The quality of medication use in older adults: methods of a longitudinal study.

BACKGROUND: The quality of medication use in older adults is a recurring problem of substantial concern. Efforts to both measure and improve the quality of medication use often define quality too narrowly and fall short of addressing the complexity of an older adult's medication regimen. OBJECTIVES: In an effort to more comprehensively define the quality of medication use in older adults, we conducted a prospective cohort study to: (1) describe the quality of medication use in community-dwelling older adults at baseline, examining differences between whites and blacks; (2) examine the effect of race on medication-related problems; and (3) assess the change in quality medication use between whites and blacks over time. This paper presents the research design and methods of this longitudinal study. METHODS: We interviewed white and black community-dwelling older adults (aged > or =60 years) 3 times over 1 year (baseline, 6, and 12 months). We oversampled blacks so that we could estimate racial differences in the quality of medication use. We collected information on the quality of medication use, relying on a clinical pharmacist's assessment of quality and the Assessing Care of Vulnerable Elders quality indicators. We also collected data on demographic characteristics, health literacy, functional status, and participant-reported drug therapy concerns. RESULTS: Four hundred thirty-five older adults were assessed for inclusion; 200 older adults (100 white, 100 black) were enrolled in the study and completed a baseline visit. Of the 200, 92% completed the 6-month visit (n = 183) and 88% completed the 12-month visit (n = 176). We present baseline demographic characteristics for the 200 older adults enrolled in the study. CONCLUSION: This longitudinal study is an initial step toward developing more comprehensive, patient-centered measures and interventions to address the quality of medication use in older adults.

Measuring the quality of medication use in older adults.

The quality of health care in the United States continues to fall short of expectations. A contributing factor is the suboptimal use of medications, a problem that is causing significant morbidity and mortality and costing the healthcare industry billions of dollars each year. Older adults are especially vulnerable to suboptimal quality medication use because of their concurrent medical conditions, multiple medications, and the physiological effects of aging on the use of drug therapy. In addition, older adults and their caregivers are often responsible for managing complex medication regimens. Efforts to measure the quality of medication use in older adults have traditionally focused on inappropriate medications and doses, select indicators of medication appropriateness, or diseases rather than the unique medication needs of individual patients. The goal is to move toward a measure that can account for the complexities of an individual's medication regimen and that is responsive to individual patient values and needs. The purpose of this article is to discuss the benefits and limitations of current strategies to measure the quality of medication use in older adults and, using a case study, illustrate the variations in quality measurement using existing measures. The article concludes with recommendations for moving toward a more-comprehensive approach to measuring the quality of medication use in older adults.

Caregiver psychological distress as a barrier to influenza vaccination among community-dwelling elderly with dementia.

OBJECTIVE: This study examined whether informal caregiver psychologic distress decreases the likelihood of influenza vaccination for community-dwelling elderly with dementia. A secondary aim was to determine whether psychologic distress mediates the relationship between other predisposing, enabling, and medical need variables and vaccination. METHODS: Data were drawn from the 1998 National Longitudinal Caregiver Survey. The final sample consisted of 1406 community-dwelling male veterans with dementia and their coresiding female informal caregivers. Presence of caregiver psychologic distress was measured using the Boston Short Form of the Center for Epidemiologic Studies Depression Scale. Vaccination was identified by examining Veteran Administration Outpatient Data Files for visits indicating influenza vaccine administration during the 1998 influenza vaccine season (September 1 to December 31). Multivariate path analysis with observed variables was used to estimate direct and indirect probit path coefficients between independent variables, caregiver psychologic distress, and veteran vaccination. RESULTS: As hypothesized, caregiver distress was significantly associated with a decreased likelihood of care-recipient vaccination (unstandardized coefficient [b] = -0.023, P < 0.01). Adjusted for other variables, the predicted probability of vaccination was 37.7% for care-recipients with nondistressed caregivers compared with 29.4% for care-recipients with distressed caregivers. Furthermore, a number of factors significantly influenced vaccination via their influence on psychologic distress. CONCLUSION: We conclude that caregiver psychologic distress may interfere with access to influenza vaccination in persons with dementia. Access to vaccination may be improved directly by detecting and treating emotional health problems in caregivers and indirectly by addressing precursors to caregiver distress.

Improving communication of drug risks to prevent patient injury: proceedings of a workshop.

PURPOSE: The Centers for Education & Research on Therapeutics (CERTs) is conducting a series of workshops on managing the risks of therapeutics, with the ultimate goal to develop an agenda for research and education about risk and its management. This paper presents the results of the first workshop in the series, a 2-day meeting focused on communication of drug risks to healthcare professionals and patients. METHODS: The 50 workshop participants represented the medical-products industry, academia, consumer groups, regulatory bodies and the media. Together, they sought to identify and understand barriers to successful risk communication, to identify tools or methods that could improve risk communication, and to develop research and education agendas that would lead to better risk communication in the future. RESULTS: Limitations of current methods of risk communication were identified, and research and education agendas were proposed to clarify and resolve these issues. CONCLUSION: Common themes for potential solutions include enhanced education of healthcare providers, increased motivation of patients and families, use of creative communication technologies, and better organization of and access to medical records and information.