Understanding the knowledge, attitudes and beliefs of community-dwelling older adults and their carers about the modification of oral medicines: A qualitative interview study to inform healthcare professional practice.
BACKGROUND
Oral medicines are commonly modified (e.g. tablets split/crushed) to meet the dosing and swallowing requirements of older adults. However, there is limited research investigating the opinions of community-dwelling patients and carers about medicine modification.


OBJECTIVES
The aim of this study was to investigate the views of community-dwelling older adults and their carers about oral medicine modification.


METHODS
Semi-structured, face-to-face interviews were conducted with community-dwelling older adults and carers of older adults who experienced difficulty swallowing medicines, or who required medicines to be modified. Participants were recruited from purposively selected community pharmacies using a combination of purposive, convenience and snowball sampling. Interviews were audio-recorded, transcribed verbatim and analysed thematically. The Francis method governed when data saturation had been reached.


RESULTS
Twenty-six interviews (13 patients, 13 carers) were conducted (76.9% female, median length 11 min (IQR 8-16 min)). Four themes emerged from the data: variation in medical needs and preferences; balancing acceptance and resignation; healthcare professional engagement and; opportunities for optimising formulation suitability. The heterogeneity of medical conditions experienced by community-dwelling older adults resulted in a variety of modifications being required. Patients and carers are accepting of their medications and formulations. However, when challenges arise, they tend to feel resigned to coping within the constraints of the current medication regimen, resulting in a lack of focused communication with healthcare professionals. Thus, healthcare professionals were unaware of their difficulties and unable to offer advice or solutions.


CONCLUSION
Healthcare professionals must engage proactively with this group. Whilst a holistic approach to medication management is ideal, the disadvantage is that no single healthcare professional may identify this as their responsibility. Whilst the input and expertise of all healthcare professionals will be required, as medication experts, the pharmacy profession should take ownership and become the champion of, and for, the patient.
['Mc Gillicuddy|Aoife|A|', 'Kelly|Maria|M|', 'Crean|Abina M|AM|', 'Sahm|Laura J|LJ|']
D000284:Administration, Oral D000368:Aged D000369:Aged, 80 and over D017028:Caregivers D004304:Dosage Forms D005260:Female D007722:Health Knowledge, Attitudes, Practice D006282:Health Personnel D006801:Humans D057187:Independent Living D007494:Ireland D008297:Male D004364:Pharmaceutical Preparations D036301:Qualitative Research
Carers Medicine modification Older patients Oral administration Qualitative research