Self-reported problems in medication self-management in older polymedicated patients in general practice

Polypharmacy is common in the older population and is recognized as a geriatric syndrome. The self-administration of medication is complex and requires cognitive and physical capacities that decrease with age. To avoid medication errors or harm, medication management capacity needs to be thoroughly assessed in routine clinical care. Here, we report on measuring self-reported medication management capacity in older polymedicated patients in primary care in an exploratory study using a questionnaire developed in the "Ability to Self-administer Medication in Non-demented In-hospital Patients" (ABLYMED) study.

102 patients (≥70 years of age, regularly taking ≥5 different medicines autonomously) from a single general practice in Germany were included from March to November 2024. Patients were interviewed using a questionnaire developed in the ABLYMED study. It consists of 30 questions covering the three domains adherence [16 questions including 5 questions of the Medication Adherence Report Scale (MARS© Professor Rob Horne)], handling (8 questions) and belief/attitude/knowledge (6 questions).

The median (Q1; Q3) age of the study sample was 77 years (74; 84), 39% were male. In the domain adherence, 20% of the patients reported running out of medication and 5% reported mixing up medication, which is very relevant to safety of medication use. Regarding handling problems, eye drops were identified as the most challenging dosage form, with 40% of patients reporting difficulties. Furthermore, 19% of the sample reported handling problems due to problems with opening packages. In the domain belief/attitude/knowledge, only 15% of the patients did not know the rationale behind all of their medications and only 3% did not express a positive perception of their benefits.

Our study showed that a high proportion of older patients from a general practice (up to 40%) reported medication handling problems. These results were similar to those observed in the ABLYMED sample of hospital in-patients. Future studies need to concentrate on the implementation of interventions to address patients' self-reported medication management problems.