The spatial dimensions of medication management by home-dwelling older adults after hospital discharge

Roux, Pauline; Verloo, Henk; Santiago-Delefosse, M.; Pereira, Filipa

doi:10.1016/j.healthplace.2019.102230

Cited by 9 publications

(13 citation statements)

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“…23 24 ADEs resulting from inappropriate drug prescribing, discrepancies between prescribed and current regimens, poor adherence, and the inadequate surveillance of adverse effects frequently lead to hospital admissions, readmissions 8 and other undesirable consequences such as increased morbidity, decreased autonomy, institutionalisation and even early death. 25 26 A systematic review by El Morabet et al 27 indicated ADE rates of 18%-38% after hospital discharge and 4.5%-24% hospital readmission rates due to those ADEs. Because older adults use more drugs, they are at a greater risk of drug-related readmission.…”

Section: Open Accessmentioning

confidence: 99%

Risk of 30-day hospital readmission associated with medical conditions and drug regimens of polymedicated, older inpatients discharged home: a registry-based cohort study

et al. 2021

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ObjectivesThe present study analysed 4 years of a hospital register (2015–2018) to determine the risk of 30-day hospital readmission associated with the medical conditions and drug regimens of polymedicated, older inpatients discharged home.DesignRegistry-based cohort study.SettingValais Hospital—a public general hospital centre in the French-speaking part of Switzerland.ParticipantsWe explored the electronic records of 20 422 inpatient stays by polymedicated, home-dwelling older adults held in the hospital’s patient register. We identified 13 802 hospital readmissions involving 8878 separate patients over 64 years old.Outcome measuresSociodemographic characteristics, medical conditions and drug regimen data associated with risk of readmission within 30 days of discharge.ResultsThe overall 30-day hospital readmission rate was 7.8%. Adjusted multivariate analyses revealed increased risk of hospital readmission for patients with longer hospital length of stay (OR=1.014 per additional day; 95% CI 1.006 to 1.021), impaired mobility (OR=1.218; 95% CI 1.039 to 1.427), multimorbidity (OR=1.419 per additional International Classification of Diseases, 10th Revision condition; 95% CI 1.282 to 1.572), tumorous disease (OR=2.538; 95% CI 2.089 to 3.082), polypharmacy (OR=1.043 per additional drug prescribed; 95% CI 1.028 to 1.058), and certain specific drugs, including antiemetics and antinauseants (OR=3.216 per additional drug unit taken; 95% CI 1.842 to 5.617), antihypertensives (OR=1.771; 95% CI 1.287 to 2.438), drugs for functional gastrointestinal disorders (OR=1.424; 95% CI 1.166 to 1.739), systemic hormonal preparations (OR=1.207; 95% CI 1.052 to 1.385) and vitamins (OR=1.201; 95% CI 1.049 to 1.374), as well as concurrent use of beta-blocking agents and drugs for acid-related disorders (OR=1.367; 95% CI 1.046 to 1.788).ConclusionsThirty-day hospital readmission risk was associated with longer hospital length of stay, health disorders, polypharmacy and drug regimens. The drug regimen patterns increasing the risk of hospital readmission were very heterogeneous. Further research is needed to explore hospital readmissions caused solely by specific drugs and drug–drug interactions.

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Section: Open Accessmentioning

confidence: 99%

Risk of 30-day hospital readmission associated with medical conditions and drug regimens of polymedicated, older inpatients discharged home: a registry-based cohort study

et al. 2021

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“…Planning health behaviors include medication planning, such as filling pillboxes, purchasing medication, and planning how to keep medication; disposing of old medication; and ordering refills [41,[48][49][50]52,54,55]. Another example is emergency planning, which has been noted as preparing or maintaining information for emergency situations [45,46,51].…”

Section: Phim Tasks Carried Out By Older Adults and Their Characteristicsmentioning

confidence: 99%

“…Many people are involved in older adults' PHIM and collaborate with them in different capacities to manage their PHI. These stakeholders include persons in the older adult's immediate circle (personal relationships), such as family, friends, and neighbors [1, 37,39,[41][42][43][44]46,47,51,[53][54][55][56], and health care workers or retirement community staff, such as health care providers and professionals [1, 37,42,43,[46][47][48]50,56]. Sometimes, older adults particularly seek the help of their friends or relatives who have medical knowledge or expertise [42].…”

