One-Year Follow-Up of Medication Management Capacity in Highly Functioning Older Adults

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Abstract
Background. We tested the hypothesis that impairment in the ability to take medication independently predicts early functional decline. Methods. A 12-month, prospective cohort study was performed at two continuing-care retirement facilities using the Drug Regimen Unassisted Grading Scale (DRUGS). This geriatric screening tool utilizes a stepwise progression of four tasks: (i) identification, (ii) access, (iii) dosage, and (iv) timing. Results. Forty-seven (86%) of the eligible participants completed the 12-month follow-up assessment; three were transferred to skilled nursing facilities. The mean age at study entry was 84.2 ± 5.1 years; 72% of the participants were women, and 68% were college educated. At 12 months there was a decline in the Mini-Mental State Examination (MMSE) score ( p = .029), an increase in the timed “Up and Go” test ( p = .023), and a decline in the DRUGS score ( p = .029). Nine (18%) of the participants resided in assisted- versus independent-living situations compared with three participants (5%) at study entry ( p = .031). Both 12-month DRUGS score and 12-month self-reported medication management capacity were associated with 12-month MMSE ( p = .0001 and p = .019, respectively). Baseline DRUGS score was associated with 12-month MMSE and Geriatric Depression Scale scores ( p = .0002 and p = .002, respectively). Both baseline DRUGS score and self-reported medication management capacity were also associated with residence in assisted-living communities at 6 months ( p = .029 and p = .040, respectively). MMSE was not associated with any of the clinical outcomes. Conclusions. The DRUGS tool may predict functional decline in highly functioning older adults.