Tools to evaluate medication management for caregivers of people living with dementia: A systematic review

Abstract

Background Caregivers often undertake medication management for people living with dementia without formal training. There is a need to evaluate caregiver medication management practices for people living with dementia to identify and address the key issues that contribute to caregiver burden. Objectives This study aimed to identify and summarize approaches that evaluate medication management for caregivers of people living with dementia and appraise caregiver's involvement in aspects of medication management. Search Strategy A systematic search was undertaken in five databases: Medline, Embase, PsycINFO, Scopus and International Pharmaceutical Abstracts. Studies written in English that contained tools and surveys that evaluated aspects of medication management for caregivers of PWD were included. Results A total of 10 studies were included. Medication selection was assessed in six studies, supply and monitoring/review was captured in seven studies, with administration assessed in nine studies. Caregivers were commonly involved in decision‐making for medication changes (77.1%–86.8%) and in the ordering (55.9%–86.0%) and collection (87.0%–92.4%) of medications. Reported caregiver involvement in medication administration showed a wide range (44%–94.7%) between the studies. Challenges in administration were commonly related to polypharmacy and dosage regimen complexity. Conclusions Current tools capture specific aspects of medication management, with medication administration the most evaluated aspect of medication management. Future research is needed to develop a tool to holistically evaluate the complexities of medication management for caregivers of people living with dementia to minimize adverse events at transitions of care. Public Contribution From the authors' previous research, caregivers highlighted the need to address key issues in medication management for people living with dementia.

Development of a tool to evaluate medication management guidance provided to carers of people living with dementia at hospital discharge: a mixed methods study

“…The tool’s inception was based on the research team’s earlier work with carers of people living with dementia which was also used to inform the tool domains. 7 15 The tool comprised five domains which comprehensively evaluated medication management guidance at discharge. As such, the tool is unique and fulfils a gap in the literature as current tools only evaluate carer activities with respect to medication management for the person with dementia in other care settings.…”

“…The content of the tool was informed by the findings of the two previous studies conducted by the research team, qualitative research 13 and a systematic review, 7 and two resources, the Australian Commission National Safety and Quality Health Service Standards 24 and the WHO Medication Safety in Transitions of Care. 25…”

“…The systematic review identified tools evaluating medication management for informal carers of people with dementia and summarised carer involvement in aspects of medication management. 7 …”

“… 4–6 Over 54% of carers are involved in medication management, and this increases to 95% of carers in people with moderate to severe dementia. 7 8 Compared with other populations, medication management for people with dementia is often complex and a major contributing factor to adverse events after discharge from the hospital. 6 Between 53% and 90% of inpatients with dementia are exposed to potentially inappropriate polypharmacy, 9 which increases the risk of non-adherence and creates difficulty in managing side effects after discharge.…”

“…Carers play an important role in overseeing medications for the person with dementia 4–6. Over 54% of carers are involved in medication management, and this increases to 95% of carers in people with moderate to severe dementia 7 8. Compared with other populations, medication management for people with dementia is often complex and a major contributing factor to adverse events after discharge from the hospital 6.…”