Objective: The purpose of this study was to identify the situations or variables that promote successful medication management processes as perceived by community-dwelling older adults. Drug therapy and medication management regimens in the elderly are not problem free. Older adults experience adverse drug reactions, incorrect use of prescription medications, and noncompliance or nonadherence to drug therapy. Situations or variables that contribute to the management of medications by the elderly have not been examined in depth, and these need to be identified so that they can be conceptualized and emphasized in nursing education and practice.
Design: The design chosen for this qualitative study was naturalistic inquiry. Instruments consisted of an interview guide and a demographic data questionnaire. Participants were interviewed only once.
Population, Sample, Setting, Years: Participants were recruited from two independent-living retirement facilities within a small Midwestern community. One of these facilities housed some elderly people in the higher income categories. The other retirement facility, which was government subsidized, housed elderly people in the lower income categories.
Twenty-seven community-dwelling elderly residing in one of the two retirement facilities were interviewed. Participants met the following inclusion criteria: (a) community-dwelling over the age of 74, (b) cognitively intact as evidenced by the ability to read and understand the consent form, (c) taking at least three prescription drugs daily, one of which was a cardiovascular medication, and (d) able to give informed consent in the English language. Data were collected from May of 1997 to September of 1997.
Concepts or Variables Studied Together: The research question was "What are the variables, as perceived by community-dwelling older adults over age 74, that influence their ability to manage their medication regimens?".
Methods: Following the signing of the informed consent, each participant was involved in the interview session at the scheduled appointment. All interviews were audiotaped and field notes were recorded. At the completion of the interview, the demographic data questionnaire was completed by the participant, with help from the investigator as needed. Duration of the interview sessions ranged from 45 to 90 minutes. Relationships with the participants were terminated after the interview and questionnaire phase. Transcripts of the taped interview sessions were read and reread. Inductive data analysis was used.
Findings: Participants answered the question "What helps you to manage your medications?" with seven reoccuring themes. These helping methods were identified as simplification, following a routine, using visual and tactile cues, knowledge and patient education, mental alertness, determination, and care-giver set-up. Five hindering methods emerged from the question "What hinders you in the process of managing your medications?". These were decreasing mental and sensory alertness, being out-of-routine, not feeling well, complicated routine, and decreased gross or fine motor ability. The most frequently cited helpful methods were simplification and routine. The most frequently cited hindering methods were decreased sensory or mental alertness and getting out of the routine. These participants also reported that staying mentally alert and determination to manage their medications correctly and independently helped them to be successful. These findings were not previously noted in the literature review.
Conclusion: This study focused on individuals over 74 years of age and their perceptions of their medication management. Through qualitative interview sessions, these 27 community-dwelling older adults gave clear, insightful information. They identified what they perceived as the most helpful and least helpful methods that affected their medication management. These participants stressed that they wanted to manage their own medications, and they wanted to "do it right". This could be associated with the desire to remain independent.
Implications: These findings are significant because the concepts came directly from the older adults themselves, rather than from a pre-established questionnaire. Although there exists an extensive amount of literature about medication and the elderly, little of the research reflects programs built upon the direct responses of the elderly themselves. The data from these interviews and field notes have the potential to influence and change patterns to decrease problems that have been repeatedly encountered in the medication management processes of older adults. Nurses can use this information to help older persons not only become informed about their medications, but also plan strategies to promote succcessful medication management practices.
Nursing professionals have the potential to have the greatest impact on successful medication management processes of community-dwelling older adults. Nurses can devise assessment or intervention strategies that evolve from almost every helpful and hindering method identified in the study. These strategies can be used to promote or maintain the health of older adults.
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