Patterns of medication management and associated medical and clinical features among home-dwelling older adults: a cross-sectional study in central Portugal

Abstract

Abstract Background: Ageing is frequently associated with multimorbidity and polypharmacy. Frailty and cognitive impairment are other important contributors to the multidimensional aspects affecting older adults’ health status. The present study aimed to explore the adequacy of medication management patterns among home-dwelling older adults in central Portugal by considering their medical conditions, frailty and cognitive status. Reducing numbers of adverse events through effective medication management increases the chances of older adults remaining in their homes for longer periods. Providing patients and caregivers with an overview of potential improvements in this area is very relevant for Portugal’s ageing population. Methods: Within the scope of this cross-sectional observational study, older adults (≥ 65 years) living in the community were assessed via face-to-face interviews. Frailty and cognitive status were assessed using validated tools. Medication management, clinical and sociodemographic variables were assessed by questioning patients or caregivers directly. Descriptive statistics, associations and odds ratios were calculated. Results: A total of 112 older adults were assessed. Mean participant age was 76.6 ± 7.1 years (median = 76), 53.6% were women, and 40.2% lived alone. More than half were categorised as frail (58.9%), and 19.6% presented moderate cognitive impairment. About 91.1% were multimorbid (3.5 ± 1.5 chronic diseases), and 60.7% were polymedicated (≥ 5 medications per day), with most medications being prescribed by a family physician. No associations were found between polymedication and medication self-management, using over-the-counter medications, living alone, poor understanding of pharmacological therapy and/or pathology, or having more than one prescriber. Self-management was associated with age, the number of medications, frailty and cognitive status. Binary regressions showed that cognitive impairment had statistically dependent correlations with external medication management, a poor understanding of pharmacological therapy and/or pathology, having one prescriber and using over-the-counter medications. Conclusion: Most of the older adult participants were multimorbid and many were frail, but only two-thirds were polymedicated, potentially suggesting cautious prescription approaches, but further studies are required. Most participants managed their own medication, and only cognitive impairment affected this ability, among a multitude of features. Measures to prevent medication-related problems in home-dwelling older adults are to be recommended.