Assessment of Compliance for Oral Medicines with MMSE, Minimental State Examination, in Hospitalized Elderly Patients

Abstract

The minimental state examination (MMSE) is a widely used, standardized method to assess cognitive function including movement-related disorders with high reliability. We studied the relationship between MMSE scores and the ability to take oral medications correctly (ingestion compliance) in 70 elderly inpatients (mean age 71.3±7.0 years). Patients with abnormal glucose tolerance as determined by an HbA 1c level of 5.8％ or greater including diabetes showed a trend of lower MMSE scores compared with patients with normal glucose tolerance, and the scores were negatively correlated with HbA1c, age, and systolic blood pressure (P＜0.05). Self-management in taking oral medications was very di‹cult in 4 patients whose MMSE scores were 21 points or less. Thus ingestion supervisions by nurses were required in these patients. Furthermore, 9 of 12 noncompliant patients had MMSE scores ranging from 22 to 26 points. We instructed these patients to take medications in a one-dose package as a useful tool to improve compliance. The MMSE score was 27 or higher in 44 of 54 compliant patients, and 10 patients had scores ranging from 21 to 26. The sensitivity and speciˆcity for noncompliance at an MMSE score cut-oŠ point of 26 were 75.0％ and 81.5％, respectively. In conclusion, it is necessary to coordinate ingestion methods matched to each patient according to their abilities to comply with medication schedules. They should be preevaluated with the MMSE to improve ingestion compliance. The MMSE is a recommended test in hospitalized elderly patients for the assessment of the ability to take medications safely.

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“…This test showed also some power to detect (sensitivity of 66%) and rule out (specificity of 81%) lack of adherence in this context. A study conducted in Japan found a sensitivity of 75% and a specificity of 81.5% for non-adherence with MM, using 26 as the cut-off point, for patients hospitalized with diabetes and intolerance to glucose [21].…”