[Drug Compliance Scale. I. Development of the Drug Compliance Scale]

Disturbed medication management in older adults with good cognitive health and mild cognitive impairment associated with semantic memory impairment: The Wakuya Project

AIM

For older adults with mild cognitive impairment or mild dementia, maintaining daily lives at home is also ideal for quality of life. However, they have serious problems with medication management. Although the Dementia Assessment Sheet in community-based integrated care system-21 items and the regimen comprehension scale are assessment scales for medication, there have been no reports evaluating both semantic memory and actual performance.

METHODS

A total of 180 older adults aged ≥75 years were entered in the Wakuya Project. They underwent the Clinical Dementia Rating, with two original tests: (i) the original semantic memory task for taking medication including the Dementia Assessment Sheet in community-based integrated care system-21 items; and (ii) the actual performance task related to medication including regimen comprehension scale. Non-demented participants were classified into two groups based on reports from their families; that is, a good management group (n = 66) and a poor management group (n = 42), and the two original tests were analyzed as explanatory variables.

RESULTS

There were no differences between the two groups for the actual performance task related to medication including regimen comprehension scale. The success rates for the actual performance task related to medication including regimen comprehension scale (good management group/poor management group) were: regimen comprehension scale 40.9/23.8, One-Day Calendar 93.9/90.5, Medicine Chest 36.4/23.8 and Sequential Behavior Task 66.7/66.7, respectively. In the original semantic memory task for taking medication including the Dementia Assessment Sheet in community-based integrated care system-21 items, logistic regression analysis showed that only the mechanism of action remained (B -2.38, SE 1.10, Wald 4.69, P-value = 0.03, OR 0.09, 95%CI 0.01-0.80).

CONCLUSION

Our results suggest that disruption of medicine management might also be associated with drug semantic memory impairment between the two groups, with no difference in general cognitive and executive functions. Geriatr Gerontol Int 2023; 23: 319-325.

Reliability and validity of a 12-item medication adherence scale for patients with chronic disease in Japan

BACKGROUND

To improve and support medication adherence among patients with chronic diseases, especially for long-term medication, it is important to consider both their relationship with healthcare providers and their lifestyle. We tested the reliability and validity of a modified 12-item Medication Adherence Scale.

METHODS

We revised a 14-item measure of medication adherence, created in 2009, to a more concise and clear 12-item version, and we verified the reliability and validity of the 12-item scale. We included 328 patients with chronic diseases participating in the Chronic Disease Self-Management Program in Japan from 2011 to 2014. Confirmatory factor analysis was used to assess whether the four factors assessed were the same as the previous 14-item Medication Adherence Scale. Cronbach's coefficient alpha was used to assess internal consistency reliability, and the relationships between patient demographic characteristics and medication adherence were compared with previous studies.

RESULTS

The 12 items were categorized into the four factors "medication compliance", "collaboration with healthcare providers", "willingness to access and use information about medication", and "acceptance to take medication and how taking medication fits patient's lifestyle". Confirmatory factor analysis showed χ2/df = 2.6, CFI = 0.94, and RMSEA = 0.069. Cronbach's alpha for the 12-item scale was 0.78. Cronbach's alpha for the four subscales was 0.74, 0.81, 0.67, and 0.45. Higher medication adherence was significantly associated with being a female patient, living with someone else, and age 40-49 years versus age 20-29 years. These relationships were the same as in previous studies.

CONCLUSIONS

We modified our original 14-item scale to a 12-item Medication Adherence Scale for patients with chronic diseases, which considers their relationship with healthcare providers and lifestyle. Refinement might be needed because of the relatively low reliability of subscales. However, the modified scale is expected to contribute to more effective self-management of medication and to improving medication adherence, particularly among patients with chronic diseases who require long-term medication not only in Japan but also in other countries.

Factors associated with changes over time in medication-taking behavior up to 12 months after initial mild cerebral infarction onset

PURPOSE

The aim of this study was to clarify the changes in medication-taking behavior and related factors over time in patients with initial mild cerebral infarction up to 12 months after onset.

METHODS

Thirty-one patients with initial mild cerebral infarction were surveyed a total of four times: on admission to hospital, 3 months after onset, 6 months after onset, and 12 months after onset. Patients were surveyed regarding medication compliance, awareness of taking medication, perceived behavioral control, lifestyle risk factors, and subjective norms.

RESULTS

Medication compliance improved over time from the time of admission, but no changes were seen in awareness of taking medication. A cluster analysis based on changes in medication compliance over time revealed a "Persistently high compliance group" and a "Persistently low compliance group" for medication compliance. The health locus of control in the "Persistently high compliance group" was perceived as the result of chance and fate.

CONCLUSIONS

Assessing the current state of medication compliance and the health locus of control during hospitalization permitted an understanding of patient characteristics, and indicated a need for recurrence prevention education and medication guidance tailored to each patient's cognitive and behavioral characteristics. J. Med. Invest. 64: 85-95, February, 2017.

Sociopsychological factors relating to suicide prevention in a Japanese rural community: coping behaviors and attitudes toward depression and suicidal ideation

In response to the rise in suicide in Japan since 1998, some suicide prevention measures in local communities have been put into action. However, in the previous suicide prevention measures, sociopsychological factors were not fully taken into consideration. In the present study, the authors surveyed sociopsychological factors relating to suicide and depression (i.e. people's coping behavior and thoughts about depression and suicidal ideation, and their attitudes toward suicide and psychiatric treatment), and their differences in gender and generations. The present study was conducted in a rural area of Japan (Town A), where the suicide rate is much higher than the national average. The authors randomly selected 10% of the residents (i.e. 532 people) aged between 40 and 79 years on the basis of resident registration. Health promotion volunteers in Town A visited these 532 people individually, distributed questionnaires, and asked them to anonymously answer the questionnaire within 4 weeks. Data from 450 residents (193 men, 257 women) were analyzed in the present study. Although there were few gender differences, some significant differences were found between the younger (40-59 years) and older (60-79 years) residents. Generally, the younger were more pessimistic about their mental health than the elderly. It was also noteworthy that about 10% of the people thought that it was natural for them to have suicidal ideation, and about 18% reported that they had experienced suicidal ideation. Some suggestions were given to provide more effective suicide prevention measures.