Martha J. Sanders, Tracy Van Oss; Using Daily Routines to Promote Medication Adherence in Older Adults. Am J Occup Ther 2013;67(1):91-99. doi: 10.5014/ajot.2013.005033.
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PURPOSE. To understand the medication routines used by older adults taking four or more medications daily.
METHOD. One hundred forty-nine community-dwelling older adults were interviewed about the individual routines, storage locations, equipment, and assistance that enabled their adherence to a medication regimen. A subsample of 84 older adults was observed completing one medication routine in their home environments.
FINDINGS. Medication habits were embedded in mealtime, wake-up, and sleep routines for 91% of the sample. Participants developed unique, individualized behaviors for taking medications that were choreographed within broader daily routines. The primary locations for storing medications were the kitchen and bathroom. Equipment used to promote adherence was primarily pillboxes or self-made adaptations. More than 50% of the entire sample required some type of assistance related to medication adherence.
IMPLICATIONS. Findings support the role of occupational therapists in collaborating with clients to develop individualized medication routines to promote medication adherence.
She turns on her Keurig coffee maker, retrieves pills from the kitchen cabinet, and sets them on the table. “The coffee takes just 1 minute, so I just double check I have enough pills while it’s brewing.” Once coffee is ready, she pours the coffee, sits down at her kitchen table, watches GMA news, and takes the pills at the local weather break.
Mrs. Smith kept her medications in the center of dining room table since she takes her medications with meals . . . that way she can see them as a reminder. “I take out the pills I need for each meal when I set the table (to help me remember). I take the pills right after I finish my meal before clearing the table with a full glass of water.”
I wake up, go to the cabinet, take a morning pill, eat breakfast, and go to work. At noon, I take one Metformin with water. I come home at 7:00 p.m. and take an evening dose, eat dinner at 9:00 p.m., inject insulin, and go to bed. When I am out of my routine, I’m stressed because my medication routines are messed up. . . . Going out to eat becomes stressful because it is hard [for me] to manage a healthy diabetes diet and the meds. I love french fries but then I have to give myself more insulin after a big dinner.
Sometimes, she forgets to take meds if she is not home for dinner; still, when she is out, if she remembers, she will place the pillbox next to her dinner plate, then take each pill out and drink water after dinner. “The only time I use a pillbox is when I go away.”
Older adults most commonly embedded medication habits into mealtime and sleep–wake hygiene routines.
The most common locations for storing medications were the kitchen and bathroom.
More than 50% of the sample needed some type of assistance with medication adherence.
Medication habits were individually developed and uniquely choreographed within a broader daily routine.
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