Characterization of Engagement in a Medication Management Role Among Informal Caregivers of Older Adult Care-Recipients.

摘要

Currently, 18.9 percent of U.S. adults serve as informal caregivers for individuals 50 years of age or older. With the aging of the U.S. population and burden of chronic disease on older adults, informal caregivers' continue to acquire increasing responsibilities in care-recipients' care management. Several calls by national associations, researchers, and practitioners have been issued to develop a standardized approach to identify caregivers in patients' health records and integrate them in the healthcare process. Although various studies have examined informal caregivers' general experiences and the impact of caregiving on their own health, research has focused less on caregivers' management of health-related activities for their older adult care-recipients, specifically medication management, and the impact on patient's health outcomes. In addition, there is little information on how to identify caregivers within the healthcare system using a systematic method.;This study utilized data from the National Health and Aging Trends study (NHATS) Round One and its supplement, the National Study of Caregiving (NSOC) to examine the following research questions: 1) how can the medication management role of informal caregivers of older adult care-recipients be defined, 2) what are the factors associated with caregivers' engagement in a medication management role, 3) what is the association between engagement in a medication management role and caregivers' use of training services, and 4) what is the relationship between the pattern of medication management between caregivers and care-recipients and the occurrence of medication errors among care-recipients. The NHATS Round One study was comprised of 8,245 Medicare beneficiaries and the NSOC study was comprised of 2,007 informal caregivers of these Medicare beneficiaries.;To define the medication management role of informal caregivers, three items from the NSOC were used to develop the Engagement in a Medication Management Role Screening Tool. These items ask caregivers if they help their care-recipients with or if they do the following tasks: order prescribed medications, keep track of medications, or administer injections. The majority of caregivers (67.4%) were involved in at least one of these activities with a mean score of 1.19 +/- 0.03 out of a possible three on the screening tool.;Factors associated with engagement in a medication management role were examined using a multivariate linear regression model. The final model was significant and explained 46 percent of the variance in caregivers' engagement in a medication management role. The following variables were statistically significant: caregivers' gender, relationship to care-recipient, and caregivers' involvement in IADLs, and medically-related activities.;Only 6.8 percent of caregivers reported receiving any training to help them take care of their care-recipient and 10.2 percent reported looking for training. The association between engagement in a medication management role and caregivers' receipt of training was not significant, after controlling for demographic variables. However, the association was significant for engagement in a medication management role and caregivers' initiation to seek training. The adjusted odds of seeking training was 1.54 (95% CI: 1.21, 1.96, p=0.00) with each one unit change in the log scale for engagement in a medication management role score.;Data from the NHATS study were used to examine the occurrence of medication errors among older adults in the home setting as well as explore the pattern of shared medication management between care-recipients and their caregivers. Among 662 NHATS respondents, 24.9 percent reported making a mistake in taking a prescribed medication in the last month, and 61.5 percent reported always managing medications by themselves. NHATS respondents who always managed medications on their own had 2.72 (95% CI: 1.43, 5.16, p=0.00) higher odds of making a mistake compared to respondents who had someone else always manage their medications.;These results emphasize the importance for researchers and clinicians to understand how older adults manage their medication regimens and identify caregivers who are potentially involved in managing medications with care-recipients. The Engagement in a Medication Management Role Screening Tool was developed as a preliminary step to systematically identify caregivers who manage or assist care-recipients in managing their medications. This information is necessary to be able to engage caregivers in healthcare settings, assess their medication management skills, and provide tailored medication-related education aimed at assisting caregivers and improving care-recipients' health outcomes.