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Gilson AM, Stone JA, Morris AO, Brown RL, Xiong KZ, Jacobson N, Holden RJ, Albert SM, Phelan CH, Walbrandt Pigarelli DL, Breslow RM, Welch L, Chui MA. Impact of a pilot community pharmacy system redesign on reducing over-the-counter medication misuse in older adults. J Am Pharm Assoc (2003) 2021; 61:555-564. [PMID: 34006480 DOI: 10.1016/j.japh.2021.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 03/28/2021] [Accepted: 04/08/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND No interventions have attempted to decrease misuse of over-the-counter (OTC) medications for adults aged 65 years or older (older adults) by addressing system barriers. An innovative structural pharmacy redesign (the Senior Section) was conceptualized to increase awareness of higher-risk OTC medications. The Senior Section contains a curated selection of OTC medications and is close to the prescription department to facilitate pharmacy staff-patient engagement to reduce misuse. OBJECTIVE This pilot study examined the Senior Section's effectiveness at influencing OTC medication misuse in older adults. METHODS A pretest-post-test nonequivalent groups design was used to recruit 87 older adults from 3 pharmacies. Using a hypothetical scenario, the participants selected an OTC medication that was compared with their medication list and health conditions, and their reported use was compared with the product labeling. Misuse outcomes comprised drug-drug, drug-disease, drug-age, and drug-label, with 5 subtypes. Patient characteristics were compiled into a propensity score matching logistic regression model to estimate their effects on the Senior Section's association with misuse at pre- or postimplementation. RESULTS Patient characteristics were uniform between pre- and postimplementation, and, once entered into a propensity score matching model, drug-label misuse (exceeds daily dosage) statistically significantly lessened over time (z = -2.42, P = 0.015). In addition, the Senior Section reduced drug-label misuse (exceeds single dosage) for both the raw score model (z = -6.38, P = 0.011) and the model in which the patient characteristics propensity score was added (z = -5.82, P = 0.011). Despite these limited statistical effects, misuse was found to decrease after implementation for 7 of 11 comparisons. CONCLUSION These nascent outcomes begin providing an evidence base to support a well-conceived, pharmacy-based OTC medication-aisle redesign for reducing older adult OTC medication misuse. The Senior Section, when broadly implemented, creates permanent structures and processes to assist older adults to access risk information when selecting safer OTC medications.
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Hamilton RKB, Phelan CH, Chin NA, Wyman MF, Lambrou N, Cobb N, Kind AJH, Blazel H, Asthana S, Gleason CE. The U-ARE Protocol: A Pragmatic Approach to Decisional Capacity Assessment for Clinical Research. J Alzheimers Dis 2019; 73:431-442. [PMID: 31868663 DOI: 10.3233/jad-190457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
With increased longevity and growth in the number of older adults comes rising rates of individuals with cognitive impairment and dementia. The expansion of this population has important implications for research on aging and dementia syndromes, namely increased enrollment of older individuals in clinical research. Ethical prerogatives, as well as historical underrepresentation of persons with dementia in research studies due to the perceived burden of traditional decisional capacity evaluations, necessitates the development of pragmatic approaches to ascertain decisional abilities in research settings. We outline a protocol used in the Wisconsin Alzheimer's Disease Research Center (ADRC) that adopts a stepped approach to the evaluation of decisional capacity meant to maximize study visit efficiency while preserving participant safety and autonomy. The protocol specifies the structure of the consent process and incorporates a brief semi-structured interview based on Appelbaum & Grisso's theoretical model for evaluating a patient's decisional capacity to provide informed consent to participate in research. This protocol is easily implemented in a research study visit and is designed to minimize participant burden and ensure reliable assessment of decisional capacity in older adults across a wide range of research protocols. The protocol emphasizes capacity optimization, using memory aids and other compensatory strategies to preserve participant autonomy while protecting welfare.
