Dissertations, Theses, and Capstone Projects

Date of Degree

6-2014

Document Type

Dissertation

Degree Name

Ph.D.

Program

Nursing Studies

Advisor

Kathleen M. Nokes

Subject Categories

Nursing

Keywords

Active Medications, Long term services and supports, Medication Regimen Complexity, Older Adults, Therapeutic Drug Class

Abstract

While the complexity of a medication regimen is a concern for all individuals, it is of significant concern for community-dwelling older adults who often require multiple medications to treat chronic health problems. Health related quality of life (HRQoL) has been identified as a key quality outcome measure when assessing care of older adults, particularly those with long-term care needs. Although the use of multiple medications has been widely explored in the literature, there is a paucity of data regarding the combination of several medication-related factors (number of active medications, therapeutic drug class, and medication regimen complexity) and HRQoL in older adults. Wilson and Cleary's health-related quality of life conceptual model was the theoretical framework used to guide this study. This secondary analysis examined the relationship among the number of active medications, the number of therapeutic drug classes, and medication regimen complexity and HRQoL in community-dwelling older adults (68% Hispanic, 75% female) who were recent recipients of home and community-based services (H&CBS). The subjects in this study (N =123) were enrolled in a large, multi-site study (N=470) (R01-AG025524, PI, M. Naylor). Medication-related data were obtained from medical charts, counted to include the active number of medications as all prescription and over the counter drugs (mean =9.3), and a therapeutic drug class tool (mean =4.9) measured the number of distinct therapeutic drug classes included in a medication regimen. Medication regimen complexity (mean = 20.6) was measured using the Medication Regimen Complexity Index (MRCI). The Medical Outcomes Study Short Form (MOS SF-12 v2) physical (PCS) and mental component scores (MCS) measured HRQoL. After controlling for age, gender, education, race, ethnicity, marital status and cognitive status, it was determined that the number of active medications (beta coefficient -.497, p=.012) was a key predictor of physical health-related quality of life, while therapeutic drug class and medication regimen complexity were not associated with either physical or mental health-related quality of life. The number of medications impacts on physical health-related quality of life but the directionality of that relationship is not clear; there were no significant effects on mental health-related-related quality of life and medication-related variables.

Keywords: Older adults, active medications, therapeutic drug class, medication regimen complexity, community-based long term services and supports.

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