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.

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.

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.

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.