Medication Management Capacity in Highly Functioning Community‐Living Older Adults: Detection of Early Deficits

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Abstract
OBJECTIVE: The Drug Regimen Unassisted Grading Scale (DRUGS) was developed and employed in testing the hypothesis that the inability to take medication independently may correlate with the presence of cognitive impairment.DESIGN: Cross‐sectional study.SETTING: Two continuing care retirement facilities in the Greater Boston area.PARTICIPANTS: The study population included outpatients ≥ 70 years old.MEASUREMENTS: We developed a novel performance‐based measure, the DRUGS tool, involving a step‐wise progression of four tasks: (1) identification; (2) access; (3) dosage; and (4) timing.RESULTS: Fifty‐nine participants aged 84.2 ± 5.1 years (mean ± SD) completed the study. The DRUGS tool score was inversely related to age (r = ‐.41, P = .001). Compared with independent‐living, residence in assisted‐living was associated with lower DRUGS tool scores (82.0% vs 93.8%, P = .009). The DRUGS tool score was associated with self‐reported Medication Management capacity (94.8% able vs 86.2% unable to take medications independently by self‐report, P = .047). Both DRUGS tool score and self‐reported Medication Management capacity were associated with MMSE (P = .0008 and P = .044, respectively). The multivariate model, with DRUGS tool Summary Score as the dependent variable, adjusted for age and sex, included MMSE (P = .023) and self‐reported IADL (P = .038).CONCLUSION: There is an association between performance on the DRUGS tool and level of cognitive function. The DRUGS tool represents a unique individualized, yet standardized, assessment of the ability to function independently for ambulatory older persons. It may be useful for identifying those highly functioning older persons, at an early phase of cognitive decline, in whom targeted intervention would likely be most effective and efficient. J Am Geriatr Soc 47:592–596, 1999.