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Affiliation(s)
- Rachel K B Hamilton
- Department of Psychology, University of Wisconsin - Madison, Madison, WI, USA.,Geriatric Research, Education, & Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
| | - Cynthia H Phelan
- Aurora Center for Nursing Research and Practice, Advocate Aurora Health Care, Milwaukee, WI, USA
| | - Nathaniel A Chin
- Department of Medicine - Division of Geriatrics, School of Medicine and Public Health, University of Wisconsin - Madison, Madison, WI, USA.,Wisconsin Alzheimer's Disease Research Center, Madison, WI, USA
| | - Mary F Wyman
- Geriatric Research, Education, & Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA.,Department of Medicine - Division of Geriatrics, School of Medicine and Public Health, University of Wisconsin - Madison, Madison, WI, USA
| | - Nickolas Lambrou
- Geriatric Research, Education, & Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
| | - Nichelle Cobb
- Health Sciences IRBs Director, University of Wisconsin - Madison, Madison, WI, USA
| | - Amy J H Kind
- Geriatric Research, Education, & Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA.,Department of Medicine - Division of Geriatrics, School of Medicine and Public Health, University of Wisconsin - Madison, Madison, WI, USA.,Wisconsin Alzheimer's Disease Research Center, Madison, WI, USA
| | - Hanna Blazel
- Department of Medicine - Division of Geriatrics, School of Medicine and Public Health, University of Wisconsin - Madison, Madison, WI, USA.,Wisconsin Alzheimer's Disease Research Center, Madison, WI, USA
| | - Sanjay Asthana
- Geriatric Research, Education, & Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA.,Department of Medicine - Division of Geriatrics, School of Medicine and Public Health, University of Wisconsin - Madison, Madison, WI, USA.,Wisconsin Alzheimer's Disease Research Center, Madison, WI, USA
| | - Carey E Gleason
- Geriatric Research, Education, & Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA.,Department of Medicine - Division of Geriatrics, School of Medicine and Public Health, University of Wisconsin - Madison, Madison, WI, USA.,Wisconsin Alzheimer's Disease Research Center, Madison, WI, USA
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Stone JA, Phelan CH, Holden RJ, Jacobson N, Chui MA. A pilot study of decision factors influencing over-the-counter medication selection and use by older adults. Res Social Adm Pharm 2019; 16:1117-1120. [PMID: 31810787 DOI: 10.1016/j.sapharm.2019.11.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 11/20/2019] [Accepted: 11/20/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND OBJECTIVES Despite their availability without prescription, OTC medications pose a risk for significant harm for older adults due to higher likelihood of polypharmacy, drug interactions, and age-related physiological changes. The purpose of this study is to identify the individual decision factors that influence how older adults select and use over-the-counter medications. METHODS A pilot study was conducted with 20 community-dwelling older adults. Older adults met the interviewer at a regional mass merchandise store where they were given both pain and insomnia standardized scenarios. Participants described how they would select and then hypothetically use a given medication to treat the problem described in the scenario. RESULTS OTC medication selection and reported use were influenced by several person-level decision-making factors including: personal beliefs/knowledge about OTCs, assessment of the ailment, and medical constraints. CONCLUSION The findings from this investigation provide direction for interventions to address unsafe OTC medication selection by older adults.
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Affiliation(s)
| | - Cynthia H Phelan
- Advocate Aurora Health and University of Wisconsin, Madison, USA.
| | - Richard J Holden
- Indiana University School of Medicine and Indiana University Center for Aging Research, Regenstrief Institute, Inc, USA.
| | | | - Michelle A Chui
- University of Wisconsin, Madison, 777 Highland Avenue, Madison, WI, 53705, USA.
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Stone JA, Lester CA, Aboneh EA, Phelan CH, Welch LL, Chui MA. A preliminary examination of over-the-counter medication misuse rates in older adults. Res Social Adm Pharm 2016; 13:187-192. [PMID: 26853833 DOI: 10.1016/j.sapharm.2016.01.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 01/08/2016] [Indexed: 02/05/2023]
Abstract
BACKGROUND Older adults are the largest consumers of over the counter (OTC) medications. Of the older adults who are at risk of a major adverse drug event, more than 50% of these events involve an OTC medication. OBJECTIVE To explore how older adults select and hypothetically use OTC medications and if the selected medications would be considered safe for use. METHODS Walking interviews were conducted with 20 community-dwelling older adults in a community pharmacy. Each participant selected an OTC medication for a hypothetical pain and sleep scenario. Data were analyzed for four types of misuse: drug-drug interaction, drug-disease interaction, drug-age interaction, and excess usage. RESULTS At least one instance of potential misuse was found in 95% of participants. For sleep medications, drug-drug interactions and drug-age interactions were more common, affecting 50% and 65% of participants respectively. The most common type of misuse noted in the pain products selected was that of drug-drug interaction, with a total of 39 occurrences, affecting 60% of the participants. CONCLUSIONS OTC misuse is common among older adults, and it is important for older adults to seek out resources, such as a pharmacist, to help them make safe OTC decisions.
