scholarly journals Optimising medication management for polymedicated home-dwelling older adults with multiple chronic conditions: a mixed-methods study protocol

BMJ Open ◽  
2019 ◽  
Vol 9 (10) ◽  
pp. e030030
Author(s):  
Filipa Pereira ◽  
Pauline Roux ◽  
Marie Santiago-Delefosse ◽  
Armin von Gunten ◽  
Boris Wernli ◽  
...  
Keyword(s):  
Older Adults ◽  
Emergency Department ◽  
Mixed Methods ◽  
Chronic Conditions ◽  
Management Practices ◽  
Medication Management ◽  
Emergency Department Visits ◽  
Mixed Methods Study ◽  
Multiple Chronic Conditions ◽  
At Home

IntroductionOptimal medication management is one of the basic conditions necessary for home-dwelling older adults living with multiple chronic conditions (OAMCC) to be able to remain at home and preserve their quality of life. Currently, the reasons for such high numbers of emergency department visits and the very significant rate of hospitalisations for OAMCC, due to medication-related problems (MRPs), is poorly explored. This study aims to reveal the current state of the medication management practices of polymedicated, home-dwelling OAMCC and to make proposals for improving clinical and medication pathways through an innovative and integrated model for supporting medication management and preventing adverse health outcomes.Methods and analysisA mixed-methods study will address the medication management of polymedicated, home-dwelling OAMCC. Its explanatory sequential design will involve two major phases conducted sequentially over time. The quantitative phase will consist of retrospectively exploiting the last 5 years of electronic patient records from a local hospital (N ≈ 50 000) in order to identify the different profiles—made up of patient-related, medication-related and environment-related factors—of the polymedicated, home-dwelling OAMCC at risk of hospitalisation, emergency department visits, hospital readmission (notably for MRPs), institutionalisation or early death. The qualitative study will involve: (a) obtaining and understanding the medication management practices and experiences of the identified profiles extracted from the hospital data of OAMCC who will be interviewed at home (N ≈ 30); (b) collecting and analysing the perspectives of the formal and informal caregivers involved in medication management at home in order to cross-reference perspectives about this important dimension of care at home. Finally, the mixed-methods findings will enable the development of an innovative, integrated model of medication management based on the Agency for Clinical Innovation framework and Bodenheimer and Sinsky’s quadruple aim.Ethics and disseminationEthical approval has been obtained from the Human Research Ethics Committee of the Canton Vaud (2018-02196). Findings will be disseminated in peer-reviewed journals, professional conferences and other knowledge transfer activities with primary healthcare providers, hospital care units, informal caregivers’ and patients’ associations.

scholarly journals Medication Management Among Older Adults With Multiple Chronic Conditions: What Role Do Caregivers Play?

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 431-432
Author(s):  
Rachel O’Conor ◽  
Morgan Eifler ◽  
Andrea Russell ◽  
Lauren Opsasnick ◽  
Julia Yoshino Benavente ◽  
...  
Keyword(s):  
Older Adults ◽  
Older Adult ◽  
Chronic Conditions ◽  
Management Practices ◽  
Qualitative Interviews ◽  
Medication Management ◽  
Multiple Chronic Conditions ◽  
A Value ◽  
Older Adult Caregivers ◽  
Constant Comparative Analysis

Abstract Many older adults manage multiple chronic conditions (MCC) that require adherence to complex medication regimens. Few studies have investigated the degree to which caregivers support medication-related behaviors. We conducted semi-structured qualitative interviews with 25 caregivers of older adults with MCC to characterize caregiver medication assistance. Two coders used content and constant comparative analysis to analyze transcripts. The mean age of caregivers was 61 years; the majority were female (68%) and identified as non-white (Black, 52%; Hispanic, 8%). Caregivers were predominantly spouses (n=10), or children (n=11). Older adults were on average 73 years old, managing 5 chronic conditions and prescribed 7 medications. Caregivers acknowledged the importance of medications to the older adult’s health, but their involvement in daily medication management was limited. Some caregivers preferred that the older adult continue these tasks to maintain autonomy, especially when caring for older adults who valued maintaining independence. Caregivers assumed medication responsibilities after older adults experienced sudden changes in health or upon observing non-adherence (e.g. full pill bottles). Older adults with higher medication burden (12+ medicines) adopted inefficient, cumbersome medication management practices; caregivers suggested simplified strategies, but the older adults refused to adopt recommended strategies. To combat resistance from the older adult, caregivers disguised assistance and deployed workaround strategies to monitor medication-taking behaviors. These findings suggest older adults and caregivers share a value of promoting independence of medication management, up until safety is seriously questioned. Additionally, there is a breakdown in communication at the time when older adults may benefit from increased caregiver involvement.

scholarly journals Emergency Department Utilization among Underserved African American Older Adults in South Los Angeles

2019 ◽  
Vol 16 (7) ◽  
pp. 1175 ◽  
Author(s):  
Mohsen Bazargan ◽  
James Smith ◽  
Sharon Cobb ◽  
Lisa Barkley ◽  
Cheryl Wisseh ◽  
...  
Keyword(s):  
Older Adults ◽  
Emergency Department ◽  
African American ◽  
Los Angeles ◽  
Continuity Of Care ◽  
Chronic Conditions ◽  
Male Gender ◽  
Multiple Chronic Conditions ◽  
South Los Angeles ◽  
Ed Visits

