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“I Just Take What I Am Given”

Adherence and Resident Involvement in Decision Making on Medicines in Nursing Homes for Older People: A Qualitative Survey

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Abstract

Background

Adherence to medication is generally considered to be poor in many patient groups, but little is known about adherence to medication in the nursing home setting. It is also unclear if residents in nursing homes are involved in decision making about medication.

Objective

This study sought to explore adherence to medication and resident involvement in prescribing and decision making in regard to medicines in the nursing home setting.

Methods

This was a qualitative study. Participants took part in either semi-structured interviews (general practitioners [GPs] and residents) or focus groups (nurses) to discuss issues around prescribing and adherence to medication in nursing homes for older people in Northern Ireland. All interviews and focus groups were digitally recorded, fully transcribed and analysed using the principles of constant comparison.

Results

Eight GPs and 17 residents participated in semi-structured interviews and nine nurses participated in two focus groups (n = 4; n = 5). The main theme that emerged was control, which was manifested in many ways. Both groups of healthcare professionals needed to maintain control of prescribing or administration of medication in order to ensure safety, quality and continuity of care. All residents accepted control without question, reported that they were adherent to medication and had little involvement in prescribing decisions or administration of their own medicines. Although the healthcare professionals thought that more involvement in decisions around medication would contribute to resident autonomy and empowerment, it was also recognized that this could adversely affect control within the nursing home.

Conclusion

Although adherence with medication was generally perceived not to be a problem in the nursing homes setting in this study, other findings raise major challenges for resident involvement in an important aspect of their own care. Although there may be some residents, because of cognitive decline, who are unable to become involved in aspects of decisions about prescribing and self-administration, healthcare professionals providing care to these patients should strive to involve them as far as possible in their own care.

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References

  1. Avorn J, Dreyer P, Connelly K, et al. Use of psychoactive medication and the quality of care in rest homes. N Engl J Med 1989; 320: 227–32

    Article  PubMed  CAS  Google Scholar 

  2. Board of Directors of the American Association for Geriatric Psychiatry. Psychotherapeutic medications in the nursing home. J Am Geriatr Soc 1992; 40: 946–9

    Google Scholar 

  3. Hughes CM, Lapane KL, Mor V, et al. The impact of legislation on psychotropic drug use in nursing homes: a cross-national perspective. J Am Geriatr Soc 2000; 48: 931–7

    PubMed  CAS  Google Scholar 

  4. Hughes CM, Lapane KL. Administrative initiatives to reduce inappropriate prescribing of psychotropics in nursing homes: how successful have they been? Drugs Aging 2005; 22: 339–51

    Article  PubMed  Google Scholar 

  5. Hughes CM. Medication non-adherence in the elderly. How big is the problem? Drugs Aging 2004; 21: 793–811

    Article  Google Scholar 

  6. From Compliance to Concordance. Achieving shared goals in medicine taking. London: Royal Pharmaceutical Society of Great Britain and Merck Sharp & Dohme, 1997

  7. Weintraub M. Intelligent non-compliance with special emphasis on the elderly. Contemp Pharm Pract 1980; 4: 8–11

    Google Scholar 

  8. Cramer J. Medicine partnerships. Heart 2003; 89Suppl. II: ii19–21

    PubMed  Google Scholar 

  9. Commission for Social Care Inspection. Handled with care? Managing medication for residents of care homes and children’s homes: a follow-up study. Newcastle: Commission for Social Care Inspection, 2006

  10. Schweizer AK, Hughes CM, Curran ML. Is psychoactive medication usage in care homes related to staffing levels? [abstract]. Int J Pharm Pract 2003; 11: R42

    Google Scholar 

  11. Hughes C, Wright RM, Lapane KL. Use of medication technicians in US nursing homes: part of the problem or part of the solution? J Am Med Dir Assoc 2006; 7: 294–304

    Article  PubMed  Google Scholar 

  12. Coulter A. Paternalism or partnership. BMJ 1999; 319: 719–20

    Article  PubMed  CAS  Google Scholar 

  13. Lothian K, Philp I. Maintaining the dignity and autonomy of older people in the healthcare setting. BMJ 2001; 322: 668–70

