JMIR Publications

ABSTRACT

Background:

Home medication management is understudied, including the factors that impact the development and effectiveness of adherence strategies under both routine and anomalous circumstances. Older adults are a particularly important population to study due to the greater likelihood of taking medication in combination with the desire to “age in place.”

Objective:

The purpose of this interview study was to (1) understand how older adults develop medication management strategies; (2) identify when and why such strategies succeed or fail; (3) learn more about how older adults think about their medication; and (4) explore interventions that increase medication adherence.

Methods:

This study utilized a qualitative, semi-structured interview design to elicit older adults’ experiences with home medication management. Twenty-two participants aged 50 and older taking 1-3 prescription medications were recruited and interviewed. Participants were recruited through the Osher Lifelong Learning Institute at Tufts University, and interviews were conducted over video conference. Interview responses were recorded, and thematic, qualitative analysis was performed by reviewing recordings and identifying recurring patterns and themes. Responses were systematically coded, which not only facilitated the identification of these themes, but also allowed us to quantify the prevalence of behaviors and perceptions, providing a robust understanding of medication management and medication adherence.

Results:

Participants reported developed home medication management strategies on their own, with none receiving guidance from healthcare providers and 59% using trial and error. The strategies developed by study participants were all unique, and generally encompassed prescription medication and vitamins or supplements with no demarcation between what was prescribed or recommended by a doctor or what they selected independently. Participants varied in how they thought about their prescription medications, with 45% using the chemical name, 36% the appearance, 9% the purpose, and 9% the generic name. Pill cases (77%) were more popular than prescription bottles (23%) for storage of daily medication. Most participants (86%) stored their pill cases or prescription bottles in visible locations in the home, and those using pill cases varied in their refill routines. Participants used 2 or more routines or objects as triggers to take their medication. Nonadherence was associated with a disruption to their routine. Finally, only 14% used a time-based reminder or alarm and no participants used a medication adherence device or app.

Conclusions:

Participants in our study varied considerably in their home medication management strategies and developed unique routines to remember to take their medication as well as to refill their pill cases. To reduce trial and error in establishing a strategy, there are opportunities for physicians and pharmacists to provide adherence guidance to older adults. To minimize the impact of disruptions on adherence, there are opportunities to develop more durable strategies and to design aids to medication adherence that leverage established daily routines.