Objectives: Using the Andersen’s Behavioral Model of Health Services Use, we explored social, behavioral, and health factors that are associated with emergency department (ED) utilization among underserved African American (AA) older adults in one of the most economically disadvantaged urban areas in South Los Angeles, California. Methods: This cross-sectional study recruited a convenience sample of 609 non-institutionalized AA older adults (age ≥ 65 years) from South Los Angeles, California. Participants were interviewed for demographic factors, self-rated health, chronic medication conditions (CMCs), pain, depressive symptoms, access to care, and continuity of care. Outcomes included 1 or 2+ ED visits in the last 12 months. Polynomial regression was used for data analysis. Results: Almost 41% of participants were treated at an ED during the last 12 months. In all, 27% of participants attended an ED once and 14% two or more times. Half of those with 6+ chronic conditions reported being treated at an ED once; one quarter at least twice. Factors that predicted no ED visit were male gender (OR = 0.50, 95% CI = 0.29–0.85), higher continuity of medical care (OR = 1.55, 95% CI = 1.04–2.31), individuals with two CMCs or less (OR = 2.61 (1.03–6.59), second tertile of pain severity (OR = 2.80, 95% CI = 1.36–5.73). Factors that predicted only one ED visit were male gender (OR = 0.45, 95% CI = 0.25–0.82), higher continuity of medical care (OR = 1.39, 95% CI = 1.01–2.15) and second tertile of pain severity (OR = 2.42, 95% CI = 1.13–5.19). Conclusions: This study documented that a lack of continuity of care for individuals with multiple chronic conditions leads to a higher rate of ED presentations. The results are significant given that ED visits may contribute to health disparities among AA older adults. Future research should examine whether case management decreases ED utilization among underserved AA older adults with multiple chronic conditions and/or severe pain. To explore the generalizability of these findings, the study should be repeated in other settings.

scholarly journals A Descriptive Analysis of Location of Older Adult Falls That Resulted in Emergency Department Visits in the United States, 2015

2020 ◽  
pp. 155982762094218
Author(s):  
Briana L. Moreland ◽  
Ramakrishna Kakara ◽  
Yara K. Haddad ◽  
Iju Shakya ◽  
Gwen Bergen
Keyword(s):  
United States ◽  
Older Adults ◽  
Emergency Department ◽  
The United States ◽  
Emergency Department Visits ◽  
Targeted Prevention ◽  
Injury Surveillance System ◽  
Injurious Falls ◽  
Ed Visits ◽  
At Home

Introduction. Falls among older adults (age ≥65) are a common and costly health issue. Knowing where falls occur and whether this location differs by sex and age can inform prevention strategies. Objective. To determine where injurious falls that result in emergency department (ED) visits commonly occur among older adults in the United States, and whether these locations differ by sex and age. Methods. Using 2015 National Electronic Injury Surveillance System-All Injury Program data we reviewed narratives for ED patients aged ≥65 who had an unintentional fall as the primary cause of injury. Results. More fall-related ED visits (71.6%) resulted from falls that occurred indoors. A higher percentage of men’s falls occurred outside (38.3%) compared to women’s (28.4%). More fall-related ED visits were due to falls at home (79.2%) compared to falls not at home (20.8%). The most common locations for a fall at home were the bedroom, bathroom, and stairs. Conclusion. The majority of falls resulting in ED visits among older adults occurred indoors and varied by sex and age. Knowing common locations of injurious falls can help older adults and caregivers prioritize home modifications. Understanding sex and age differences related to fall location can be used to develop targeted prevention messages.

scholarly journals Emergency Department Visits for Nontraumatic Dental Problems: A Mixed-Methods Study

2015 ◽  
Vol 105 (5) ◽  
pp. 947-955 ◽  
Author(s):  
Benjamin C. Sun ◽  
Donald L. Chi ◽  
Eli Schwarz ◽  
Peter Milgrom ◽  
Annick Yagapen ◽  
...  
Keyword(s):  
Emergency Department ◽  
Mixed Methods ◽  
Emergency Department Visits ◽  
Mixed Methods Study

scholarly journals Experiences of an Emergency Department Visit Among Older Adults and Their Families: Qualitative Findings From a Mixed-Methods Study

2019 ◽  
Vol 7 (3) ◽  
pp. 346-356
Author(s):  
Deniz Cetin-Sahin ◽  
Francine Ducharme ◽  
Jane McCusker ◽  
Nathalie Veillette ◽  
Sylvie Cossette ◽  
...  
Keyword(s):  
Older Adults ◽  
Emergency Department ◽  
Mixed Methods ◽  
Family Members ◽  
Home Care Services ◽  
Mixed Methods Study ◽  
Telephone Interviews ◽  
Care Services ◽  
Ed Visits ◽  
Family Perceptions

