Longitudinal Investigation of Older Adults' Ability to Self-Manage Complex Drug Regimens

Stacy Cooper Bailey; Lauren A. Opsasnick; Laura M. Curtis; Alex D. Federman; Julia Y. Benavente; Rachel O'Conor; Michael S. Wolf

doi:10.1111/jgs.16255

Longitudinal Investigation of Older Adults' Ability to Self-Manage Complex Drug Regimens

Stacy Cooper Bailey^*, Lauren A. Opsasnick, Laura M. Curtis, Alex D. Federman, Julia Y. Benavente, Rachel O'Conor, Michael S. Wolf

^*Corresponding author for this work

Medicine, General Medicine Division

Research output: Contribution to journal › Article › peer-review

17 Scopus citations

Abstract

OBJECTIVES: We sought to investigate older patients' ability to correctly and efficiently dose multidrug regimens over nearly a decade and to explore factors predicting declines in medication self-management. DESIGN: Longitudinal cohort study funded by the National Institute on Aging. SETTING: One academic internal medicine clinic and six community health centers. PARTICIPANTS: Beginning in 2008, 900 English-speaking adults, aged 55 to 74 years, were enrolled in the study, completing a baseline (T1) assessment. To date, 303 participants have completed the same assessment 9 years postbaseline (T4). MEASUREMENTS: At T1, subjects were given a standardized, seven-drug regimen and asked to demonstrate how they would take medicine over 24 hours. The number of dosing errors made and times per day that a participant would take medicine were recorded. Health literacy was measured via the Newest Vital Sign, and cognitive decline was measured by the Mini-Mental State Examination. RESULTS: Participants on average made 2.9 dosing errors (SD = 2.5 dosing errors; range = 0-21 dosing errors) of 21 potential errors at T1 and 5.0 errors (SD = 2.1 errors; range = 1-18 errors; P <.001) at T4. In a multivariate model, limited literacy (β =.69; 95% confidence interval [CI] =.18-1.20; P =.01), meaningful cognitive decline (β = 1.72; 95% CI =.70-2.74; P =.01), number of chronic conditions (β =.21; 95% CI =.07-.34; P =.01), and number of baseline dosing errors (β = −.76; 95% CI = −.85 to −.67; P <.001) were significant, independent predictors of changes in dosing errors. Most patients overcomplicated their daily medication schedule; no sociodemographic characteristics were predictive of poor regimen organization in multivariate models. In a multivariate model, there were no significant predictors of changes in regimen consolidation over time, except regimen consolidation at T1. CONCLUSIONS: Older patients frequently overcomplicated drug regimens and increasingly made more dosing errors over 9 years of follow-up. Patients with limited literacy, cognitive decline, and multimorbidity were at greatest risk for errors. J Am Geriatr Soc 68:569–575, 2020.

Original language	English (US)
Pages (from-to)	569-575
Number of pages	7
Journal	Journal of the American Geriatrics Society
Volume	68
Issue number	3
DOIs	https://doi.org/10.1111/jgs.16255
State	Published - Mar 1 2020

Funding

This work was supported by the National Institute on Aging (R01AG030611; principal investigator: Wolf). We would like to thank Eleanor Small for her work designing the Figure graphic. This work was supported by the National Institute on Aging (R01AG030611; principal investigator: Wolf). Stacy Cooper Bailey has served as a consultant to Merck, Sharp & Dohme Corp, Northwestern University/Gordon and Betty Moore Foundation, Pfizer, Inc, and Luto LLC for work unrelated to this article. She has also received funding support via her institution from Merck, Sharp & Dohme Corp and Eli Lilly and Company. Michael S. Wolf has served as a consultant to Merck, Sharp & Dohme Corp, Abbvie, Vivus, Inc, Luto LLC, Pfizer, Inc, Anheuser Busch Imbev, DenverHealth, and Teva Pharmaceuticals for work unrelated to this article. He also has received funding support via his institution from Merck, Sharp & Dohme Corp, Eli Lilly and Company, Abbvie, and UnitedHealthcare. Other authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the article. All individuals who contributed significantly to this work have been included as authors. S.C.B., L.A.O., L.M.C., A.D.F., J.Y.B., R.O., and M.S.W. all contributed to the conception and design of the study and in the acquisition, analysis, and interpretation of data. All authors were involved in the drafting of the manuscript and gave final approval for submission. The findings and conclusions in this article do not represent the official views or opinions of the National Institute on Aging. The funder was not involved in the design, analysis, or interpretation of study findings.

