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Jallow F, Stehling E, Sajwani-Merchant Z, Daniel KM, Fulda KG, Gurses AP, Arbaje AI, Xiao Y. Medication Management Strategies by Community-Dwelling Older Adults: A Multisite Qualitative Analysis. J Patient Saf 2024; 20:192-197. [PMID: 38372504 PMCID: PMC10963160 DOI: 10.1097/pts.0000000000001200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
OBJECTIVES Community-dwelling older adults taking 5 or more medications are at risk for medication-related harm. Managing multiple medications is a challenging task for patients and caregivers. Community-dwelling older adults self-manage their medications with minimal healthcare professional supervision. Although organizations, such as the Food and Drug Administration, often issue guidelines to ensure medication safety, how older adults understand and mitigate the risk of harm from medication use in the home environment is poorly understood. METHODS We conducted semistructured interviews with community-dwelling older adults 65 years and older who took 5 or more prescription medications to explore medication safety strategies they use. We also compared 2 organizations' medication safety guidelines for areas of concordance and discordance. RESULTS A total of 28 older adults were interviewed. Four overarching themes of medication management strategies emerged: collaborating with prescribers, collaborating with pharmacists, learning about medications, and safe practices at home. Study findings revealed that older adults followed some of the published guidelines by the 2 government organizations, although there were some areas of discord. Some of the strategies used were unintentionally against the recommended guidelines. For example, older adults tried weaning themselves off their medications without notifying their providers. CONCLUSIONS Older adults and their caregivers in our study used strategies different from those recommended by government organizations in managing medications to enhance drug safety. Patient-provider collaboration and positive patient outcomes can be improved by understanding and respecting strategies older adults use at home. Future studies must effectively incorporate older adults' perspectives when developing medication safety guidelines.
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Affiliation(s)
- Fatoumata Jallow
- University of Texas at Arlington, College of Nursing and Health Innovation, Arlington, Texas
| | - Elisa Stehling
- University of Texas at Arlington, College of Nursing and Health Innovation, Arlington, Texas
| | - Zara Sajwani-Merchant
- University of Texas at Arlington, College of Nursing and Health Innovation, Arlington, Texas
| | - Kathryn M. Daniel
- University of Texas at Arlington, College of Nursing and Health Innovation, Arlington, Texas
| | - Kimberly G. Fulda
- The University of North Texas Health Science Center, Department of Family Medicine and Osteopathic Manipulative Medicine. Fort Worth, TX; North Texas Primary Care Practice-Based Research Network (NorTex), Fort Worth, TX
| | - Ayse P Gurses
- Armstrong Institute Center for Health Care Human Factors, Johns Hopkins Medicine. Baltimore, Maryland
| | - Alicia I. Arbaje
- Armstrong Institute Center for Health Care Human Factors, Johns Hopkins Medicine. Baltimore, Maryland
- Division of Geriatric Medicine and Gerontology, Center for Transformative Geriatric Research, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Yan Xiao
- University of Texas at Arlington, College of Nursing and Health Innovation, Arlington, Texas
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Jallow F, Stehling E, Sajwani-Merchant Z, Daniel KM, Fulda KG, Espinoza AM, Gurses AP, Arbaje AI, Xiao Y. A Multisite Qualitative Analysis of Perceived Roles in Medication Safety: Older Adults' Perspectives. J Patient Exp 2023; 10:23743735231158887. [PMID: 36865379 PMCID: PMC9972051 DOI: 10.1177/23743735231158887] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023] Open
Abstract
Older adults and caregivers play an essential role in medication safety; however, self-perception of their and health professionals' roles in medication safety is not well-understood. The objective of our study was to identify the roles of patients, providers, and pharmacists in medication safety from the perspective of older adults. Semi-structured qualitative interviews were held with 28 community-dwelling older adults over 65 years who took five or more prescription medications daily. Results suggest that older adults' self-perceptions of their role in medication safety varied widely. Older adults perceived that self-learning about their medications and securing them are critical to avoiding medication-related harm. Primary care providers were perceived as coordinators between older adults and specialists. Older adults expected pharmacists to inform them of any changes in the characteristics of medications to ensure medications were taken correctly. Our findings provide an in-depth analysis of older adults' perceptions and expectations of their providers' specific roles in medication safety. Educating providers and pharmacists about the role expectations of this population with complex needs can ultimately improve medication safety.
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Affiliation(s)
- Fatoumata Jallow
- College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, USA.,West Coast University Dallas, Richardson, USA
| | - Elisa Stehling
- College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, USA
| | - Zara Sajwani-Merchant
- College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, USA
| | - Kathryn M Daniel
- College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, USA
| | - Kimberly G Fulda
- Department of Family Medicine and Osteopathic Manipulative Medicine, The University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Anna M Espinoza
- Department of Family Medicine and Osteopathic Manipulative Medicine, The University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Ayse P Gurses
- Armstrong Institute Center for Health Care Human Factors, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Alicia I Arbaje
- Division of Geriatric Medicine and Gerontology, Center for Transformative Geriatric Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.,Armstrong Institute Center for Health Care Human Factors, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Yan Xiao
- College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, USA
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Jallow F, Stehling E, Sajwani Z, Daniel K, Xiao Y, Fulda K, Espinoza A. PERCEIVED ROLES IN MEDICATION SAFETY: PATIENTS' PERSPECTIVES. Innov Aging 2022. [PMCID: PMC9770763 DOI: 10.1093/geroni/igac059.2577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Community-dwelling older adults are vulnerable to medication safety-related harms. Prevention of medication-related harms in the outpatient setting starts with thorough and thoughtful medication reconciliation at each patient encounter. Comprehensive medication reconciliation is challenging for prescribers to provide in busy time-pressured practices. Older adults currently taking five or more daily prescription medications were recruited for this qualitative study. From the participants’ perspective, we explored the role of the prescriber, pharmacist, and patient in medication safety. During the COVID-19 pandemic, interviews were conducted from October 2020 to June 2021. Results from these interviews suggest that older adults recognized their role in medication safety supersedes just taking the pills as prescribed. Older adults understand that they must play an essential role in the coproduction of quality health services. Subthemes that emerged from the patient’s perceived role were “taking fewer medications,” “locking them up,” “keeping appointments,” and “reading the label.” Pharmacists were expected to inform participants of any changes in their medications, such as the color, shape, or dosage, and ensure no drug interactions. Primary care providers are expected to coordinate care between all specialists treating their patients and any medication prescribed by those specialists. There was a high level of trust in the provider’s knowledge, skill, and experience, along with a low level of patient engagement in decision-making around deprescribing. Among older adults, self-perceptions of their role in medication safety varied widely. Educating prescribers and pharmacists about the role expectations of this vulnerable population can help improve medication safety.
