Promoting medication adherence in older adults through early diagnosis of neurocognitive disorders.

Abstract

Community-dwelling older adults with neurocognitive disorders experience high risk of and often suffer severe consequences from medication nonadherence. Due to the important role of informal caregivers in the care of patients with neurocognitive disorders, medication management involves both patients and families. A formal diagnosis of a neurocognitive disorder may improve both provider-patient and provider-family communications and resulting regimen adherence, yet many with signs of neurocognitive disorders remain undiagnosed. The goal of this study was to examine the differences in medication management behaviors for family caregivers of mildly impaired older adults with or without a formal neurocognitive disorder diagnosis. The study included 112 women who provided at least 2 forms of medication assistance for a mildly cognitively impaired older adult with (n = 38, 34%) or without (n = 75, 66%) a reported neurocognitive disorder diagnosis and who completed online self-assessments of medication adherence and self-efficacy for medication management from May 2012 to May 2013. Cases were selected for analyses based on analog Clinical Dementia Rating scores between 0.5 and 1, indicating mild cognitive impairment in the older adult. Compared to families unaware of a neurocognitive disorder diagnosis, caregivers reporting knowledge of a neurocognitive disorder diagnosis in their older family member endorsed higher medication management self-efficacy and increased levels of adherence-related behaviors. Step-wise logistic regression analyses demonstrated statistical significance in using these adherence and self-efficacy variables to differentiate between the presence or absence of a known neurocognitive disorder diagnosis (N = 112, χ (2) 6 = 22.84, P < .05). A formally charted and communicated neurocognitive disorder diagnosis is associated with improved medication management behaviors and medication-related self-efficacy in neurocognitive disorder family caregivers.