Background: Emergency department (ED) visits are critical events for older adults, but little is known regarding their experiences, particularly about their physical needs, the involvement of accompanying family members, and the transition back to the community. Objective: To explore experiences of an ED visit among patients aged 75 and older. Methods: In a mixed-methods study, a cohort of patients aged 75 and older (or a family member) discharged from the ED back to the community was recruited from 4 urban EDs. A week following discharge, structured telephone interviews supplemented with open-ended questions were conducted. A subsample (76 patients, 32 family members) was purposefully selected. Verbatim transcripts of responses to the open-ended questions were thematically analyzed. Results: Experiences related to physical needs included comfort, equipment supporting mobility and autonomy, help when needed, and access to drink and food. Family members required opportunities to provide patient support and greater involvement in their care. At discharge, patients/families required adequate discharge education, resolution of their health problem, information on medications, and greater certainty about planned follow-up medical and home care services. Conclusions: Our findings suggest several areas that could be targeted to improve patient and family perceptions of the care at an ED visit.

scholarly journals Medication Management Models for Polymedicated Home-Dwelling Older Adults With Multiple Chronic Conditions: Protocol of a Systematic Review

10.2196/13582 ◽  
2019 ◽  
Vol 8 (5) ◽  
pp. e13582
Author(s):  
Filipa Pereira ◽  
Pauline Roux ◽  
Joëlle Rosselet Amoussou ◽  
Maria Manuela Martins ◽  
Armin von Gunten ◽  
...  
Keyword(s):  
Systematic Review ◽  
Older Adults ◽  
Chronic Conditions ◽  
Medication Management ◽  
Multiple Chronic Conditions ◽  
Management Models

scholarly journals Emergency Department and Inpatient Utilization among U.S. Older Adults with Multiple Chronic Conditions: A Post-Reform Update

2020 ◽  
Author(s):  
SangNam Ahn ◽  
Mustafa Hussein ◽  
Asos Mahmood ◽  
Matthew Lee Smith
Keyword(s):  
Older Adults ◽  
Emergency Department ◽  
Low Income ◽  
Chronic Conditions ◽  
Medical Expenditure Panel Survey ◽  
Medical Expenditure ◽  
Multiple Chronic Conditions ◽  
Medicare Beneficiaries ◽  
Percentage Points ◽  
Ed Visits

Abstract Background. The Affordable Care Act (ACA) was enacted to enhance access to care primarily among nonelderly and low-income populations; however, several provisions addressed key determinants of emergency department (ED) and inpatient visits among Medicare beneficiaries over age 65 years. We take stock of the overall changes in these visits among older Medicare beneficiaries, focusing on those with multiple chronic conditions (MCCs), and provide a nationally representative post-reform update. Methods. We analyzed a sample of 32,919 older adults (65+) on Medicare from the 2006-2015 Medical Expenditure Panel Survey (MEPS). Using a survey-weighted two-part model, we examined changes in ED visits, inpatient visits, and length of stay (LOS) by MCC status, before (2006-2010), during (2011-2013), and after the ACA (2014-2015). Results. Prior to the ACA, 18.1% of Medicare older adults had ≥1 ED visit, whereas 17.1% had ≥1 inpatient visits, with an average of 5.1 nights/visit. Following ACA reforms, among those with 2+ chronic conditions, the rate of ever having an ED visit increased by 4.3 percentage points [95% confidence intervals [CI]: 2.5, 6.1, p < 0.01], whereas the rate of inpatient visits decreased by 1.4 percentage points [95%CI: -2.9, 0.2, p < 0.1], after multivariable adjustment. Conclusions. We found sizable increases in ED visits and nontrivial decreases in inpatient visits among older Medicare beneficiaries with MCCs, underscoring the continuing need for improving access to and quality of care among older adults with MCCs to decrease reliance on the ED and reduce preventable hospitalizations.

scholarly journals SAFER MEDICATION MANAGEMENT FOR HOME-DWELLING OLDER ADULTS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S758-S758
Author(s):  
Henk Verloo ◽  
Armin von Gunten ◽  
Boris Wernli ◽  
Marie SANTIAGO-DELEFOSSE ◽  
Maria Manuela MARTINS ◽  
...  
Keyword(s):  
Older Adults ◽  
Side Effects ◽  
Adverse Effects ◽  
Chronic Conditions ◽  
Medication Management ◽  
Informal Caregivers ◽  
Premature Death ◽  
Difficult Challenge ◽  
At Home

Abstract Taking several medications at the same time can lead to adverse effects and dangerous situations for home-dwelling older adults with chronic conditions. Accurate medication management can be a difficult challenge, especially for people living at home. However, little research has been carried out into the experience of older adults and their informal caregivers with medication management. The aim of the study is, first, to identify factors that can cause undesirable side effects and make taking multiple medications potentially dangerous for home-dwelling older adults. Second, the study will investigate the experiences of this group of patients with medication management. Third, the role of both professional and informal caregivers will be examined. Recommendations will be made on how to improve the safety of medication management for home-dwelling older adults with chronic conditions and should help to prevent the adverse effects and dangerous situations that can lead to hospitalization, institutionalization or premature death

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