a) Sociodemographic characteristics
A total of 112 older adults participated in our study. After applying 6-CIT questionnaire, 3 caregivers answered to the interview instead of the older adult. The 112 participants’ mean age was 76.6 ± 7.1 years (median = 76), with 53.6% women and 46.4% men (Table 1). Most were born in Portugal (93.8%), were married (59.8%), lived with a partner or spouse (61.4%), and about three-quarters (70.5%) only had a basic level of education of ≤ 4 years) (Table 1) . More than half (58.1%) had an income lower than the Portuguese national minimum wage (< EUR 554 per month), defined as poverty 31.
Table 1: Participants’ sociodemographic characteristics (n = 112).
Variables
|
n
|
%
|
Marital Status
|
Married
|
67
|
59.8
|
Unmarried
|
7
|
6.3
|
Separated/divorced
|
11
|
9.8
|
Widow/widower
|
27
|
24.1
|
Household status (Who do you live with?):
|
Alone
|
29
|
25.5
|
Spouse/partner
|
70
|
61.4
|
Children
|
12
|
10.5
|
Others
|
3
|
2.6
|
Educational level
|
None or 1st cycle (1st to 4th school years)
|
79
|
70.5
|
2nd cycle (5th and 6th school years)
|
7
|
6.2
|
3rd cycle (7th to 9th school years)
|
9
|
8.0
|
Secondary education (8th to 12th school years)
|
12
|
10.7
|
Higher education (professional or university)
|
5
|
4.5
|
b) Medication management patterns, profiles and clinical conditions
Most home-dwelling older adult participants (n = 94; 84.3%) managed their own medication, 14 (12.2%) needed support from their first- or second-degree relatives, and 4 (3.5%) required professional support. Sixty-eight (60.7%) were classified as being polymedicated, with the majority of medications being prescribed by their family physician. Indeed, 80 (71.4%) participants took no over-the-counter medication, whereas 32 (28.6%) did, mainly analgesics, non-steroidal anti-inflammatory drugs, vitamins, and magnesium and calcium supplements. Most older adults (104; 92.9%) had a personal community pharmacist and 8 (7.1%) had multiple pharmacists.
Regarding participants’ clinical conditions, the majority (n = 102, 91.1%) presented with multimorbidity, with an average of 3.5 ± 1.5 chronic diseases. In the last 12 months, 87 (77.6%) participants had had an average of 2.87 ± 3.4 medical consultations, mainly with family practitioners and nurses; 25 (22.3%) had been admitted to the emergency department.
Following evaluation using the 6CIT-P, most participants showed no cognitive problems (n = 90, 80.4%), whereas 22 (19.6%) were classified as having a moderate cognitive impairment (Table 2). Based on TFI-P subscale B’s 5-point cut-off, 58.9% of older adults were considered frail, with higher scores for social frailty (see Table 2).
Table 2. Participants’ medication management, medical conditions and the Tilburg Frailty Indicator’s physical, psychological and social frailty variables (n = 112).
|
Variables
|
nº
|
%
|
mean/SD
|
How many prescribed medications do you currently take per day?
|
≤ 4 pills
|
44
|
39.3
|
|
≥ 5 pills
|
68
|
60.7
|
|
Number of hospitalisations/ emergency department admissions in last 12 months
|
0
|
87
|
77.7
|
|
1
|
21
|
18.8
|
|
2
|
2
|
1.8
|
|
4
|
1
|
0.9
|
|
5
|
1
|
0.9
|
|
Reasons for the above admissions
|
Pain (back; legs; arms; others)
|
5
|
22.8
|
|
Falls
|
4
|
18.2
|
|
Urinary tract infection
|
4
|
18.2
|
|
Fracture (leg; wrist; others)
|
2
|
9.0
|
|
Heart problems
|
4
|
18.2
|
|
Stroke
|
1
|
4.6
|
|
Psychiatric disorders
|
2
|
9.0
|
|
Medical consultations in the last 12 months
|
Yes
|
87
|
77.6
|
|
No
|
25
|
22.4
|
|
Which medical specialists were consulted?
|
Family practitioner
|
102
|
49.3
|
|
Nurse
|
63
|
30.4
|
|
Cardiologist
|
32
|
15.5
|
|
Diabetologist
|
4
|
1.9
|
|
Geriatrician
|
0
|
0.0
|
|
Psychiatrist
|
6
|
2.9
|
|
Who prescribed your current medications?
