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Karan Dawson, PhD, MS, RPh University of Washington School of Pharmacy

Karan Dawson, PhD, MS, RPh University of Washington School of Pharmacy

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Karan Dawson, PhD, MS, RPh University of Washington School of Pharmacy

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  1. Karan Dawson, PhD, MS, RPhUniversity of WashingtonSchool of Pharmacy MEDICATION ADHERENCE, HEALTH LITERACY, AGING

  2. Direct Costs of Non-adherence • Nearly 3 times as many clinic visits • Used almost 3 times as many medications • Hospitalized about 50% more often • Length of stay - nearly 50% longer • NH admissions - $ 5 billion per year • $25 billion estimated cost per year in US for hospital admissions

  3. Indirect Costs of Non-adherence T • Lost productivity > $50 billion/yr • 125,000 deaths per year • Total = > $100 billion/year

  4. Most Common Types of Non-adherence • Failing to have prescription filled • Taking incomplete dose • Taking at the wrong time • Forgetting 1 or more • Stopping the medication

  5. Adherence Risk Factors • Difficult route of administration • Difficult preparation required • Adverse drug reactions • Lack of confidence in therapy • Fear of addiction/ADR • Caregiver giving medications • Irregular hours • Poor or low literacy including health literacy

  6. Is age a risk factor for non-adherence?

  7. Adherence Variables • Age and Adherence • Cognition – working memory • Health literacy

  8. Magnitude of Medication Use in Older Adults • Older adults = 13% of population • Use 23% of all prescription medications in US1 • Women 65 and older • 12% take 10 prescriptions daily • 23% take at least 5 prescriptions

  9. Example Patient Profile See handout

  10. Magnitude of Medication Use in Older Adults • Older adults = 13% of population • Use 23% of all prescription medications in US1 • Women 65 and older • 12% take 10 prescriptions daily • 23% take at least 5 prescriptions • 17% hospital admissions involve ADR • By 2030, 20% of population will be > 65 y.o.

  11. ADR Risk, Adherence, Aging • Multiple medications • Multiple prescribers • Multiple pharmacies • Multiple disease states • Possible functional and cognitive changes • Hearing • Sight • Strength, dexterity • Memory, comprehension

  12. Intrapersonal Elements of Adherence Behavioral Behavioral Motivational Motivational Understanding Understanding ChronicDisease AcuteDisease Social and economic factors – Access– Relationship with provider

  13. Relation of Adherence and Knowledge • Cognitive abilities Working memory, long term, etc • Health beliefs about Illness, medications, treatments, susceptibility • External cues Social support, reminders • Relationship with health care provider

  14. Relation of Age to Cognition - Short Term Memory • Recall = several seconds to a minute • without rehearsal • Limited capacity • Original research = 7 ± 2 • Today = 4-5 • Chunking increases capacity (3/chunk)

  15. Enhancing Learning Retention • Attention • Thinking • Generate motivation

  16. Patient Centered Instruction “More information will only improve knowledge if this information is easy to understand and remember especially for adults who experience declines in cognitive resources for comprehension.” DG Morrow, M Weiner, J Young, D Steinley, M Deer, M Murray. Improving medication knowledge among older adults with heart failure: A patient-centered approach to instruction design. Gerontol 45 (4):546, 2005

  17. Patient Centered Instructional Elements • Respond to patient’s needs and abilities • Support comprehension • “minimize demands on sensory and cognitive abilities” = visual acuity and working memory • Use patient’s previous knowledge • Use patient’s expectations – organize information in fashion familiar to patient • Reinforce text with graphics

  18. Example of patient-centered instructions for diuretic medication. Morrow D G et al. The Gerontologist 2005;45:545-552 The Gerontological Society of America

  19. Summary • Our goal – good medication and self care outcomes • Communication practices to achieve our goal • Determining barriers to adherence • Multiple medications, multiple providers, health beliefs, cues, support, social-economic, access, relationship with health care providers • Cognitive and functional • Motivational • Enhancing understanding via materials that

  20. Enhance Understanding • Respond to patient’s needs and abilities • Support comprehension • Simple language assists working memory • Large font, reduce glare ,  noise, f-2-f, enunciate,  light • Use patient’s previous knowledge • Use patient’s expectations – organize information in fashion familiar to patient • Reinforce text with graphics

  21. How? • Supportive environment • Ask open ended questions • Listen to the patient • Clarify • Summarize • Facilitate problem solving