Evaluation of an Educational Intervention on Knowledge and Awareness of Medication Safety in Older Adults with Low Health Literacy

Chanel F. Whittaker, Sarah E. Tom, Angel Bivens, and Wendy Klein-Schwartza

Older adults are at increased risk of serious adverse drug events due to due to age-related physiologic changes. Patient and provider factors such as polypharmacy, incorrect medication administration, inappropriate prescribing, and monitoring also contribute to increased risk. Prevalence of prescription and over-the-counter (OTC) medication use increases with age. Data from the 2011–2012 National Health and Nutrition Examination Survey found that 39% of adults aged 65 years and older 30 reported polypharmacy (defined as use of ≥ 5 drugs), an increase from 24% in 1999–2000. Among community dwelling older adults who used prescription medications, 46%–52% used OTC medications and dietary supplements concomitantly. Of the 4% of older adults at risk of a major drug–drug interactions, half involved OTCs.

Limited health literacy is another important risk factor for adverse events and therapeutic errors in older adults. According to the National Assessment of Adult Literacy Survey (NAALS), two thirds of US adults over 40 the age of 60 have inadequate health literacy skills. Low health literacy in older adults is associated with decreased medication adherence, limited knowledge about medications, and increased number of unreconciled medications and accidental drug exposures.

The consequences of adverse drug events in older adults 45 are significant. It is estimated that approximately 177 500 emergency department visits and 100 000 emergency hospitalizations per year in the United States are due to adverse drug events in adults 65 years of age or older. Approximately 37% of emergency department visits for 50 adverse drug events result in hospitalization. Close to 66% of hospitalizations are due to unintentional overdoses. These largely preventable misadventures have a profound impact on the health status of older adults and are a significant financial burden to the health care system.

Preventing adverse drug events and improving medication safety in older adults requires a multipronged approach. Prevention strategies must be directed to take into account risk factors for having a preventable adverse drug event, which include older age (ie, ≥80 years), pre- 60 sence of multiple medical conditions, taking multiple scheduled medications or taking certain medications or medication categories (eg, nonopioid analgesics, anticoagulants, diuretics, anticonvulsants), and low health literacy.

One important strategy to decrease risk of negative health outcomes related to adverse drug events in older adults is through direct education to this population, particularly to older adults who independently manage their medications. However, there are limited data regarding the benefits of education on the prevention and management of unintended drug exposures in older adults.

Various methods of Health Education have been used in older adults, such as live interactive presentations, brochures, and online resources. When designing educational methodology, resources are an important consideration. A study regarding motor vehicle safety found that more intensive high-resource interventions involving direct instruction from experts were more effective than low-resource interventions using brochures in older adults. The Health Resources and Services Administration Poison Control Program funded a pilot educational program geared toward older adults to prevent poisoning due to accidental misuse and drug interactions with their medications but did not have a comparator group. The program was well received by participants and significantly increased their knowledge, improved attitudes, and changed behavior. The value of more intensive resources for medication safety programs for older adults needs further investigation.

To read the rest of this article, click on the link below to download the pdf.

Read the Full Cover Story