    Article  PubMed  CAS  Google Scholar 

  14. Aujoulat I, D’Hoore W, Deccache A. Patient empowerment in theory and practice: polysemy or cacophony? Pat Educ Coun 2007; 66: 13–20

    Article  Google Scholar 

  15. Coulter A, Ellins J. Effectiveness of strategies for informing, educating and involving patients. BMJ 2007; 335: 24–7

    Article  PubMed  Google Scholar 

  16. McCormack B. A conceptual framework for person-centred practice with older people. Int J Pharm Pract 2003; 9: 202–9

    Google Scholar 

  17. Kitzinger J. Focus groups. In: Pope C, Mays N, editors. Qualitative research in health care. 3rd ed. Oxford: Blackwell Publishing, 2006: 21–31

  18. Malterud K. Qualitative research: standards, challenges and guidelines. Lancet 2001; 358: 483–8

    Article  PubMed  CAS  Google Scholar 

  19. Glaser B, Strauss A. The discovery of grounded theory. Chicago (IL): Aldine, 1967

    Google Scholar 

  20. Haynes RB, Ackloo E, Sahota N, et al. Interventions for enhancing medication adherence. Cochrane Database Syst Rev 2008; (2):CD000011

    Google Scholar 

  21. Lee JK, Grace KA, Taylor AJ. Effect of a pharmacy care program on medication adherence and persistence, blood pressure and low-density lipoprotein cholesterol: a randomized controlled trial. JAMA 2006; 296: 2563–71

    Article  PubMed  CAS  Google Scholar 

  22. Jones JS, Dwyer PR, White LJ, et al. Patient transfer from nursing home to emergency department: outcomes and policy implications. Acad Emerg Med 1997; 4: 908–15

    Article  PubMed  CAS  Google Scholar 

  23. Institute of Medicine. Crossing the quality chasm: a new health system of the 21st century. Washington, DC: National Academy Press, 2001

    Google Scholar 

  24. Anderson M, Helms L. Communication between continuing care organisations. Res Nurs Health 1995; 18: 49–57

    Article  PubMed  CAS  Google Scholar 

  25. Gittell JH, Fairfield KM, Bierbaum B, et al. Impact of relational coordination on quality of care, postoperative pain and functioning and length of stay. Med Care 2000; 38: 807–19

    Article  PubMed  CAS  Google Scholar 

  26. NICE. Hypertension: management of hypertension in adults in primary care. London: NICE, 2004

    Google Scholar 

  27. NICE. Statins for the prevention of cardiovascular events. Technology appraisal, 94. London: NICE, 2006

    Google Scholar 

  28. Cairncross L, Magee H, Askham J. A hidden problem: pain in older people. A qualitative study. Oxford: Picker Institute Europe, 2007 Mar

    Google Scholar 

  29. Crotty M, Halbert J, Rowett D, et al. An outreach geriatric medication advisory service in residential aged care: a randomised controlled trial of care conferencing. Age Ageing 2004; 33: 612–7

    Article  PubMed  Google Scholar 

  30. Matthews FE, Dening T. Prevalence of dementia in institutional care. Lancet 2002; 360: 225–6

    Article  PubMed  Google Scholar 

  31. Department of Health. Care homes for older people. National minimum standards. London: The Stationery Office, 2003

    Google Scholar 

  32. O’Neill O. Paternalism and partial autonomy. J Med Ethics 1984; 10: 173–4

    Article  PubMed  Google Scholar 

  33. Salmon P, Hall GM. Patient empowerment and control: a psychological discourse in the service of medicine. Soc Sci Med 2003; 57: 1969–80

    Article  PubMed  Google Scholar 

  34. Report to Congress: appropriateness of minimum nurse staffing ratios in nursing homes. Phase I report. Cambridge (MA): Abt Associates, 2000

  35. Zinn J, Spector W, Hsieh L, et al. Do trends in the reporting of quality measures on the nursing home compare website differ by nursing home characteristics? Gerontologist 2005; 45: 720–30