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Affiliation(s)
- Fatoumata Jallow
- University of Texas at Arlington, Arlington, Texas, United States
| | - Elisa Stehling
- University of Texas at Arlington, Arlington, Texas, United States
| | | | - Kathryn Daniel
- University of Texas at Arlington, Arlington, Texas, United States
| | - Yan Xiao
- University of Texas at Arlington, Arlington, Texas, United States
| | - Kimberly Fulda
- University of North Texas Health Science Center, Fort Worth, Texas, United States
| | - Anna Espinoza
- University of North Texas Health Science Center, Fort Worth, Texas, United States
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Jallow F, Stehling E, Sajwani Z, Daniel K, Xiao Y. Opportunities and Barriers to Medication Safety in Community-Dwelling Older Adults. Innov Aging 2021. [PMCID: PMC8968404 DOI: 10.1093/geroni/igab046.2332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Community-dwelling multi-morbid older adults are a vulnerable population for medication safety-related threats. We interviewed a sample of these older adults recruited from local retirement communities and from primary care practices to learn their perceptions of barriers and enablers for their medication safety. The present study is part of the Partnership in Resilience for Medication Safety (PROMIS) study. One of the aims of this project is to identify barriers and opportunities to improve older adults' medication safety. These interviews were conducted during COVID-19 pandemic conditions. Results from this qualitative study suggest that trust between these older adults and their healthcare providers is an essential component of medication safety. Overarching themes include disruptions in medication management, caregivers caring for each other, patient safety practices or habits, and medication management literacy. Participants also shared strain due to lack of skills to navigate telemedicine visits, trust in Primary Care Providers (PCPs) and pharmacists to prescribe and dispense safely for them, reliance on PCPs and pharmacists to give essential information about medications without having to be asked. Our interviews illustrated large variations in older adults’ perceived role in medication safety, with some developing expertise in understanding how medications work for them and how long-term medications should be periodically reviewed. The types of information needs and supports from PCPs were likely different. Understanding these barriers and enablers for safe medication management can help us develop medication safety improvements for this vulnerable population.
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Affiliation(s)
- Fatoumata Jallow
- University of Texas at Arlington, Arlington, Texas, United States
| | - Elisa Stehling
- University of Tx. at Arlington, Arlington, Texas, United States
| | - Zara Sajwani
- The University of Texas at Arlington, The University of Texas at Arlington, Texas, United States
| | - Kathryn Daniel
- University of Texas at Arlington, Arlington, Texas, United States
| | - Yan Xiao
- University of Texas at Arlington, Arlington, Texas, United States
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Abstract
PURPOSE OF REVIEW To discuss the impact of deleterious changes in skeletal muscle morphology and function on exercise intolerance in patients with heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF), as well as the utility of exercise training and the potential of novel treatment strategies to preserve or improve skeletal muscle morphology and function. RECENT FINDINGS Both HFrEF and HFpEF patients exhibit a reduction in percent of type I (oxidative) muscle fibers and oxidative enzymes coupled with abnormal mitochondrial respiration. These skeletal muscle abnormalities contribute to impaired oxidative metabolism with an earlier shift towards glycolytic metabolism during exercise that is strongly associated with exercise intolerance. In both HFrEF and HFpEF patients, peripheral "non-cardiac" factors are important determinants of the improvement in exercise tolerance following aerobic exercise training. Adjunctive strategies that include nutritional supplementation with amino acids and/or anabolic drugs to stimulate anabolic molecular pathways in skeletal muscle show great promise for improving exercise tolerance and treating heart failure-associated sarcopenia, but these efforts remain early in their evolution, with no immediate clinical applications. There is consistent evidence that heart failure is associated with multiple skeletal muscle abnormalities which impair oxygen uptake and utilization and contribute greatly to exercise intolerance. Exercise training induces favorable adaptations in skeletal muscle morphology and function that contribute to improvements in exercise tolerance in patients with HFrEF. The contribution of skeletal muscle adaptations to improved exercise tolerance following exercise training in HFpEF remains unknown and warrants further investigation.
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Affiliation(s)
| | | | - Yaewon Seo
- The University of Texas at Arlington, Arlington, TX, USA
| | - Elisa Stehling
- The University of Texas at Arlington, Arlington, TX, USA
| | - Daniel E Forman
- Department of Medicine, Section of Geriatric Cardiology, Veterans Affairs Geriatric Research Education, and Clinical Center, University of Pittsburgh, 3471 Fifth Avenue, Suite 500, Pittsburgh, PA, 15213, USA.
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