34 A collaborative, patient-centered medication management model to promote home-dwelling older adults’ safety at home

In a first phase, around 20,000 electronic patient records from the Cantonal Hospital of Valais pertaining to home-dwelling older adults with chronic conditions were evaluated. The aim of the analysis was to provide evidence of risk factors for adverse effects and dangerous situations associated with taking medication. In a second phase, 28 patients and their professional and informal caregivers were interviewed about their experience of taking several medication and collaborative medication management after hospital discharge. On this basis, a collaborative interprofessional model for optimised medication management was developed.

Older adults suffering from chronic conditions often take several medications at the same time. Accurate medication management can be challenging, especially for people living at home. However, little research has been carried out into the experience of older adults and their informal caregivers (such as family members, friends, neighbours) with medication management after hospital discharge.

The aim of the study was, first, to identify factors that can lead to adverse effects and make taking multiple medication potentially dangerous for home-dwelling older adults. Second, the study investigated the experiences of this group of patients with medication management after hospital discharge. Third, the role of both professional and informal caregivers was examined.

The study indicated that medications such as sedatives, anti-nausea medications or hormonal preparations are relevant risk factors for unplanned hospital readmissions and nursing home admissions of home-dwelling older adults. Furthermore, the results showed that the patients and the informal caregivers wished for greater involvement in the hospital discharge planning. The patients themselves would like to be more involved in medication decision-making; the informal carers, in turn, would like more support in medication management. Patients as well as informal and professional caregivers expressed a need for better communication and coordination between the professional caregivers and institutions. The involvement of a specially trained health professional could have a supportive effect on safe medication management.

Significance of the results for research and practice

The study highlighted not only the importance of safe medication management for home-dwelling older adults, but also the associated needs of patients and informal and professional caregivers. The interprofessional model for safe medication management developed in the study may help to prevent dangerous situations and adverse effects that can lead to hospitalisations or nursing home admissions.

Optimising medication management for polymedicated home-dwelling older adults with multiple chronic conditions - ME@home