kaasalainen s, dolovich l, papaioannou a, holbrook a, lau e, ploeg j, levine m, cosby j & emily a (2011) Journal of Nursing and Healthcare of Chronic Illness 3, 407–418 
The process of medication management for older adults with dementia Aim.  The purpose of this study was to explore the personal experiences related to medication management of community‐dwelling older adults diagnosed with dementia, their informal caregivers, as well as healthcare professionals who assist them. Background.  Older adults who have dementia face many challenges in managing their medications while living in the community. Medication regimens used to treat a variety of conditions in older adults with dementia are usually overseen and coordinated by healthcare professionals such as community nurses, physicians and pharmacists, but often, more supports are needed. However, little research has been conducted to study the barriers and facilitators to medication adherence in this unique population. Methods.  Using a grounded theory approach, 57 interviews were completed (10 nurses, 10 pharmacists, 6 physicians, 20 caregivers and 11 patients) in southern Ontario, Canada, in 2007. Findings.  The findings indicate that the processes of medication management differ according to the level of dementia. A number of corresponding facilitators and barriers to medication management were identified. Medication management in early stage dementia is characterised by patients’ desire to maintain independence, denial of issues or disease, and a refusal to take medications owing to feeling angry. In late‐stage dementia, older adults often refuse medications owing to delusional or suspicious thinking, which results in caregivers assuming responsibility for managing their medications. Conclusions.  Older adults with dementia, their informal caregivers and the healthcare professionals who assist them are faced with the challenges of declining cognitive function and memory while trying to manage medications at home. However, a number of adherence strategies appear to be helpful and should be considered. Relevance to clinical practice.  Healthcare professionals struggle with helping older adults who have dementia manage medications safely and therapeutically, often with little resources to draw from. Future work is needed to design, implement and evaluate supportive networks and interventions with the goal of helping older adults with dementia manage their medications better while living in the community.

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Background The impact and consequences of the COVID-19 pandemic on people with rheumatic disease are unclear. We developed the COVID-19 Global Rheumatology Alliance Patient Experience Survey to assess the effects of the COVID-19 pandemic on people with rheumatic disease worldwide.Methods Survey questions were developed by key stakeholder groups and disseminated worldwide through social media, websites, and patient support organisations. Questions included demographics, rheumatic disease diagnosis, COVID-19 diagnosis, adoption of protective behaviours to mitigate COVID-19 exposure, medication access and changes, health-care access and communication with rheumatologists, and changes in employment or schooling. Adults age 18 years and older with inflammatory or autoimmune rheumatic diseases were eligible for inclusion. We included participants with and without a COVID-19 diagnosis. We excluded participants reporting only non-inflammatory rheumatic diseases such as fibromyalgia or osteoarthritis. Findings 12 117 responses to the survey were received between April 3 and May 8, 2020, and of these, 10 407 respondents had included appropriate age data. We included complete responses from 9300 adults with rheumatic disease (mean age 46•1 years; 8375 [90•1%] women, 893 [9•6%] men, and 32 [0•3%] participants who identified as non-binary). 6273 (67•5%) of respondents identified as White, 1565 (16•8%) as Latin American, 198 (2•1%) as Black, 190 (2•0%) as Asian, and 42 (0•5%) as Native American or Aboriginal or First Nation. The most common rheumatic disease diagnoses included rheumatoid arthritis (3636 [39•1%] of 9300), systemic lupus erythematosus (2882 [31•0%]), and Sjögren's syndrome (1290 [13•9%]). Most respondents (6921 [82•0%] of 8441) continued their antirheumatic medications as prescribed. Almost all (9266 [99•7%] of 9297) respondents adopted protective behaviours to limit SARS-CoV-2 exposure. A change in employment status occurred in 2524 (27•1%) of 9300) of respondents, with a 13•6% decrease in the number in full-time employment (from 4066 to 3514).Interpretation People with rheumatic disease maintained therapy and followed public health advice to mitigate the risks of COVID-19. Substantial employment status changes occurred, with potential implications for health-care access, medication affordability, mental health, and rheumatic disease activity.Funding American College of Rheumatology.