agreed to be interviewed.

The interviews were held in participants’ homes, where they showed investigators the various places in which they engaged in medication-related work. While most interviews were one-on-one, a small number also included contributions from caregivers.

The investigators used the systems approach to home medication management model (SAHMM) to understand factors that influence adherence. The 3 components of the patient’s home medication management system were person, tools and technology, and household (Table).

Table. Home Medication Management

The home medication management process included common activities such as procurement, organization (e.g., filling pill boxes with 7 days being most common), use of medication lists, established routine of medication-taking, and monitoring of medications. Of the tools and technologies, pill boxes and medication lists needed the most improvement.

The findings suggest that improving and maintaining adherence to medication regimens may not be achieved despite desired clinical outcomes, such as quality of life improvement and avoidance of adverse events. Rather, collaboration with a focus on the outcomes that are of personal interest to the patient are beneficial. When assessing adherence, health care providers should expand by inquiring patients about their motivation, how their routines affect medication management, and incorporation of tools, such as up-to-date medication lists and adherence packaging.

Although older adults may have well-developed routines for medication management, some may have processes that put them at risk for medication misadventure. In their words, “there is method to this madness.”

At the time of hospital discharge or when picking up a medication from the pharmacy, pharmacists should augment counseling by discussing personalized home medication management techniques. Older adults and caregivers engaged in medication management that revolves around their routine of daily living will result in them being concordant and adherent to their medication regimens. Improved adherence is associated with positive patient outcomes, improved quality of life, and reduction in health care utilization.

About the Author

Lisa A. Rosenberg, PharmD, BCGP, CMWA is vice president, Clinical Initiatives at Tabula Rasa HealthCare.

REFERENCES

1. Hales CM, Servais J, Martin CB, Kohen D. Prescription Drug Use Among Adults Aged 40–79 in the United States and Canada. NCHS Data Brief. 2019 Aug;(347):1-8.
2. Fadare O, Witry M. "There Is Method to This Madness" A Qualitative Investigation of Home Medication Management by Older Adults. Pharmacy (Basel). 2023;11(2):42. Published 2023 Feb 23. doi:10.3390/pharmacy11020042
3. Doucette WR, Vinel S, Pennathur P. Initial development of the Systems Approach to Home Medication Management (SAHMM) model. Res Social Adm Pharm. 2017 Jan-Feb;13(1):39-47. Published 2016 Jan 7. doi:10.1016/j.sapharm.2015.12.013.