|
Family practitioner
|
110
|
76.9
|
|
Cardiologist
|
16
|
11.2
|
|
Diabetologist
|
1
|
0.7
|
|
Geriatrician
|
0
|
0.0
|
|
Psychiatrist
|
5
|
3.5
|
|
Others
|
11
|
7.7
|
|
Medical conditions (ICD–10)
|
Diseases of the circulatory system
|
108
|
27.0
|
|
Endocrine, nutritional and metabolic diseases
|
65
|
16.2
|
|
Diseases of the musculoskeletal system and connective tissue
|
49
|
12.2
|
|
Diseases of the genitourinary system;
|
48
|
12.0
|
|
Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism
|
7
|
1.8
|
|
Mental and behavioural disorders
|
45
|
11.2
|
|
Neoplasms
|
30
|
7.5
|
|
Diseases of the ear and mastoid process
|
7
|
1.8
|
|
Diseases of the eye and adnexa
|
7
|
1.8
|
|
Diseases of the respiratory system
|
13
|
3.3
|
|
Diseases of the digestive system
|
21
|
5.2
|
|
Understanding of medication prescribed and/or the disease
|
No
|
|
70
|
62.5
|
|
Yes
|
|
42
|
37.5
|
|
TFI Physical frailty (0–8)
|
3.04 ± 1.98
|
TFI Psychological frailty (0–4)
|
1.55 ± 1.16
|
TFI Social frailty (0–3)
|
0.80 ± 0.91
|
TFI Total frailty score (0–15)
|
5.40 ± 3.18
|
1 = only 4 participants remembered the date.
c) Associations between patient-level medication management patterns and their sociodemographic and clinical characteristics
The present study’s multimorbid patients took more medications (p = 0.005) and were more often responsible for managing their own medication (p < 0.001). No associations were observed between being a polymedicated patient and medication self-management (p = 0.343), using over-the-counter medication (p = 0.081), living alone (p = 0.625), not fully understanding one’s prescribed medication and/or disease (p = 0.023) or having more than one prescriber (p = 0.893).
Older adults with only one prescriber had a statistically significant (p < 0.001) higher 6CIT-P score (9.0 ± 6.1; median = 8) than those with more than one prescriber (5.5 ± 5.2; median = 4).
Medication management variables (who oversees medication preparation, number of over-the-counter medications, number of prescribed medications taken per day, understanding of one’s medication prescription and/or disease) were not statistically correlated with sex or household status. On the other hand, self-management of medication showed a statistically significant correlation with age (p < 0.001), cognitive status (p < 0.001) and frailty (p < 0.001), with those responsible for their own medication management being younger (75.6 ± 5.6; median = 75.5) than those who were not (82.5 ± 11.3; median = 85), presenting with a better cognitive status score (6.7 ± 4.4; median = 8 vs 18.0 ± 7.3; median = 20) and having a lower frailty index score (4.9 ± 3.0; median = 5 vs 8.5 ± 2.5; median = 9).
Patients who took over-the-counter medication had statistically significant (p = 0.049) lower 6CIT-P scores (5.9 ± 3.2; median = 6) than those who did not (9.0 ± 6.7; median = 8) (Table 3)
Table 3: Associations between medication management patterns and sociodemographic and clinical characteristics (n = 112).
Older adults’ variables
|
Cognitive Impairment*
|
Frailty*
|
Age*
|
Number of medical conditions**
|
Income**
|
Sex**
|
P25
|
P50
|
P75
|
p**
|
P25
|
P50
|
P75
|
p
|
P25
|
P50
|
P75
|
p
|
P25
|
P50
|
P75
|
p
|
p
|
p
|
|
In charge of medication management
|
Own (1)
|
4
|
8
|
10
|
< 0.001
|
7
|
9
|
11
|
< 0.001
|
79.2
|
85
|
89
|
< 0.001
|
1
|
2
|
3
|
< 0.001
|
0.089
|
0.296
|
|
Other
|
10
|
20
|
22
|
3
|
5
|
7
|
72
|
75.5
|
79
|
2.7
|
4
|
5
|
|
Take over-the-counter medications without prescription
|
No
|
4
|
8
|
12
|
0.049
|
3
|
5
|
7
|
0.892
|
72
|
76
|
81.7
|
0.897
|
2
|
3
|
4
|
0.036
|
0.973
|
0.881
|
|
Yes
|
4
|
6
|
8
|
3.2
|
6
|
7
|
73
|
76.5
|
80
|
3
|
4
|
5
|
|
Number of prescribed medications currently taken per day
|
0–4
|
4
|
8
|
14
|
0.148
|
2.2
|
6
|
7.7
|
0.926
|
73.2
|
78
|
82.5
|
0.132
|
2
|
3
|
4
|
0.005
|
0.318
|
1.000
|
|
> 5
|
4
|
8
|
10
|
3
|
5
|
7
|
71.2
|
75
|
81
|
3
|
4
|
5
|
|
Understanding of medication prescribed and/or the disease
|
No
|
2
|
4
|
8
|
< 0.001
|
2
|
4
|
7
|
< 0.001
|
71
|
74
|
78
|
< 0.001
|
3
|
4
|
5
|
0.136
|
0.036
|
0.696
|
|
Yes
|
10
|
12
|
18.5
|
4.7
|
7
|
8.2
|
75
|
81.5
|
8.2
|
2
|
3
|
5
|
|
Note. *Mann–Whitney test; **Chi-squared test; Statistically significant results are highlighted in bold
Binary regression analysis was used to assess associations between dependent and independent variables (Table 4). Only the cognitive impairment variable presented statistically significant correlation probability values with independent variables, being highest among older adults who had medication management support (OR = 0.197; 95%CI: 0.046–0.853), who reported problems understanding their medication prescription and/or their disease (OR = 0.169; 95%CI: 0.051–0.566) and who did not take over-the-counter medications (OR = 0.280; 95%CI: 0.097–0.803).
