The process of medication management for older adults with dementia

Abstract

kaasalainen s, dolovich l, papaioannou a, holbrook a, lau e, ploeg j, levine m, cosby j & emily a (2011) Journal of Nursing and Healthcare of Chronic Illness 3, 407–418 The process of medication management for older adults with dementia Aim. The purpose of this study was to explore the personal experiences related to medication management of community-dwelling older adults diagnosed with dementia, their informal caregivers, as well as healthcare professionals who assist them. Background. Older adults who have dementia face many challenges in managing their medications while living in the community. Medication regimens used to treat a variety of conditions in older adults with dementia are usually overseen and coordinated by healthcare professionals such as community nurses, physicians and pharmacists, but often, more supports are needed. However, little research has been conducted to study the barriers and facilitators to medication adherence in this unique population. Methods. Using a grounded theory approach, 57 interviews were completed (10 nurses, 10 pharmacists, 6 physicians, 20 caregivers and 11 patients) in southern Ontario, Canada, in 2007. Findings. The findings indicate that the processes of medication management differ according to the level of dementia. A number of corresponding facilitators and barriers to medication management were identified. Medication management in early stage dementia is characterised by patients’ desire to maintain independence, denial of issues or disease, and a refusal to take medications owing to feeling angry. In late-stage dementia, older adults often refuse medications owing to delusional or suspicious thinking, which results in caregivers assuming responsibility for managing their medications. Conclusions. Older adults with dementia, their informal caregivers and the healthcare professionals who assist them are faced with the challenges of declining cognitive function and memory while trying to manage medications at home. However, a number of adherence strategies appear to be helpful and should be considered. Relevance to clinical practice. Healthcare professionals struggle with helping older adults who have dementia manage medications safely and therapeutically, often with little resources to draw from. Future work is needed to design, implement and evaluate supportive networks and interventions with the goal of helping older adults with dementia manage their medications better while living in the community.