Medicine self-administration errors in the older adult population: A systematic review

Aldila, Fatma; Walpola, Ramesh

doi:10.1016/j.sapharm.2021.03.008

Cited by 11 publications

(16 citation statements)

References 38 publications

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“…a lack of granularity in the analysis). In addition, the team faced a familiar methodological challenge when defining 'older adults' 43,44 45 although these should be used in combination with other strategies such as simplifying medication treatment regimens and improving self-management skills. 46 However, effective communication and education strategies might not be equally effective for everyone and everywhere.…”

Section: Discussionmentioning

confidence: 99%

“…a lack of granularity in the analysis). In addition, the team faced a familiar methodological challenge when defining ‘older adults’ 43,44 in relation to where the cut‐off age should begin, how mean age, median age or age range should be implemented in eligibility decisions and how to handle studies that included mixed age groups. In the last of these challenges a study needed to breakdown the population by both age and ethnicity for the data to contribute to the review.…”

Section: Discussionmentioning

confidence: 99%

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Medication management in M inority, A sian and B lack ethnic older people in the United Kingdom: A mixed‐studies systematic review

Secchi

Maidment

Sud

et al. 2022

Clinical Pharmacy Therapeu

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What Is New and Objectives Older people from ethnic minorities experience the intersectionality of age and ethnicity in relation to complex medication management and polypharmacy. Minority ethnic groups in the United Kingdom are at risk of poor medication management because factors such as cultural beliefs, language barriers, lack of knowledge of how the healthcare system works may affect their ability to safely manage their medications. The aim of this systematic review was to review the literature focussing on medication management in the older population amongst ethnic minority communities in United Kingdom. Methods The review was conducted and reported according to methods in the Cochrane Handbook and in the PRISMA 2020 statement using databases such as EMBASE, ASSIA, MEDLINE, PsychINFO and others. Studies conducted in the United Kingdom on individuals over 60 years of age and from a minority ethnic background were included. A thematic analysis was used to synthesize the results. Results and Discussion Nine studies (eight from initial searches, one from a search update in 2021) met the inclusion criteria. Three main themes were identified: misbeliefs around medications, poor health literacy, communication and education as possible intervention to improve medication management. Misbeliefs around long‐term illnesses exert a negative impact on medication management. Poor health literacy around medications influences patients' adherence to treatments. Poor communication is perceived as barrier to successful medication management. Despite extensive searching, the team identified a limited number of studies and a lack of intersectional studies focussing on minority ethnic groups and the older population. What is New and Conclusion Our findings suggest tailored education as a possible intervention to improve medication management amongst these minority groups. Future research should look at recruiting participants from specific ethnic groups and from rural as well as urban areas to explore how medication management operates in different areas of the United Kingdom.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Medication management in M inority, A sian and B lack ethnic older people in the United Kingdom: A mixed‐studies systematic review

Secchi

Maidment

Sud

et al. 2022

Clinical Pharmacy Therapeu

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“…If this is done, it will cause a dumping dose. 29 However, in this study, researchers did not find the same problem. 9).…”

Section: Discussionmentioning

confidence: 53%

Identification of Drug-Related Problems (DRPS) of drugs with special dosage forms in geriatric patients (study at the outpatient pharmacy unit, Airlangga University Hospital, Surabaya)

Yulistiani,

Utomo,

Nugroho

et al. 2023

PHARMPRACT

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Background: Geriatric syndrome is a condition of decreased organ function that causes DRPs, especially drugs with special dosage forms, such as an inhaler, insulin pens, and modified release drugs. Objective: To identify DRPs of drugs with special dosage forms in geriatric patients at the Outpatient Pharmacy Unit of RSUA Surabaya. Methods: It was an observational and prospective study with the interview method. Each problem identified was given a score to be analyzed descriptively and statistically. Data collection was carried out from April to June 2022. Results: The sample is 82 special dosage forms, there are drug delivery devices including inhaler (26%) and insulin pen (29%), and drug delivery systems including OROS (33%), retard (6%), and sustained-release (6%). DRPs were found in 40% of them. In inhaler form, the DRPs of DPI are failure to load the dose, shaking after the dose was loaded, and not checking the remaining dose after using the device. While in MDI, no DRPs were found. The DRPs of insulin pens are errors in device storage (25%), injection position (8%), and repeated use of blunt/broken needles (38%). While in modified release drugs is an error in drug storage (5%). The percentages of nonadherence are Turbuhaler 33%, Breezhaler 60%, Diskus 25%, MDI 0%, insulin pen 29%, and modified release drugs 24%. The solution is given by using verbal education such as leaflets. Statistical analysis showed a significant difference in the insulin pen and the modified release drug, while there was no significant difference in the inhaler. Conclusion: Each type of drug with a special dosage form has its problems and problem-solving in the form of interventions has not given maximum results.