    Article  PubMed  Google Scholar 

  36. Castle NG, Engeberg J. Staff turnover and quality of care in nursing homes. Med Care 2005; 43: 616–26

    Article  PubMed  Google Scholar 

  37. Hickey EC, Young GJ. The effects of changes in nursing home staffing on pressure ulcer rates. J Am Med Dir Assoc 2005; 6: 50–3

    Article  PubMed  Google Scholar 

  38. Institute of Medicine. Improving the quality of care in nursing homes. Washington (DC): National Academy Press, 1986

    Google Scholar 

  39. Hughes CM, Lapane K, Mor V. The impact of legislation on nursing home care in the United States: lessons for the United Kingdom. BMJ 1999; 319: 1060–3

    Article  PubMed  CAS  Google Scholar 

  40. National Care Standards Commission. The management of medication in care services 2002–03. London: The Stationery Office, 2004

    Google Scholar 

  41. Stabell A, Eide H, Solheim GA, et al. Nursing homes residents’ dependence and independence. J Clin Nurs 2004; 13: 677–86

    Article  PubMed  Google Scholar 

  42. Nijs KAND, de Graaf C, Kok FJ, et al. Effect of family style mealtimes on quality of life, physical performance, and body weight of nursing home residents: cluster randomised controlled trial. BMJ 2006; 332: 1180–4

    Article  PubMed  Google Scholar 

  43. Grau L, Chandler B, Saunders C. Nursing home residents’ perceptions of the quality of their care. J Psychosoc Nurs 1995; 33: 34–41

    CAS  Google Scholar 

  44. Flesner MK, Rantz MJ. Mutual empowerment and respect: effect on nursing home quality of care. J Nurs Care Qual 2004; 21: 354–61

    Google Scholar 

  45. Andrews GJ, Homes D, Poland B, et al. ‘Airplanes are flying nursing homes’: geographies in the concepts and locales of gerontological nursing practice. J Clin Nurs 2005; 14: 109–20

    Article  PubMed  Google Scholar 

  46. Mattiasson AC, Andersson L. Quality of nursing home care assessed by competent nursing home patients. J Adv Nurs 1997; 26: 1117–24

    PubMed  CAS  Google Scholar 

  47. Anderson RM, Arnold MS, Funnell MM, et al. Patient empowerment: results of a randomised controlled trial. Diabetes Care 1995; 18: 343–9

    Google Scholar 

  48. Joint Committee on Human Rights. The human rights of older people in healthcare. London: The Stationery Office, 2007

    Google Scholar 

  49. Denny M. ‘This is who I am, don’t let them move me’: autonomy in nursing homes. Quinnipiac Health Law J 1999; 2: 203–25

    PubMed  CAS  Google Scholar 

  50. Krause M. Medication administration in a resident-centred nursing home. Am J Nurs 2006; 75: 6

    Google Scholar 

  51. Nolan M, Dellasega C. “I really feel I’ve let him down”: supporting family carers during long-term care placement for elders. J Adv Nursing 2000; 31: 759–67

    Article  CAS  Google Scholar 

  52. Alzheimer’s Society. London: Dementia UK, Alzheimer’s Society, 2007

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Acknowledgements

The authors wish to acknowledge all those who participated in this study. Atlantic Philanthropies funded this work, but played no role in any aspects of the study from conception through to final analysis and production of this article. The authors have no conflicts of interest that are directly relevant to the content of this article.

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Authors and Affiliations

  1. School of Pharmacy, Queen’s University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, Northern Ireland

    Carmel M. Hughes

  2. Institute of Governance, Queen’s University Belfast, Belfast, Northern Ireland

    Roz Goldie

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  1. Carmel M. Hughes
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  2. Roz Goldie
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Correspondence to Carmel M. Hughes.

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Hughes, C.M., Goldie, R. “I Just Take What I Am Given”. Drugs Aging 26, 505–517 (2009). https://doi.org/10.2165/00002512-200926060-00007

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