Optimizing Older Adults' Medication Use.

Mary C Zonsius, Klodiana Myftari, Michelle Newman, Erin E Emery-Tiburcio
Author Information
  1. Mary C Zonsius: Mary C. Zonsius is an associate professor in the College of Nursing at Rush University Medical Center in Chicago, where Klodiana Myftari is a clinical pharmacy specialist in the Department of Ambulatory Care Management, Michelle Newman is a program manager in the Department of Social Work and Community Health, and Erin E. Emery-Tiburcio is an associate professor in the Department of Psychiatry and Behavioral Sciences. Myftari is also an assistant professor of pharmacy practice at Midwestern University College of Pharmacy in Downers Grove, IL. Contact author: Mary C. Zonsius, mary_c_zonsius@rush.edu . The authors have disclosed no potential conflicts of interest, financial or otherwise.

Abstract

This article is the third in a series, Supporting Family Caregivers in the 4Ms of an Age-Friendly Health System, published in collaboration with the AARP Public Policy Institute as part of the ongoing Supporting Family Caregivers: No Longer Home Alone series. The 4Ms of an Age-Friendly Health System (What Matters, Medication, Mentation, and Mobility) is an evidence-based framework for assessing and acting on critical issues in the care of older adults across settings and transitions of care. Engaging the health care team, including older adults and their family caregivers, with the 4Ms framework can help to ensure that every older adult gets the best care possible, is not harmed by health care, and is satisfied with the care they receive. The articles in this series present considerations for implementing the 4Ms framework in the inpatient hospital setting and incorporating family caregivers in doing so. Resources for both nurses and family caregivers, including a series of accompanying videos developed by AARP and the Rush Center for Excellence in Aging and funded by The John A. Hartford Foundation, are also provided. Nurses should read the articles first, so they understand how best to help family caregivers. Then they can refer caregivers to the informational tear sheet-Information for Family Caregivers-and instructional videos, encouraging them to ask questions. For additional information, see Resources for Nurses.