Section: Socio-organizational Environment In Phim Among Older Adults: Stakeholders Involvedmentioning

confidence: 99%

“…Tools, solutions, and technologies that are currently offered or which older adults use to manage their PHI include electronic approaches[1,37,40,42,43,[46][47][48][49]51,52], such as computers or laptops[42,46,51] and the internet[37,40,[42][43][44][47][48][49]51,52]; paper-based approaches [1,37,41,42,[46][47][48]51,54], such as printouts[37,42] and calendars[51,54]; and medical, every day, and other objects that include tangible objects[41,[46][47][48]50,51,54,55], such as portable file cabinets[47] and pill boxes[41,48,50,51,…”

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Personal Health Information Management Among Older Adults: Scoping Review

2021

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Background Older adults face growing health care needs and could potentially benefit from personal health information management (PHIM) and PHIM technology. To ensure effective PHIM and to provide supportive tools, it is crucial to investigate the needs, challenges, processes, and tools used by this subpopulation. The literature on PHIM by older adults, however, remains scattered and has not provided a clear picture of what we know about the elements that play a role in older adults’ PHIM. Objective The goal of our review was to provide a comprehensive overview of extant knowledge on PHIM by older adults, establish the status quo of research on this topic, and identify research gaps. Methods We carried out a scoping review of the literature from 1998 to 2020, which followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) framework. First, we executed a broad and structured search. We then carried out a qualitative analysis of papers pertinent to the topic taking into consideration the five elements of the patient work system as follows: (1) personal-level factors, (2) PHIM tasks, (3) tools used, (4) physical settings of PHIM activities, and (5) socio-organizational aspects. Results The review included 22 studies. Consolidated empirical evidence was related to all elements of the patient work system. Multiple personal factors affected PHIM. Various types of personal health information were managed (clinical, patient-generated, and general) and tools were used (electronic, paper-based, and others). Older adults’ PHIM was intertwined with their surroundings, and various individuals participated. The largest body of evidence concerned personal factors, while findings regarding the physical environment of PHIM were scarce. Most research has thus far examined older adults as a single group, and scant attention has been paid to age subgroups. Conclusions Opportunities for further PHIM studies remain across all elements of the patient work system in terms of empirical, design science, or review work.

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“…Managing chronic polypharmacy in the home could almost be considered an intrinsic part of the Instrumental Activities of Daily Living (IADL) [ 12 , 13 , 14 ]. That medication practices can be integrated into specific spatiotemporal contexts shows just how quotidian they are in nature and how they can transform a home space into a care space [ 15 ]. Beyond the apparent normality of living with polypharmacy, overlapping positive and negative attitudes about it underline the existence of ambivalent beliefs: OAs recognise medication as useful, helping to ensure their better health, but at the same time, some negative beliefs persist and lead to fears about drug–drug interactions, side-effects and medication overconsumption [ 12 , 16 , 17 , 18 ].…”

Section: Introductionmentioning

confidence: 99%

Beliefs about Polypharmacy among Home-Dwelling Older Adults Living with Multiple Chronic Conditions, Informal Caregivers and Healthcare Professionals: A Qualitative Study

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Although home-dwelling older adults are frequently assisted with polypharmacy management by their informal caregivers, they can still face medication-related problems. Identifying older adults’ and their informal caregivers’ beliefs about medication is a gateway to understanding and improving medication adherence. This study aimed to analyse beliefs about polypharmacy among home-dwelling older adults with multiple chronic conditions and their informal caregivers, focusing on their daily medication practices. Semi-structured interviews were conducted with 28 older adults, 17 informal caregivers, but also 13 healthcare professionals. Based on an inductive methodological approach, data were analysed using thematic content analysis. Interviews revealed the different attitudes adopted by older adults and their informal caregivers in relation to the treatment information provided by healthcare professionals. A variety of beliefs were identified and linked to medication adherence by examining daily medication practices. Polypharmacy was experienced as a habit but also an obligation, highlighting some of the strategies and negotiations underlying medication use at home. Collecting viewpoints from multiple stakeholders is an innovative way of accessing and analysing beliefs about polypharmacy. Daily medication practices provided information about medication beliefs and may contribute to developing targeted professional interventions that improve medication adherence.

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The spatial dimensions of medication management by home-dwelling older adults after hospital discharge

Cited by 9 publications

References 60 publications

Risk of 30-day hospital readmission associated with medical conditions and drug regimens of polymedicated, older inpatients discharged home: a registry-based cohort study

Risk of 30-day hospital readmission associated with medical conditions and drug regimens of polymedicated, older inpatients discharged home: a registry-based cohort study

Personal Health Information Management Among Older Adults: Scoping Review

Beliefs about Polypharmacy among Home-Dwelling Older Adults Living with Multiple Chronic Conditions, Informal Caregivers and Healthcare Professionals: A Qualitative Study

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