Medication self-management skills and cognitive impairment in older adults hospitalized for heart failure: A cross-sectional study

Abstract

Background:Cognitive impairment is highly prevalent among older adults (aged ≥65 years) hospitalized for heart failure and has been associated with poor outcomes. Poor medication self-management skills have been associated with poor outcomes in this population as well. The presence and extent of an association between cognitive impairment and poor medication self-management skills in this population has not been clearly defined.Objective:We assessed the cognition of consecutive older adults hospitalized for heart failure, in relation to their medication self-management skills.Methods:We conducted a cross-sectional study of older adults (aged ≥65 years) who were hospitalized for heart failure and were being discharged home. Prior to discharge, we assessed cognition using the Mini-Cog. We also tested patients’ ability to read a pill bottle label, open a pill bottle safety cap, and allocate mock pills to a pill box. Pill allocation performance was assessed quantitatively (counts of errors of omission and commission) and qualitatively (patterns suggestive of knowledge-based mistakes, rule-based mistakes, or skill-based slips).Results:Of 55 participants, 22% were found to have cognitive impairment. Patients with cognitive impairment tended to be older as compared to those without cognitive impairment (mean age = 81 vs 76 years, p = NS). Patients with cognitive impairment had a higher prevalence of inability to read pill bottle label (prevalence ratio = 5.8, 95% confidence interval = 3.2–10.5, p = 0.001) and inability to open pill bottle safety cap (prevalence ratio = 3.3, 95% confidence interval = 1.3–8.4, p = 0.03). While most patients (65%) had pill-allocation errors regardless of cognition, those patients with cognitive impairment tended to have more errors of omission (mean number of errors = 48 vs 23, p = 0.006), as well as more knowledge-based mistakes (75% vs 40%, p = 0.03).Conclusion:There is an association between cognitive impairment and poor medication self-management skills. Medication taking failures due to poor medication self-management skills may be part of the pathway linking cognitive impairment to poor post-discharge outcomes among patients with heart failure transitioning from hospital to home.

Association Between Medication Adherence and the Outcomes of Heart Failure

“…Adherence is also influenced by levels of social support, comorbid conditions such as depression and dementia, and patients’ perceptions of the importance of taking medication . Cognitive impairment is also a determinant of adherence and poor outcomes . However, we did not have access to data on patient cognitive status.…”

Prospective assessment of combined handgrip strength and Mini‐Cog identifies hospitalized heart failure patients at increased post‐hospitalization risk

“…This was a single‐centre prospective cohort study of older adults (age ≥65 years) hospitalized for a primary diagnosis of HF, intended to discharge to home. Details of this cohort including inclusion and exclusion criteria have been published elsewhere . Recruitment and study procedures were carried out by two internal medicine resident physicians who are also co‐authors of this work (E. H. H. and A. S.).…”

“…Recruitment and study procedures were carried out by two internal medicine resident physicians who are also co‐authors of this work (E. H. H. and A. S.). Study participants were identified from a daily hospital admission list that was cross‐verified by the inclusion criteria . Recruitment was carried out in intermittent 1 week blocks between November 2012 and March 2013.…”

“…Details of this cohort including inclusion and exclusion criteria have been published elsewhere. 9 Recruitment and study procedures were carried out by two internal medicine resident physicians who are also co-authors of this work (E. H. H. and A. S.). Study participants were identified from a daily hospital admission list that was cross-verified by the inclusion criteria.…”

“…Study participants were identified from a daily hospital admission list that was cross-verified by the inclusion criteria. 9 Recruitment was carried out in intermittent 1 week blocks between November 2012 and March 2013. During these blocks, all patients were reviewed, approached, and if agreeable to participate, were required to sign informed consent in a consecutive manner.…”