People with mild cognitive impairment (MCI) and dementia, as well as their family caregivers, lean toward keeping those caregivers from managing medications until safety is a concern, a new study shows.
A team of researchers conducted interviews among 32 groups (one patient, one caregiver) of patients with MCI, mild or moderate dementia, and those managing three or more chronic conditions. Participants were on an average of nine medications. Of patients, 34% had MCI, 32% were diagnosed with mild dementia and 34% had moderate dementia, according to the study published Monday in Journal of the American Geriatrics Society. Caregivers were at least 18 years old, and were members of the patients’ families. Patient participants were 78 years on average, and 62% of them were female.
The groups used multiple strategies to manage their medications, including pill boxes and daily routines. Of those with moderate dementia, caregivers managed all medication-related responsibilities except when they lived separately; when they lived apart from the patient they set up reminders. But the patient-to-caregiver transitions in terms of medication management wasn’t proactive but reactive (meaning caregivers took the reins after there was a medication error or other adverse event), the data showed.
“A delayed approach rather than proactive planning could be related to a tendency for caregivers to focus predominantly on dementia rather than all health conditions,” the authors wrote. “Due to a paucity of education around dementia, caregivers may not recognize that poor management of other chronic conditions could affect their family member’s cognition and overall well-being.”
Multiple barriers got in the way of helping caregivers assume more responsibility in terms of the patients’ medications, affecting both the older adult and the caregiver or their relationship on the whole. These include living arrangements of patients and caregivers, as well as dynamics of their relationships and privacy preferences of older adults. Based on responses, caregivers either accepted the medication management responsibilities or felt overwhelmed by it.
Family caregiver involvement must be balanced with preserving older adults’ ability to stay as independent as possible, the authors wrote.
“Clinicians should work to initiate conversations with family caregivers and individuals living with MCI or dementia about transitioning medication responsibilities as memory loss progresses, simplify regimens, and deprescribe, as appropriate,” the authors wrote.
