OBJECTIVES: We sought to investigate older patients' ability to correctly and efficiently dose multidrug regimens over nearly a decade and to explore factors predicting declines in medication self-management. DESIGN: Longitudinal cohort study funded by the National Institute on Aging. SETTING: One academic internal medicine clinic and six community health centers. PARTICIPANTS: Beginning in 2008, 900 English-speaking adults, aged 55 to 74 years, were enrolled in the study, completing a baseline (T1) assessment. To date, 303 participants have completed the same assessment 9 years postbaseline (T4). MEASUREMENTS: At T1, subjects were given a standardized, seven-drug regimen and asked to demonstrate how they would take medicine over 24 hours. The number of dosing errors made and times per day that a participant would take medicine were recorded. Health literacy was measured via the Newest Vital Sign, and cognitive decline was measured by the Mini-Mental State Examination. RESULTS: Participants on average made 2.9 dosing errors (SD = 2.5 dosing errors; range = 0-21 dosing errors) of 21 potential errors at T1 and 5.0 errors (SD = 2.1 errors; range = 1-18 errors; P < .001) at T4. In a multivariate model, limited literacy (β = .69; 95% confidence interval [CI] = .18-1.20; P = .01), meaningful cognitive decline (β = 1.72; 95% CI = .70-2.74; P = .01), number of chronic conditions (β = .21; 95% CI = .07-.34; P = .01), and number of baseline dosing errors (β = -.76; 95% CI = -.85 to -.67; P < .001) were significant, independent predictors of changes in dosing errors. Most patients overcomplicated their daily medication schedule; no sociodemographic characteristics were predictive of poor regimen organization in multivariate models. In a multivariate model, there were no significant predictors of changes in regimen consolidation over time, except regimen consolidation at T1. CONCLUSIONS: Older patients frequently overcomplicated drug regimens and increasingly made more dosing errors over 9 years of follow-up. Patients with limited literacy, cognitive decline, and multimorbidity were at greatest risk for errors. J Am Geriatr Soc 68:569-575, 2020.
OBJECTIVES: We sought to investigate older patients' ability to correctly and efficiently dose multidrug regimens over nearly a decade and to explore factors predicting declines in medication self-management. DESIGN: Longitudinal cohort study funded by the National Institute on Aging. SETTING: One academic internal medicine clinic and six community health centers. PARTICIPANTS: Beginning in 2008, 900 English-speaking adults, aged 55 to 74 years, were enrolled in the study, completing a baseline (T1) assessment. To date, 303 participants have completed the same assessment 9 years postbaseline (T4). MEASUREMENTS: At T1, subjects were given a standardized, seven-drug regimen and asked to demonstrate how they would take medicine over 24 hours. The number of dosing errors made and times per day that a participant would take medicine were recorded. Health literacy was measured via the Newest Vital Sign, and cognitive decline was measured by the Mini-Mental State Examination. RESULTS:Participants on average made 2.9 dosing errors (SD = 2.5 dosing errors; range = 0-21 dosing errors) of 21 potential errors at T1 and 5.0 errors (SD = 2.1 errors; range = 1-18 errors; P < .001) at T4. In a multivariate model, limited literacy (β = .69; 95% confidence interval [CI] = .18-1.20; P = .01), meaningful cognitive decline (β = 1.72; 95% CI = .70-2.74; P = .01), number of chronic conditions (β = .21; 95% CI = .07-.34; P = .01), and number of baseline dosing errors (β = -.76; 95% CI = -.85 to -.67; P < .001) were significant, independent predictors of changes in dosing errors. Most patients overcomplicated their daily medication schedule; no sociodemographic characteristics were predictive of poor regimen organization in multivariate models. In a multivariate model, there were no significant predictors of changes in regimen consolidation over time, except regimen consolidation at T1. CONCLUSIONS: Older patients frequently overcomplicated drug regimens and increasingly made more dosing errors over 9 years of follow-up. Patients with limited literacy, cognitive decline, and multimorbidity were at greatest risk for errors. J Am Geriatr Soc 68:569-575, 2020.
Authors: Barry D Weiss; Mary Z Mays; William Martz; Kelley Merriam Castro; Darren A DeWalt; Michael P Pignone; Joy Mockbee; Frank A Hale Journal: Ann Fam Med Date: 2005 Nov-Dec Impact factor: 5.166
Authors: Michael S Wolf; Laura M Curtis; Katherine Waite; Stacy Cooper Bailey; Laurie A Hedlund; Terry C Davis; William H Shrank; Ruth M Parker; Alastair J J Wood Journal: Arch Intern Med Date: 2011-02-28
Authors: Terry C Davis; Alex D Federman; Pat F Bass; Robert H Jackson; Mark Middlebrooks; Ruth M Parker; Michael S Wolf Journal: J Gen Intern Med Date: 2008-11-01 Impact factor: 5.128
Authors: Ana Paula Helfer Schneider; Mari Ângela Gaedke; Anderson Garcez; Nêmora Tregnago Barcellos; Vera Maria Vieira Paniz Journal: Int J Clin Pract Date: 2017-11-29 Impact factor: 2.503
Authors: Elisa Fabbri; Marco Zoli; Marta Gonzalez-Freire; Marcel E Salive; Stephanie A Studenski; Luigi Ferrucci Journal: J Am Med Dir Assoc Date: 2015-05-07 Impact factor: 4.669
Authors: John Devin Peipert; Sherif M Badawy; Sharon H Baik; Laura B Oswald; Fabio Efficace; Sofia F Garcia; Daniel K Mroczek; Michael Wolf; Karen Kaiser; Betina Yanez; David Cella Journal: Patient Prefer Adherence Date: 2020-06-09 Impact factor: 2.711
Authors: Rachel O'Conor; Morgan Eifler; Andrea M Russell; Lauren Opsasnick; Marina Arvanitis; Allison Pack; Laura Curtis; Julia Yoshino Benavente; Michael S Wolf Journal: J Am Geriatr Soc Date: 2021-06-18 Impact factor: 7.538