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Affiliation(s)
- Jamie A Stone
- University of Wisconsin-School of Pharmacy, 777 Highland Ave., Madison, WI 53705, USA
| | - Corey A Lester
- University of Wisconsin-School of Pharmacy, 777 Highland Ave., Madison, WI 53705, USA
| | - Ephrem A Aboneh
- University of Wisconsin-School of Pharmacy, 777 Highland Ave., Madison, WI 53705, USA
| | - Cynthia H Phelan
- William S. Middleton Memorial Veterans Hospital, Department of Veterans Affairs, 2500 Overlook Terrace, Madison, WI 53705, USA
| | - Lauren L Welch
- William S. Middleton Memorial Veterans Hospital, Department of Veterans Affairs, 2500 Overlook Terrace, Madison, WI 53705, USA
| | - Michelle A Chui
- University of Wisconsin-School of Pharmacy, 777 Highland Ave., Madison, WI 53705, USA.
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Moon C, Phelan CH, Lauver DR, Bratzke LC. Is sleep quality related to cognition in individuals with heart failure? Heart Lung 2015; 44:212-8. [PMID: 25796476 DOI: 10.1016/j.hrtlng.2015.02.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 01/30/2015] [Accepted: 02/08/2015] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To examine how self-reported sleep quality and daytime symptoms are associated with selected domains of cognitive function among individuals with heart failure (HF). BACKGROUND HF patients suffer from poor sleep quality and cognitive decline. The relationship between sleep and cognition has not been well documented among individuals with HF. METHODS In this descriptive, cross-sectional study, 68 individuals with HF (male: 63%, mean age = 72 years, SD = 11) completed sleep questionnaires and a neuropsychological battery. RESULTS Participant had mean Pittsburgh Sleep Quality Index score of 5.04 (SD = 2.8). Regression analyses demonstrated neither sleep quality or excessive daytime sleepiness (EDS) were related to cognitive function, but daytime dysfunction was related to lower letter fluency and attention index. CONCLUSION Contrary to some earlier reports, subjective sleep and EDS in this group of individuals was not associated with cognitive decline.
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Affiliation(s)
- Chooza Moon
- University of Wisconsin-Madison, School of Nursing, 701 Highland Avenue, Madison, WI 53705, USA.
| | - Cynthia H Phelan
- University of Wisconsin-Madison, School of Nursing, 701 Highland Avenue, Madison, WI 53705, USA; William S. Middleton Memorial Veterans Hospital Geriatrics Research, Education and Clinical Center (GRECC), 2500 Overlook Terrace, Madison, WI 53705, USA
| | - Diane R Lauver
- University of Wisconsin-Madison, School of Nursing, 701 Highland Avenue, Madison, WI 53705, USA
| | - Lisa C Bratzke
- University of Wisconsin-Madison, School of Nursing, 701 Highland Avenue, Madison, WI 53705, USA
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Phelan CH, Love GD, Ryff CD, Brown RL, Heidrich SM. Psychosocial predictors of changing sleep patterns in aging women: a multiple pathway approach. Psychol Aging 2011; 25:858-66. [PMID: 20731498 DOI: 10.1037/a0019622] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The authors of this investigation sought to examine changes in the sleep quality of older women over time and to determine whether dimensions of psychological well-being, health (subjective health and number of illnesses), and psychological distress (depression and anxiety) predict these changes. A secondary analysis was conducted with a longitudinal sample of aging women (Kwan, Love, Ryff, & Essex, 2003). Of 518 community-dwelling older women in the parent study, 115 women (baseline M age = 67 years, SD = 7.18) with data at baseline, 8 years, and 10 years were used for this investigation. Participants completed self-administered questionnaires and participated in in-home interviews and observations. Growth curve modeling was used to examine the overall linear trajectories of sleep quality. Growth mixture modeling was used to examine whether there were different patterns of change in sleep quality over time and to examine baseline predictors of each pattern. Sleep quality declined over time but not for all women. Two distinctly different sleep patterns emerged: good but declining sleep quality and disrupted sleep quality. Higher psychological well-being (positive relations with others, environmental mastery, personal growth, purpose in life, and self-acceptance), fewer illnesses, and lower depression scores at baseline predicted reduced odds for membership in the disrupted sleep group. Future research is needed to examine whether interventions focused on maintaining or enhancing psychological well-being could minimize later life declines in sleep quality.
