Assessing medication self-management in older people at hospital-to-home transition: A systematic review of measures and tools

Introduction: Adverse drug events from medication-related harm (MRH) can lead to hospital readmissions, compromised quality of life, and even death. After hospital discharge, older people can experience heightened vulnerability, and are often unprepared for self-care and medication self-management. Effective medication self-management involves more than adherence; it requires patients to monitor their condition(s), build routines, recognise errors, seek help, understand when to alter medications, and discuss these issues with healthcare professionals. Determining medication self-management capability in older people can guide supportive interventions and improve medication-related outcomes. This systematic review identifies measures which assess medication self-management capability for older people transitioning from hospital-to-home.

Method: A comprehensive search was conducted in electronic databases (Medline, EMBASE, PsychINFO, CINAHL, Cochrane Library of Systematic Reviews, and PROSPERO) for articles from database inception to 2023. Eligible studies included participants aged 65 or older experiencing a hospital-to-home transition, and measures containing at least one medication self-management component. Data extraction was performed using a standardised form. Characteristics of measures were tabulated and summarised descriptively. This review is registered with PROSPERO (CRD42023464325).

Results: 14 studies were included, identifying 12 unique measures. These measures predominantly had an adherence-focus, with other medication self-management components included to a lesser degree. Timing of measure administration and the individual administering the measure varied greatly across studies. Medication self-management capability was assessed through physical and cognitive skills. The number and type of skills assessed differed between measures. None of the measures considered all medication self-management components, with self-monitoring and adaptability specifically lacking.

Conclusion: Current measures for medication self-management capability assessment primarily focus on cognitive and physical skills, with significant emphasis on medication adherence. This can lead to other important skills being overlooked. Findings further highlight the importance of comprehensive definitions when considering medication self-management across the hospital-to-home transition, and recommendations are provided for developing future measures.