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“…18,19 A minority of studies has examined occurrences of medicines safety issues in people's homes, 20 with some identifying polypharmacy and complexity of treatment as contributing factors in older adults. 21 Previous studies, informed by a resilient healthcare (Safety II) approach, 22 which highlights how variability plays an important contributory role in safety in complex systems, 23 offered insight into the medicines management experiences of patients at discharge from hospital. Some older patients and their informal carers were found to play an important safety role, for example, in anticipating discrepancies and mitigating the occurrence of errors by facilitating communication between care settings.…”

Section: Introductionmentioning

confidence: 99%

“…A minority of studies has examined occurrences of medicines safety issues in people's homes, 20 with some identifying polypharmacy and complexity of treatment as contributing factors in older adults. 21 Previous studies, informed by a resilient healthcare (Safety II) approach, 22 which highlights how variability plays an important contributory role in safety in complex systems, 23 offered insight into the medicines management experiences of patients at discharge from hospital. Some older patients and their informal carers were found to play an important safety role, for example, in anticipating discrepancies and mitigating the occurrence of errors by facilitating communication between care settings.…”

Section: Introductionmentioning

confidence: 99%

‘It's a job to be done’. Managing polypharmacy at home: A qualitative interview study exploring the experiences of older people living with frailty

Previdoli,

Alldred,

Silcock

et al. 2024

Health Expectations

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IntroductionMany older people live with both multiple long‐term conditions and frailty; thus, they manage complex medicines regimens and are at heightened risk of the consequences of medicines errors. Research to enhance how people manage medicines has focused on adherence to regimens rather than on the wider skills necessary to safely manage medicines, and the older population living with frailty and managing multiple medicines at home has been under‐explored. This study, therefore, examines in depth how older people with mild to moderate frailty manage their polypharmacy regimens at home.MethodsBetween June 2021 and February 2022, 32 patients aged 65 years or older with mild or moderate frailty and taking five or more medicines were recruited from 10 medical practices in the North of England, United Kingdom, and the CARE 75+ research cohort. Semi‐structured interviews were conducted face to face, by telephone or online. The interviews were recorded, transcribed verbatim and analysed using reflexive thematic analysis.FindingsFive themes were developed: (1) Managing many medicines is a skilled job I didn't apply for; (2) Medicines keep me going, but what happened to my life?; (3) Managing medicines in an unclear system; (4) Support with medicines that makes my work easier; and (5) My medicines are familiar to me—there is nothing else I need (or want) to know.While navigating fragmented care, patients were expected to fit new medicines routines into their lives and keep on top of their medicines supply. Sometimes, they felt let down by a system that created new obstacles instead of supporting their complex daily work.ConclusionFrail older patients, who are at heightened risk of the impact of medicines errors, are expected to perform complex work to safely self‐manage multiple medicines at home. Such a workload needs to be acknowledged, and more needs to be done to prepare people in order to avoid harm from medicines.Patient and Public InvolvementAn older person managing multiple medicines at home was a core member of the research team. An advisory group of older patients and family members advised the study and was involved in the first stages of data analysis. This influenced how data were coded and themes shaped.

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Medicine self-administration errors in the older adult population: A systematic review

Cited by 11 publications

References 38 publications

Medication management in M inority, A sian and B lack ethnic older people in the United Kingdom: A mixed‐studies systematic review

Medication management in M inority, A sian and B lack ethnic older people in the United Kingdom: A mixed‐studies systematic review

Identification of Drug-Related Problems (DRPS) of drugs with special dosage forms in geriatric patients (study at the outpatient pharmacy unit, Airlangga University Hospital, Surabaya)

‘It's a job to be done’. Managing polypharmacy at home: A qualitative interview study exploring the experiences of older people living with frailty

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