Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
Center for Applied Health Research on Aging, Institute for Public Health and Medicine, Northwestern University, Chicago, Illinois, USA.
J Am Geriatr Soc. 2024 Oct;72(10):3011-3021. doi: 10.1111/jgs.19065. Epub 2024 Jul 15.
With changing cognitive abilities, individuals with mild cognitive impairment (MCI) and dementia face challenges in successfully managing multidrug regimens. We sought to understand how individuals with MCI or dementia and their family caregivers manage multidrug regimens and better understand patient-to-caregiver transitions in medication management responsibilities.
We conducted qualitative interviews among patient-caregiver dyads. Eligibility included: patients with a diagnosis of MCI, mild or moderate dementia, managing ≥3 chronic conditions, ≥5 prescription medications, who also had a family caregiver ≥18 years old. Semi-structured interview guides, informed by the Medication Self-Management model, ascertained roles and responsibilities for medication management and patient-to-caregiver transitions in medication responsibilities.
We interviewed 32 patient-caregiver dyads. Older adults and caregivers favored older adult autonomy in medication management, and individuals with MCI and mild dementia largely managed their medications independently using multiple strategies (e.g., establishing daily routines, using pillboxes). Among individuals with moderate dementia, caregivers assumed all medication-related responsibilities except when living separately. In those scenarios, caregivers set up organizers and made reminder calls, but did not observe family members taking medications. Patient-to-caregiver transitions in medication responsibilities frequently occurred after caregivers observed older adults making errors with medications. As caregivers sought to assume greater responsibilities with family members' medicines, they faced multiple barriers. Most barriers were dyadic; they affected both the older adult and the caregiver and/or the relationship. Some barriers were specific to caregivers; these included caregivers' competing responsibilities or inaccurate perceptions of dementia, while other barriers were related to the healthcare system.
To ease medication management transitions, balance must be sought between preservation of older adult autonomy and early family caregiver involvement. Clinicians should work to initiate conversations with family caregivers and individuals living with MCI or dementia about transitioning medication responsibilities as memory loss progresses, simplify regimens, and deprescribe, as appropriate.
随着认知能力的变化，轻度认知障碍 (MCI) 和痴呆症患者在成功管理多药物治疗方案方面面临挑战。我们试图了解 MCI 或痴呆症患者及其家庭照顾者如何管理多药物治疗方案，并更好地了解药物管理责任方面患者向照顾者的过渡。
我们对患者-照顾者二人组进行了定性访谈。入选标准包括：患有 MCI、轻度或中度痴呆症、管理≥3 种慢性疾病、≥5 种处方药的患者，以及≥18 岁的家庭照顾者。半结构化访谈指南，以药物自我管理模型为依据，确定了药物管理的角色和责任以及药物管理责任向照顾者的过渡。
我们采访了 32 对患者-照顾者二人组。老年人和照顾者倾向于让老年人自主管理药物，而 MCI 和轻度痴呆症患者则主要通过多种策略（例如，建立日常生活规律、使用药盒）独立管理药物。在中度痴呆症患者中，除了独居的情况外，照顾者承担了所有与药物相关的责任。在这些情况下，照顾者会设置组织者并打电话提醒，但不会观察家庭成员服药。当照顾者观察到老年人在用药方面出现错误时，药物管理责任经常在患者和照顾者之间发生转变。随着照顾者试图承担起更多的家庭用药责任，他们面临着多种障碍。大多数障碍是双重的；它们会影响老年人和照顾者，以及他们之间的关系。一些障碍是特定于照顾者的；这些障碍包括照顾者的竞争责任或对痴呆症的不准确认知，而其他障碍则与医疗保健系统有关。
为了缓解药物管理过渡，必须在保持老年人自主权和早期家庭照顾者参与之间取得平衡。临床医生应努力与患有 MCI 或痴呆症的家庭照顾者和个人就随着记忆力下降而过渡药物责任进行对话，适当简化方案并减少不必要的用药。