Keywords

health literacy
medication safety
polypharmacy

ASJC Scopus subject areas

Geriatrics and Gerontology

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10.1111/jgs.16255

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title = "Longitudinal Investigation of Older Adults' Ability to Self-Manage Complex Drug Regimens",

abstract = "OBJECTIVES: We sought to investigate older patients' ability to correctly and efficiently dose multidrug regimens over nearly a decade and to explore factors predicting declines in medication self-management. DESIGN: Longitudinal cohort study funded by the National Institute on Aging. SETTING: One academic internal medicine clinic and six community health centers. PARTICIPANTS: Beginning in 2008, 900 English-speaking adults, aged 55 to 74 years, were enrolled in the study, completing a baseline (T1) assessment. To date, 303 participants have completed the same assessment 9 years postbaseline (T4). MEASUREMENTS: At T1, subjects were given a standardized, seven-drug regimen and asked to demonstrate how they would take medicine over 24 hours. The number of dosing errors made and times per day that a participant would take medicine were recorded. Health literacy was measured via the Newest Vital Sign, and cognitive decline was measured by the Mini-Mental State Examination. RESULTS: Participants on average made 2.9 dosing errors (SD = 2.5 dosing errors; range = 0-21 dosing errors) of 21 potential errors at T1 and 5.0 errors (SD = 2.1 errors; range = 1-18 errors; P <.001) at T4. In a multivariate model, limited literacy (β =.69; 95% confidence interval [CI] =.18-1.20; P =.01), meaningful cognitive decline (β = 1.72; 95% CI =.70-2.74; P =.01), number of chronic conditions (β =.21; 95% CI =.07-.34; P =.01), and number of baseline dosing errors (β = −.76; 95% CI = −.85 to −.67; P <.001) were significant, independent predictors of changes in dosing errors. Most patients overcomplicated their daily medication schedule; no sociodemographic characteristics were predictive of poor regimen organization in multivariate models. In a multivariate model, there were no significant predictors of changes in regimen consolidation over time, except regimen consolidation at T1. CONCLUSIONS: Older patients frequently overcomplicated drug regimens and increasingly made more dosing errors over 9 years of follow-up. Patients with limited literacy, cognitive decline, and multimorbidity were at greatest risk for errors. J Am Geriatr Soc 68:569–575, 2020.",

keywords = "health literacy, medication safety, polypharmacy",

author = "Bailey, {Stacy Cooper} and Opsasnick, {Lauren A.} and Curtis, {Laura M.} and Federman, {Alex D.} and Benavente, {Julia Y.} and Rachel O'Conor and Wolf, {Michael S.}",

note = "Funding Information: This work was supported by the National Institute on Aging (R01AG030611; principal investigator: Wolf). Funding Information: We would like to thank Eleanor Small for her work designing the Figure graphic. This work was supported by the National Institute on Aging (R01AG030611; principal investigator: Wolf). Stacy Cooper Bailey has served as a consultant to Merck, Sharp & Dohme Corp, Northwestern University/Gordon and Betty Moore Foundation, Pfizer, Inc, and Luto LLC for work unrelated to this article. She has also received funding support via her institution from Merck, Sharp & Dohme Corp and Eli Lilly and Company. Michael S. Wolf has served as a consultant to Merck, Sharp & Dohme Corp, Abbvie, Vivus, Inc, Luto LLC, Pfizer, Inc, Anheuser Busch Imbev, DenverHealth, and Teva Pharmaceuticals for work unrelated to this article. He also has received funding support via his institution from Merck, Sharp & Dohme Corp, Eli Lilly and Company, Abbvie, and UnitedHealthcare. Other authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the article. All individuals who contributed significantly to this work have been included as authors. S.C.B., L.A.O., L.M.C., A.D.F., J.Y.B., R.O., and M.S.W. all contributed to the conception and design of the study and in the acquisition, analysis, and interpretation of data. All authors were involved in the drafting of the manuscript and gave final approval for submission. The findings and conclusions in this article do not represent the official views or opinions of the National Institute on Aging. The funder was not involved in the design, analysis, or interpretation of study findings. Publisher Copyright: {\textcopyright} 2019 The American Geriatrics Society",

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T1 - Longitudinal Investigation of Older Adults' Ability to Self-Manage Complex Drug Regimens

AU - Bailey, Stacy Cooper

AU - Opsasnick, Lauren A.

AU - Curtis, Laura M.

AU - Federman, Alex D.

AU - Benavente, Julia Y.

AU - O'Conor, Rachel

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N1 - Funding Information: This work was supported by the National Institute on Aging (R01AG030611; principal investigator: Wolf). Funding Information: We would like to thank Eleanor Small for her work designing the Figure graphic. This work was supported by the National Institute on Aging (R01AG030611; principal investigator: Wolf). Stacy Cooper Bailey has served as a consultant to Merck, Sharp & Dohme Corp, Northwestern University/Gordon and Betty Moore Foundation, Pfizer, Inc, and Luto LLC for work unrelated to this article. She has also received funding support via her institution from Merck, Sharp & Dohme Corp and Eli Lilly and Company. Michael S. Wolf has served as a consultant to Merck, Sharp & Dohme Corp, Abbvie, Vivus, Inc, Luto LLC, Pfizer, Inc, Anheuser Busch Imbev, DenverHealth, and Teva Pharmaceuticals for work unrelated to this article. He also has received funding support via his institution from Merck, Sharp & Dohme Corp, Eli Lilly and Company, Abbvie, and UnitedHealthcare. Other authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the article. All individuals who contributed significantly to this work have been included as authors. S.C.B., L.A.O., L.M.C., A.D.F., J.Y.B., R.O., and M.S.W. all contributed to the conception and design of the study and in the acquisition, analysis, and interpretation of data. All authors were involved in the drafting of the manuscript and gave final approval for submission. The findings and conclusions in this article do not represent the official views or opinions of the National Institute on Aging. The funder was not involved in the design, analysis, or interpretation of study findings. Publisher Copyright: © 2019 The American Geriatrics Society