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Affiliation(s)
- Cynthia H Phelan
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, Madison, WI 53705, USA.
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Abstract
PURPOSE/OBJECTIVES To use Leventhal's Common Sense Model (CSM) to describe older breast cancer survivors' symptom representations, symptom management strategies, and perceived barriers to symptom management. DESIGN A secondary analysis was conducted using data from three pilot studies that tested a theory-based intervention to improve symptom management in older breast cancer survivors. SETTING Advanced practice nurses conducted open-ended interviews with older breast cancer survivors either in their homes or via telephone. SAMPLE Participants were recruited from the community, an oncology clinic, and a state tumor registry. The women (N = 61, X age = 69.5) were an average of 4.7 years after breast cancer diagnosis and reported an average of 17 symptoms. METHODS Content analysis was conducted with field notes taken during baseline interviews. MAIN RESEARCH VARIABLES Symptom representations, symptom management strategies, and perceived barriers to symptom management. FINDINGS Women described their symptoms as chronic, incurable, and uncontrollable, with multiple causes (usually not aging) and numerous negative consequences. Women described an average of six symptom management strategies, most typically self-care. The most frequent barrier to symptom management was communicating with healthcare providers. CONCLUSIONS The CSM is a useful framework for understanding the symptom beliefs of older breast cancer survivors. IMPLICATIONS FOR NURSING Addressing women's beliefs and barriers may result in better communication with healthcare providers and more effective interventions for symptom management.
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Heidrich SM, Brown RL, Egan JJ, Perez OA, Phelan CH, Yeom H, Ward SE. An individualized representational intervention to improve symptom management (IRIS) in older breast cancer survivors: three pilot studies. Oncol Nurs Forum 2009; 36:E133-43. [PMID: 19403441 DOI: 10.1188/09.onf.e133-e143] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE/OBJECTIVES To test the feasibility and acceptability of an individualized representational intervention to improve symptom management (IRIS) in older breast cancer survivors and test the short-term effects of an IRIS on symptom distress. DESIGN Two small randomized clinical trials and one pre-experimental study. SETTING Oncology clinic and community. SAMPLE 41 women with breast cancer (aged 65 years and older) in pilot study 1, 20 in pilot study 2, and 21 in pilot study 3. METHODS In pilot study 1, women were randomized to the IRIS or usual care control. In pilot study 2, women were randomized to the IRIS or delayed IRIS (wait list) control. In pilot study 3, all women received the IRIS by telephone. Measures were collected at baseline, postintervention, and follow-up (up to four months). MAIN RESEARCH VARIABLES Feasibility, acceptability, symptom distress, symptom management behaviors, symptom management barriers, and quality of life. FINDINGS Across three pilot studies, 76% of eligible women participated, 95% completed the study, 88% reported the study was helpful, and 91% were satisfied with the study. Some measures of symptom distress decreased significantly after the IRIS, but quality of life was stable. Women in the IRIS group changed their symptom management behaviors more than controls. CONCLUSIONS Preliminary evidence supports the need for and feasibility of an IRIS. IMPLICATIONS FOR NURSING Nurses may help older breast cancer survivors manage their numerous chronic symptoms more effectively by assessing women's beliefs about their symptoms and their current symptom management strategies.
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