Older adults with multi-morbidity: medication management processes and design implications for personal health applications

Abstract

Background: Older adults often have multiple chronic problems requiring them to manage complex medication regimens overseen by various clinicians. Personal health applications (PHAs) show promise assisting in medication self-management, but adoption of new computer technologies by this population is challenging. Optimizing the utility of PHAs requires a thorough understanding of older adults' needs, preferences, and practices.

Objective: The objective of our study was to understand the medication self-management issues faced by older adults and caregivers that can be addressed by an electronic PHA.

Methods: We conducted a qualitative analysis of a series of individual and group semistructured interviews with participants who were identified through purposive sampling.

Results: We interviewed 32 adult patients and 2 adult family caregivers. We identified 5 core themes regarding medication self-management challenges: seeking reliable medication information, maintaining autonomy in medication treatment decisions, worrying about taking too many medications, reconciling information discrepancies between allopathic and alternative medical therapies, and tracking and coordinating health information between multiple providers.

Conclusions: This study provides insights into the latent concerns and challenges faced by older adults and caregivers in managing medications. The results suggest that PHAs should have the following features to accommodate the management strategies and information preferences of this population: (1) provide links to authoritative and reliable information on side effects, drug interactions, and other medication-related concerns in a way that is clear, concise, and easy to navigate, (2) facilitate communication between patients and doctors and pharmacists through electronic messaging and health information exchange, and (3) provide patients the ability to selectively disclose medication information to different clinicians.

Figure 1

Example of one participant’s personal health information management area

Figure 2

Example of another participant’s personal health information management area

Figure 3

A caregiver created this medication management system to provide some autonomy to her older adult mother. Her mother could access these envelopes fastened together with a pin and pull off the appropriate envelope to receive the correct dosage. This system was also used to carry her mid-day pills with her if she was out of the house