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Oral medicine modification for older adults: a qualitative study of nurses
  1. Aoife Mc Gillicuddy1,
  2. Abina M Crean2,
  3. Maria Kelly1,
  4. Laura Sahm1,3
  1. 1 Pharmaceutical Care Research Group, School of Pharmacy, University College Cork National University of Ireland, Cork, Republic of Ireland
  2. 2 Synthesis and Solid State Pharmaceutical Centre, School of Pharmacy, University College Cork, Cork, Republic of Ireland
  3. 3 Pharmacy Department, Mercy University Hospital, Cork, Republic of Ireland
  1. Correspondence to Aoife Mc Gillicuddy; a.mcgillicuddy{at}


Objective Oral medicines are frequently modified (eg, tablets crushed) for older adults. However, these modifications can have clinical, legal and/or ethical implications. Nurses bear responsibility for medicine administration and hence, perform these modifications. The aim of this study was to investigate the knowledge, attitudes and beliefs of nurses about oral medicine modification for older adults.

Design A qualitative study was conducted using semi-structured, face-to-face interviews with nurses providing care to older adults in acute and long-term care settings. Interviews were audio-recorded, transcribed verbatim and analysed thematically.

Settings Sixteen purposively selected care settings; 4 acute-care and 12 long-term care settings were included. Nurses were recruited by convenience sampling at these sites.

Participants Eighteen nurses participated (83% female, 67% long-term care, 33% acute-care, median age (IQR) 38 years (32.5–52.0)).

Results Three major themes: modifying—a necessary evil, nurses’ role as patient advocate and modifying—we are working very much as a team and two minor themes: fractional dosing, and covert administration emerged from the data. Nurses viewed oral medicine modifications as being a routine and necessary occurrence in geriatric patient care due to limitations of available formulations and the presence of age-related challenges in drug administration. Nurses’ knowledge of residents’ requirements ensured that they advocate for those with individualised formulation needs, however, nurses rely on pharmacists for information about modifications. Nurses expressed a desire for supports including increased education and ward-specific, pharmacist-developed recommendations on common modifications.

Conclusions This study has provided useful insights into the views of nurses regarding oral medicine modification for older adults. The unique and varied formulation requirements of older adults must be acknowledged. Increased engagement by healthcare professionals, the pharmaceutical industry, regulatory agencies and policy-makers is required to facilitate the development of age-appropriate formulations. In the interim, practical interventions, informed by the findings of this study, are required.

  • medicine administration
  • medicine modification
  • nurses
  • oral medicines
  • qualitative
  • interviews

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  • Contributors AMG was responsible for the conception and design of the study, data collection, data analysis, drafting and critical revision of the manuscript and approval of the final manuscript. AMC and LJS were involved in the conception and design of the study, discussions around data analysis and interpretation, critical revision of the manuscript and final approval of the manuscript. MK was responsible for analysis and interpretation of the data, critical revision of the manuscript and approval of the final manuscript.

  • Funding AMG is in receipt of a Government of Ireland Postgraduate Scholarship from the Irish Research Council (grant number GOIPG/2016/1634) and was previously in receipt of a University College Cork Strategic Research Fund PhD Studentship; AMC is a funded researcher in the Synthesis and Solid State Pharmaceutical Centre supported by the Science Foundation of Ireland under grant number 12/RC/2275.

  • Competing interests None declared.

  • Ethics approval Ethical approval for this study was granted by the Clinical Research Ethics Committee of the Cork Teaching Hospitals, Cork, Ireland.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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