The association between family caregivers' involvement in managing older adults' medications and caregivers' information-seeking behavior

The Usability, Acceptability, and Functionality of Smart Oral Multidose Dispensing Systems for Medication Adherence: A Scoping Review

BACKGROUND

Medication non-adherence is a leading cause of non-optimal disease management, resulting in poor health outcomes, poor quality of life, and increased healthcare costs. Smart oral multidose dispensing systems (SOMDS) are being developed to address non-adherence; however, little is known about their integration into daily use by patients.

METHODS

Using Arksey and O'Malley's scoping review framework, relevant literature was searched for in electronic databases (PubMed, EMBASE, International Pharmaceutical Abstracts, and Scopus). Observational and interventional studies reporting the integration and impact on adherence from SOMDS in adults ≥18 years and published after 1960 were included.

RESULTS

Thirteen articles including one case study, 8 cohort studies, and 4 randomized trials were eligible. SOMDS included smart blister packaging, automated dispensers, and electronic medication trays. The number of medications dispensed per SOMDS was one (n = 3), >1 (n = 2), placebo (n = 1) and not reported (n = 7). Reported outcomes included impact on medication adherence (n = 3), integration (n = 2) and both parameters (n = 8).

CONCLUSION

Although most studies reported that SOMDS appear usable, there was significant variability in the SOMDS types, patient populations, medication adherence definitions, and measurements; impacting the interpretation of results. Future studies should be designed to address effectiveness of SOMDS on medication adherence in patients with multi-drug therapy and the utilization of real-time adherence data for informing clinical decision making.

The Medication-Related, Information-Seeking Experiences and Barriers for Family Caregivers of Older People

Objective To characterize family caregivers of older people' experiences related to medication information-seeking, including the ability to find medication information and barriers faced in the medication information-seeking process. Design A prospective cross-sectional survey of family caregivers of older people. Setting An online panel of self-identified family caregivers. Participants Family caregivers of older people 60 years of age or older. Results A total 555 family caregivers of older people responded to the survey. Caregiver respondents' mean age was 43.6 (± 14.0) years; they were primarily female (82.5%) and White (74.4%). About three-quarters of respondents assisted with managing medications for care-recipients. Caregivers whose care-recipients were taking medications (n = 537) performed a variety of medication-related activities with 67.8% looking up information online in the last month. While 70.6% of caregivers have asked pharmacists about medication information, only 21.0% considered pharmacists their primary source of such information. Barriers to looking for medication-related information included lack of time to speak to medical providers (51.0%) and pharmacists (45.3%), being unsure about the best source for information (45.9%), and time needed to care for others (43.0%). Conclusion Family caregivers of older people are involved in managing medications, including looking up medication-related information. Several barriers impact caregivers' ability to find medication-related information. Pharmacists can be more proactive in assessing and supporting caregivers' medication-related information needs.

Stimulating the Involvement of Family Members in the Medication Management Activities of Older Adults Through Ambient Displays: Qualitative Study

Little attention has been paid to how medication management technologies, designed for older adults, modify the participation of family caregivers. We developed a tablet-based ambient display that provides external cues to remind and motivate older adults to take their medications. This study aimed to understand the effect of ambient displays on the involvement of family members in the elderly's medication management. We conducted a 10-week study consisting of interviews administered weekly to nine elderly-caregivers. We identify that new involvement patterns of the family caregivers were provoked through external cues, which made them aware of older adults' medication adherence and encouraged younger relatives to help older adults.

Training Needs Among Family Caregivers Assisting During Home Health, as Identified by Home Health Clinicians

OBJECTIVES

To estimate the proportion of family caregivers assisting older adults during Medicare home health who have an identified need for activity-specific training and identify characteristics associated with caregiver training needs.

DESIGN

Nationally representative retrospective cohort study.

SETTING AND PARTICIPANTS

1758 (weighted n = 8,477,990) Medicare beneficiaries who participated in the National Health and Aging Trends Study (NHATS) and received Medicare-funded home health care between 2011 and 2016.

MEASURES

Older adult and caregiving network characteristics before home health (sociodemographic factors, caregiver assistance, older adult health and function) were drawn from NHATS; characteristics during home health (family caregiver training needs, older adult health and function) were drawn from home health patient assessments. Weighted proportions of family caregivers with an identified need for activity-specific training were estimated. Weighted, multivariable logistic regressions modeled associations between older adult/caregiving network characteristics and family caregivers' identified activity-specific training needs during home health.

RESULTS

More than 1 in 3 (35.7%) family caregivers assisting older adults during Medicare home health had an identified training need with at least 1 caregiving activity. Rates of need for training varied widely, from 8.6% among caregivers helping with advocacy to 48.2% among caregivers helping with medical procedures. In weighted analyses that adjusted for older adults' health and function, family caregivers were less likely to have identified training needs when assisting older adults with ongoing disability or who received caregiver assistance before home health admission.

CONCLUSIONS AND IMPLICATIONS

Findings highlight the pervasiveness of family caregivers' training needs, particularly with medically oriented activities, and indicate that escalations in older adults' care needs are linked to caregiver training needs. Therefore, transitions of care may present critical opportunities to connect family caregivers with training resources.

Support for Australian carers from community pharmacy: Insight into carer perspectives of a novel service

The feasibility of an individualised carer support service delivered in community pharmacies was assessed from the perspective of carer participants using a pre-post questionnaire and semistructured interviews. Eligible pharmacies were required to offer a medication management service relevant to carers and have a semiprivate space for conversations. Carers were required to self-identify as an unpaid support person for someone with a chronic condition or disability. Between September 2016 and March 2017, staff from 11 community pharmacies in South-East Queensland, Australia were trained, and provided with ongoing mentoring from a pharmacist and carer to support service implementation. Identification of carers and support to achieve a personal and care-giving goal were key features of the service. Questionnaires included the EQ-5D-3L, the Bakas Caregiving Outcomes Scale, and questions relating to goal achievement, carer roles, and responsibilities. Seven follow-up carer interviews were undertaken between March and May 2017 and analysed thematically. Pre-post questionnaires were available for 17 carers (one withdrew, two incomplete). Of the 29 goals set, 10 were achieved and 14 partially achieved. EQ-5D-3L scores were unchanged, while 7 of the 15 items comprising the Bakas score improved (p < 0.05). Carer service evaluation was generally favourable, and these two main interview themes were the impact of caring and pharmacy experience. The impact of caring, while variable, was significant. Pharmacy experiences were mostly positive and the opportunity for carers to further engage with pharmacy staff was appreciated. The service was feasible and initial reported benefits to carers may support further research potentially in terms of a larger controlled trial.