ABSTRACT
Medication mismanagement is a growing public health concern, especially among elders. Annually, it is a major contributor to emergency hospitalization and nursing home placement. Elders and their caregivers, as healthcare consumers and stakeholders in this issue, are uniquely qualified to inform strategies to improve medication adherence. We conducted a qualitative study to ascertain caregiver and elder perceptions of barriers to medication management and to identify community-derived solutions to improve medication management. Nine focus groups (N = 65, mean age = 71) were conducted with caregivers or elders from five communities. Participants were recruited by key informants utilizing snowball sampling methodology. The following themes were identified in the participant-recommended proposed solutions improving medication adherence: (i) use of personal systems to overcome barriers to medication adherence, (ii) various solutions to address cost concerns, (iii) the need for regular review of medications by doctors or pharmacists to eliminate unnecessary medications, (iv) desire for community-driven support systems, and (v) using medical advocates. Elders and caregivers recognized medication non-adherence as a community-wide issue and were eager to offer solutions they thought would work in their communities. These solutions can lend credibility to strategies currently being developed/utilized and offer innovative recommendations for future interventions.
Subject(s)
Caregivers/psychology , Community Health Services/organization & administration , Medication Adherence/psychology , Adult , Aged , Aged, 80 and over , Fees, Pharmaceutical , Female , Humans , Male , Middle Aged , Polypharmacy , Qualitative Research , Reminder SystemsABSTRACT
In order to test the hypothesis that significant linguistic deficits could be associated with predominantly subcortical dopaminergic pathways which projected to the frontal lobes (in patients with Parkinson's Disease-PD), we compared language performance in PD patients to that of Broca's aphasics with linguistic deficits. On tests of grammaticality judgements and sentence comprehension, performance by patients with Parkinson's Disease did not vary with different types of sentence structure (as was the case with the aphasics) and was instead, uniformly high (about 75% correct). Comprehension performance, however, did significantly decline in a subgroup of patients with PD who were tested when withdrawn from their dopaminergic medications. We conclude that patients with treated Parkinson's Disease evidence no selective linguistic dysfunction. When, however, they are withdrawn from dopaminergic medication language functions suffer.
Subject(s)
Aphasia, Broca/psychology , Language , Parkinson Disease/psychology , Adult , Aged , Aged, 80 and over , Female , Humans , Language Tests , Linguistics , Male , Memory, Short-Term , Middle Aged , Neuropsychological Tests , Psychomotor Performance/physiology , Wechsler ScalesABSTRACT
We assessed markers of anomalous cerebral dominance in 70 problem drinkers at risk for alcoholism, 43 alcoholics who had been sober for at least six months, and 311 healthy control subjects age-matched to the problem drinkers. Markers of anomalous cerebral dominance included left-handedness, learning disabilities, neuro-immune disorders, and special cognitive talents. We also administered a "drinking inventory" to assess frequency and severity of drinking patterns for self and family. Analysis showed elevated rates of left-handedness and learning disabilities in the alcoholic group and in the "at risk" problem drinkers. These same subjects rated themselves and their families as relatively poor at left-hemisphere-mediated cognitive talents. Alcoholic women evidenced significantly greater incidence of immune disorders than alcoholic men. Alcoholism appears to be related to biological factors which have been associated with anomalous cerebral dominance.
Subject(s)
Alcoholism/genetics , Dominance, Cerebral/genetics , Adolescent , Adult , Alcoholism/psychology , Alcoholism/rehabilitation , Aptitude , Female , Functional Laterality/genetics , Humans , Learning Disabilities/genetics , Learning Disabilities/psychology , Male , Middle AgedABSTRACT
Available studies reveal alarming rates of substance and medication abuse among older adults. Professionals addressing the substance and medication abuse problems of seniors have argued for a move to medication monitoring in the home. At present, however, there has been only scattered evidence to support the contention that adequate medication monitoring actually occurs. The present study reports two surveys of all home care agencies in the state of Michigan. The first study reports the medication monitoring practices of home care staff. The second study examines possible medication monitoring interventions that might be implemented in home care agencies. Those medication monitoring interventions with the highest likelihood of successful implementation among home care staff are discussed.