Table 4. Binary logistic regressions for medication management patterns and sociodemographic and clinical characteristics (n = 112).
Dependent Variables
|
Sex (M/W)
|
Age
|
Cognitive impairment
(No/Yes)
|
Frailty
(No/Yes)
|
Number of medical conditions
(No/Yes)
|
Income
|
|
M/W
|
OR (95%CI)†
|
p-value
|
65–74/ ≥ 75
|
OR (95%CI)†
|
p-value
|
No/Yes
|
OR (95%CI)†
|
p-value
|
No/
Yes
|
OR (95%CI)†
|
p-value
|
1/>1
|
OR (95%CI)†
|
p-value
|
≤ EUR 705/> EUR 705
|
OR (95%CI)†
|
p-value
|
|
Who oversees medication preparation? (1)
|
Older adult (1)
|
47/49
|
0.972 (0.242–3.913)
|
0.969
|
42/54
|
0.161 (0.018–1.434)
|
0.102
|
67/29
|
|
0.030
|
46/50
|
0.997 (0.000–0.000)
|
0.997
|
5/91
|
3.72 (0.641–21.69)
|
0.143
|
29/67
|
0.460 (0.046–4.64)
|
0.511
|
Other (0)
|
5/11
|
|
1/15
|
|
3/13
|
0.197 (0.046–0.853)
|
0/16
|
|
5/11
|
|
1/15
|
|
Do you take over-the-counter medications without a prescription? (1)
|
No (0)
|
38/42
|
|
0.923
|
32/48
|
|
0.171
|
45/35
|
0.280 (0.097–0.803)
|
0.018
|
35/45
|
|
0.157
|
10/70
|
,
|
NA**
|
22/58
|
|
0.815
|
Yes (1)
|
14/18
|
1.04 (0.406–2.70)
|
11/21
|
1.92 (0.754–4.93)
|
25/7
|
|
11/21
|
2.04 (0.758–5.53)
|
0/32
|
NA**
|
8/21
|
1.13 (0.390–3.30)
|
Nº medications currently taken per day (1)
|
0–4 (0)
|
20/24
|
|
0.887
|
14/30
|
|
0.452
|
24/20
|
|
0.365
|
19/25
|
|
0.215
|
6/38
|
|
0.264
|
9/35
|
|
0.232
|
> 5 (1)
|
32/36
|
0.941 (0.404–2.19)
|
29/39
|
0.718 (0.302–1.70)
|
46/22
|
0.666 (0.276–1.606)
|
27/41
|
1.77 (0.718–4.36)
|
4/64
|
2.21 (0.548–8.97)
|
21/47
|
0.546 (0.202–1.47)
|
Understanding of medication prescribed and/or the disease (1)
|
No (0)
|
34/36
|
|
0.369
|
35/35
|
|
0.830
|
70/0
|
0.169 (0.051–0.566)
|
0.004
|
36/34
|
|
0.341
|
3/67
|
|
0,.13
|
46/24
|
|
0.748
|
Yes (1)
|
18/24
|
0.642 (0.245–1.68)
|
8/34
|
1.10 (0.436–2.81)
|
0/42
|
|
10/32
|
1.63 (0.595–4.48)
|
7/35
|
2.55 (0.271–23.91)
|
36/6
|
0.845 (0.302–2.36)
|
† OR (odds ratio); CI (confidence interval); * Dummy variable (0 = No;1 = Yes); ** Not applicab