Medication Management for People with Dementia following a Hospital Stay
Monday, July 19th, 2021
Instructions: “Take one tablet three times a day”
So, is that dividing 24 hours by three and taking the medication every eight hours? Or can I coordinate it with my meals and take them all within 12 hours? Will it matter if I take it with my other morning tablet?
A Potential for Medication Mishaps
People living with dementia can take multiple medications. Yet, confusion or lapses around medication are often a trademark symptom of dementia. Add to that the overwhelm of a hospital stay and then a transition back home, no wonder medication mix-ups are a very real issue for people with dementia. Involvement of a caregiver is one important way we can support medication adherence.
A StepUp Study Asks More
A study led by Dr Sawan at the University of Sydney explored caregivers’ experiences of medication related issues for people with dementia transitioning from hospital. Using StepUp for Dementia Research, thirty-one caregivers of a person with dementia who had been discharged from hospital within the last 12 months, were recruited to be interviewed over the phone. Around two-thirds of the participants were adult children, a third were the partner of the person with dementia, and a handful were a friend. Participants resided across all of Australia, although the majority were from New South Wales. Caregivers were quizzed on three topics: i) the medication resources they received; (ii) things that helped or got in the way of their involvement; and (iii) the support they felt they needed regarding safe medication use at home.
Caregivers Feel Excluded and Under-supported
The authors identified three themes. These included: (a) inadequate information about medication management; (b) limited involvement in the medication decision-making; and (c) difficulties ensuring medication supply post-discharge. Caregivers reported feeling overwhelmed by the discharge process, and proactively seeking information to avoid any medication-related harm -often with a great deal of challenges.
Opportunities to Improve
The study only obtained caregivers’ perspectives. It could have benefited from the involvement of people with dementia and hospital staff. The study was also heavily reliant on caregivers’ recollection, with many participants being asked to reflect on a hospital admission that happened some months ago. Nonetheless, the study highlighted several opportunities to improve the processes in discharge medication management. These included health care professionals:
- organising meetings with the caregiver during admission;
- providing a detailed summary and justification of the treatment plan, that incorporates tailored information on medication that may impact the patient’s cognition;
- communication of the discharge letter to the community pharmacist, GP, and care services; and
- providing more than three days’ supply of medication at discharge especially over the weekend, and planning for future prescriptions.