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N2 - OBJECTIVES: We sought to investigate older patients' ability to correctly and efficiently dose multidrug regimens over nearly a decade and to explore factors predicting declines in medication self-management. DESIGN: Longitudinal cohort study funded by the National Institute on Aging. SETTING: One academic internal medicine clinic and six community health centers. PARTICIPANTS: Beginning in 2008, 900 English-speaking adults, aged 55 to 74 years, were enrolled in the study, completing a baseline (T1) assessment. To date, 303 participants have completed the same assessment 9 years postbaseline (T4). MEASUREMENTS: At T1, subjects were given a standardized, seven-drug regimen and asked to demonstrate how they would take medicine over 24 hours. The number of dosing errors made and times per day that a participant would take medicine were recorded. Health literacy was measured via the Newest Vital Sign, and cognitive decline was measured by the Mini-Mental State Examination. RESULTS: Participants on average made 2.9 dosing errors (SD = 2.5 dosing errors; range = 0-21 dosing errors) of 21 potential errors at T1 and 5.0 errors (SD = 2.1 errors; range = 1-18 errors; P <.001) at T4. In a multivariate model, limited literacy (β =.69; 95% confidence interval [CI] =.18-1.20; P =.01), meaningful cognitive decline (β = 1.72; 95% CI =.70-2.74; P =.01), number of chronic conditions (β =.21; 95% CI =.07-.34; P =.01), and number of baseline dosing errors (β = −.76; 95% CI = −.85 to −.67; P <.001) were significant, independent predictors of changes in dosing errors. Most patients overcomplicated their daily medication schedule; no sociodemographic characteristics were predictive of poor regimen organization in multivariate models. In a multivariate model, there were no significant predictors of changes in regimen consolidation over time, except regimen consolidation at T1. CONCLUSIONS: Older patients frequently overcomplicated drug regimens and increasingly made more dosing errors over 9 years of follow-up. Patients with limited literacy, cognitive decline, and multimorbidity were at greatest risk for errors. J Am Geriatr Soc 68:569–575, 2020.

AB - OBJECTIVES: We sought to investigate older patients' ability to correctly and efficiently dose multidrug regimens over nearly a decade and to explore factors predicting declines in medication self-management. DESIGN: Longitudinal cohort study funded by the National Institute on Aging. SETTING: One academic internal medicine clinic and six community health centers. PARTICIPANTS: Beginning in 2008, 900 English-speaking adults, aged 55 to 74 years, were enrolled in the study, completing a baseline (T1) assessment. To date, 303 participants have completed the same assessment 9 years postbaseline (T4). MEASUREMENTS: At T1, subjects were given a standardized, seven-drug regimen and asked to demonstrate how they would take medicine over 24 hours. The number of dosing errors made and times per day that a participant would take medicine were recorded. Health literacy was measured via the Newest Vital Sign, and cognitive decline was measured by the Mini-Mental State Examination. RESULTS: Participants on average made 2.9 dosing errors (SD = 2.5 dosing errors; range = 0-21 dosing errors) of 21 potential errors at T1 and 5.0 errors (SD = 2.1 errors; range = 1-18 errors; P <.001) at T4. In a multivariate model, limited literacy (β =.69; 95% confidence interval [CI] =.18-1.20; P =.01), meaningful cognitive decline (β = 1.72; 95% CI =.70-2.74; P =.01), number of chronic conditions (β =.21; 95% CI =.07-.34; P =.01), and number of baseline dosing errors (β = −.76; 95% CI = −.85 to −.67; P <.001) were significant, independent predictors of changes in dosing errors. Most patients overcomplicated their daily medication schedule; no sociodemographic characteristics were predictive of poor regimen organization in multivariate models. In a multivariate model, there were no significant predictors of changes in regimen consolidation over time, except regimen consolidation at T1. CONCLUSIONS: Older patients frequently overcomplicated drug regimens and increasingly made more dosing errors over 9 years of follow-up. Patients with limited literacy, cognitive decline, and multimorbidity were at greatest risk for errors. J Am Geriatr Soc 68:569–575, 2020.

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Longitudinal Investigation of Older Adults' Ability to Self-Manage Complex Drug Regimens

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