Medication regimen complexity in institutionalized elderly people in an aging society

Background Complex medication regimens may adversely affect compliance and treatment outcomes. Complexity can be assessed with the medication regimen complexity index (MRCI), which has proved to be a valid, reliable tool, with potential uses in both practice and research. Objective To use the MRCI to assess medication regimen complexity in institutionalized elderly people. Setting Five nursing homes in mainland Portugal. Methods A descriptive, cross-sectional study of institutionalized elderly people (n = 415) was performed from March to June 2009, including all inpatients aged 65 and over taking at least one medication per day. Main outcome measure Medication regimen complexity index. Results The mean age of the sample was 83.9 years (±6.6 years), and 60.2 % were women. The elderly patients were taking a large number of drugs, with 76.6 % taking more than five medications per day. The average medication regimen complexity was 18.2 (±SD = 9.6), and was higher in the females (p < 0.001). The most decisive factors contributing to the complexity were the number of drugs and dosage frequency. In regimens with the same number of medications, schedule was the most relevant factor in the final score (r = 0.922), followed by pharmaceutical forms (r = 0.768) and additional instructions (r = 0.742). Conclusion Medication regimen complexity proved to be high. There is certainly potential for the pharmacist’s intervention to reduce it as part as the medication review routine in all the patients.

Cuidar da pessoa com esquizofrenia em processo de reabilitação psicossocial

Este ensino clínico permitiu-nos prestar cuidados de enfermagem especializados a 16 homens com esquizofrenia em processo de reabilitação psicossocial. Na sua maioria são: adultos, solteiros, da região sul de Portugal, com uma média de 9 anos de escolaridade, com história de consumo de substâncias (álcool, tabaco, haxixe, cocaína, heroína e anfetaminas), institucionalizados na Casa de Saúde do Telhal (CST) há mais de 11 anos. Todos apresentam diagnósticos de enfermagem das várias dimensões do adoecer, com exceção da dimensão comportamental excitatória, sendo os de maior prevalência: “Conhecimento sobre Processo de doença/Cuidados na doença/Tratamento, Não Demonstrado”; Cognição, Comprometida”; “Processo Social, Alterado”; “Autoestima, Diminuída”. Foram desenvolvidos 4 programas de intervenção: consulta de enfermagem de saúde mental e psiquiatria (CESMP); atelier de estimulação cognitiva (AEC); programa de desenvolvimento de competência intrapessoais, interpessoais e profissionais (PDCIIP); programa de psicoeducação (SABER+). A satisfação global com os programas foi superior a 7 (numa escala de 1 a 10) e os resultados que foram percebidos pela maioria dos reabilitandos situaram-se acima das suas expectativas iniciais. De uma forma geral, todos registaram ganhos: no desempenho cognitivo (em particular os que beneficiaram do AEC); na adaptação psicossocial – nomeadamente ao nível do insight; os reabilitandos que beneficiaram do programa SABER+ melhoraram ainda os comportamentos demonstrados de aceitação do estado de saúde; no bem-estar psicológico – nomeadamente ao nível da autoestima (sobretudo os que beneficiaram da CESMP e/ou do PDCIIP), dos afetos positivos e dos comportamentos de motivação; nos vários domínios da qualidade de vida (QdV) medidos pelo WHOQOL-Bref em particular o domínio ambiental; todos elevaram o seu nível de conhecimentos nos 3 eixos em que que se estruturou o programa de psicoeducação (processo da doença, cuidados na doença, tratamento da doença); na adesão à medicação, sobretudo os que integraram o programa de psicoeducação, contudo todos tendem a necessitar de ajuda parcial para conseguir demonstrar conhecimento no cumprimento do esquema terapêutico e estão envolvidos em treinos supervisionados de preparação e autoadministração; ABSTRACT: This clinical training allowed us to provide skilled nursing care to 16 men with schizophrenia in a psychosocial rehabilitation setting. Most of these individuals are: adults, singles, from the southern region of Portugal, with an average of 9 years of schooling, with a history of substance abuse (alcohol, tobacco, cannabis, cocaine, heroin and amphetamines), institutionalized in Casa de Saúde do Telhal (CST) for over 11 years. We find nursing diagnoses from all of the disease dimensions with the exception of excitatory behavioral dimension, being the most prevalent: "knowledge about disease process / care / treatment, not stated"; cognition, impaired", "social process, impaired”, “self-esteem, decreased". We developed 4 intervention programs: psychiatry and mental health nursing consultation (CESMP); atelier of cognitive stimulation (AEC); intrapersonal, interpersonal and professional competences training (PDCIIP); psychoeducation (SABER+). The overall satisfaction with the programs was above 7 (on a scale of 1 to 10) and the results noticed by most patients were above their initial expectations. All registered nursing results were: in cognitive performance (particularly those who benefited from the AEC); in psychosocial adaptation - especially in terms of insight; patients who benefited from the SABER+ program demonstrated improved further acceptance of their health condition, psychological well-being, particularly in terms of self-esteem (especially those who benefited from the CESMP and/or the PDCIIP), positive affects and motivation; in the different domains of quality of life (QoL) measured by WHOQOL-Bref in particular the environmental domain; every patients raised their level of knowledge in the 3 axes in which the psychoeducational program (SABER+) was structured (disease process, care and treatment); in medication adherence, especially those who benefited of the psychoeducational program, however all the patients tend to need partial help to demonstrate knowledge in meeting the therapeutic regimen and are involved in supervised training programs for preparation and self administration.