Measures and tools assessing medication self-management capability in older people across the hospital-to-home transition: a systematic scoping review.

Abstract

Background: Adverse drug events from medication-related harm (MRH) can lead to hospital readmissions, compromised quality of life, and even death. Post-hospital discharge is a vulnerable period for older adults, who are often unprepared to resume self-care and medication self-management. Assessing medication self-management capability in older people can guide supportive interventions and improve medication-related outcomes. This review aimed to identify measures and tools used to assess medication self-management capability for older patients during the hospital-to-home transition.

Methods: Medline, EMBASE, PsycINFO, CINAHL and Cochrane Library of Systematic Reviews were comprehensively searched for articles from database inception to December 2023. Eligible studies included participants aged 65 or older across the 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 tabulated, and a narrative approach used to describe measures. Reporting conforms to the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews checklist (PRISMA-ScR).

Results: Fourteen studies were included, and 12 unique measures identified. Measures predominantly focused on adherence rather than broader medication self-management components. Timing of measure administration and the individual administering the measure varied greatly. Medication self-management capability was determined through assessment of physical and cognitive skills. Number and type of skills assessed varied between measures. No measures considered all medication self-management components.

Conclusions: Current measures for medication self-management capability assessment primarily focus on cognitive and physical skills, with significant emphasis on adherence. Findings emphasise the importance of comprehensive definitions of medication self-management across the hospital-to-home transition. Recommendations are provided for developing future measures.