References

  1. AARP and National Alliance for Caregiving. Caregiving in the U.S. 2020 . Washington, DC; 2020 May 14. https://www.aarp.org/content/dam/aarp/ppi/2020/05/full-report-caregiving-in-the-united-states.doi.10.26419-2Fppi.00103.001.pdf .
  2. Fulmer T, et al. The age-friendly health system imperative. J Am Geriatr Soc 2018;66(1):22–4.
  3. Qato DM, et al. Changes in prescription and over-the-counter medication and dietary supplement use among older adults in the United States, 2005 vs 2011. JAMA Intern Med 2016;176(4):473–82.
  4. Steinman MA. Polypharmacy: time to get beyond numbers. JAMA Intern Med 2016;176(4):482–3.
  5. Clark CM, et al. Potentially inappropriate medications are associated with increased healthcare utilization and costs. J Am Geriatr Soc 2020;68(11):2542–50.
  6. Alves-Conceição V, et al. Medication regimen complexity measured by MRCI: a systematic review to identify health outcomes. Ann Pharmacother 2018;52(11):1117–34.
  7. Reeve E, et al. Deprescribing: a narrative review of the evidence and practical recommendations for recognizing opportunities and taking action. Eur J Intern Med 2017;38:3–11.
  8. Clyne B, et al. Beliefs about prescribed medication among older patients with polypharmacy: a mixed methods study in primary care. Br J Gen Pract 2017;67(660):e507–e518.
  9. Kantor ED, et al. Trends in prescription drug use among adults in the United States from 1999-2012. JAMA 2015;314(17):1818–31.
  10. Urfer M, et al. Intervention to improve appropriate prescribing and reduce polypharmacy in elderly patients admitted to an internal medicine unit. PLoS One 2016;11(11):e0166359.
  11. Chen Z, Buonanno A. Geriatric polypharmacy: two physicians' personal perspectives. Clin Geriatr Med 2017;33(2):283–8.
  12. Ponte ML, et al. Prescribing cascade: a proposed new way to evaluate it. Medicina (B Aires) 2017;77(1):13–6.
  13. Reinhard SC, et al. Home alone: family caregivers providing complex chronic care . Washington, DC: AARP Public Policy Institute and the United Health Fund; 2012 Oct. https://www.aarp.org/content/dam/aarp/research/public_policy_institute/health/home-alone-family-caregivers-providing-complex-chronic-care-rev-AARP-ppi-health.pdf .
  14. Nicosia FM, et al. What is a medication-related problem? A qualitative study of older adults and primary care clinicians. J Gen Intern Med 2020;35(3):724–31.
  15. Donohoe KL, et al. Geriatrics: the aging process in humans and its effects on physiology. In: DiPiro JT, et al., editors. Pharmacotherapy: a pathophysiologic approach . 11th ed. New York: McGraw Hill; 2021.
  16. Brandt NJ, et al. Practice and policy/research implications of deprescribing on medication use and safety in older adults. Policy Aging Rep 2018;28(4):116–21.
  17. Lehane E, McCarthy G. Intentional and unintentional medication non-adherence: a comprehensive framework for clinical research and practice? A discussion paper. Int J Nurs Stud 2007;44(8):1468–77.
  18. Lindauer A, et al. Medication management for people with dementia. Am J Nurs 2017;117(5 Suppl 1):S17–S21.
  19. Joint Commission. National Patient Safety Goals effective January 2022 for the hospital program . Oakbrook Terrace, IL; 2021. National patient safety goals for hospitals; https://www.jointcommission.org/-/media/tjc/documents/standards/national-patient-safety-goals/2022/npsg_chapter_hap_jan2022.pdf .
  20. LaValley S, et al. Caregivers' roles in medication management for older family members [abstract from GSA annual scientific meeting]. Innov Aging 2018;2(S1):290.
  21. Jou J, Johnson PJ. Nondisclosure of complementary and alternative medicine use to primary care physicians: findings from the 2012 National Health Interview Survey. JAMA Intern Med 2016;176(4):545–6.
  22. Brandt NJ. Optimizing medication use through deprescribing: tactics for this approach. J Gerontol Nurs 2016;42(1):10–4.
  23. American Geriatrics Society Beers Criteria Update Expert Panel. American Geriatrics Society 2019 updated AGS Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc 2019;67(4):674–94.
  24. National Health Service Cumbria Clinical Commissioning Group. STOPP START Toolkit: supporting medication review (version 2) . Durham, UK: North of England Commissioning Support (NECS) Medicines Optimisation Team on behalf of Cumbria CCG; 2016 Jun.
  25. Motter FR, et al. Potentially inappropriate medication in the elderly: a systematic review of validated explicit criteria. Eur J Clin Pharmacol 2018;74(6):679–700.
  26. Liu F, et al. Patient-centred pharmaceutical design to improve acceptability of medicines: similarities and differences in paediatric and geriatric populations. Drugs 2014;74(16):1871–89.
  27. Institute for Healthcare Improvement. Age-friendly health systems: guide to using the 4Ms in the care of older adults . Boston; 2020 Jul. http://www.ihi.org/Engage/Initiatives/Age-Friendly-Health-Systems/Documents/IHIAgeFriendlyHealthSystems_GuidetoUsing4MsCare.pdf .
  28. Scott IA, et al. Reducing inappropriate polypharmacy: the process of deprescribing. JAMA Intern Med 2015;175(5):827–34.
  29. Pellegrin KL, et al. Reductions in medication-related hospitalizations in older adults with medication management by hospital and community pharmacists: a quasi-experimental study. J Am Geriatr Soc 2017;65(1):212–9.
  30. Gabauer J. Mitigating the dangers of polypharmacy in community-dwelling older adults. Am J Nurs 2020;120(2):36–42.
  31. Harvath TA, et al. Managing complex medication regimens. Am J Nurs 2016;116(11):43–6.
  32. Fulmer T, Berman A. Age-friendly health systems: the 4Ms . New York, NY: The Hartford Institute for Geriatric Nursing, New York University Rory Meyers College of Nursing; 2019. Try this: best practices in nursing care to older adults (general assessment series); https://hign.org/sites/default/files/2020-06/Try_This_General_Assessment_35.pdf .
  33. Health in Aging. Medications and older adults . American Geriatrics Society Health in Aging Foundation. n.d. https://www.healthinaging.org/medications-older-adults .
  34. U.S. Food and Drug Administration. Medicines and you: a guide for older adults . Silver Spring, MD; 2015 Oct 7. https://www.fda.gov/drugs/resources-you-drugs/medicines-and-you-guide-older-adults .
  35. Cameron KA. Medications: a double-edged sword . San Francisco: Family Caregiver Alliance; n.d.; https://www.caregiver.org/resource/caregiver's-guide-medications-and-aging/# .

MeSH Term

Aged
Caregivers
Humans
Patient Care Team

Word Cloud

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