Informal caregivers played a limited role in managing medications for relatively independent oldest-old patients without dementia. Caregivers had little knowledge of patients' medications and rarely questioned the appropriateness or necessity of potentially inappropriate medications prescribed by doctors. Communication between caregivers, patients, and doctors was also limited. The study highlights the need for better education of caregivers, evaluation of patients' medication abilities, and more effective communication strategies between all parties involved in medication management of older adults.

1. Elder Abuse in the COVID-19 Era
嘉基老醫病房讀書會
FM R3盧敬文
2021/3/18

2. • massive increase in reports of elder abuse
during the pandemic.
• elder abuse
as an intentional act or failure to act
by a caregiver or another person in a relationship involving an
expectation of trust
that causes or creates a risk of harm to an older adult.
• physical, emotional, financial, neglect

3. THE VULNERABLE OLDER ADULT
• Vulnerabilities
• high rates of depressive and anxiety
symptoms
• social distancing programs
growing dependency on others for the
completion of daily living activities
• social isolation
one of the strongest predictors of elder
abuse

4. THE TRUSTED OTHER
• when trust is broken
• “shelter-in place” orders in effect to
promote social distancing
increased dependency of older adults on
Others
• perpetrators of abuse are often close
Relations
• shuttering of adult daycare programs,
senior centers, and outpatient programs

5. THE CONTEXT
• Cultural norms
• Ageism
• coronavirus has inspired ageist
thoughts and comments given its
predilection toward harming older
adults
• tragic and unjust utilitarian
conversations
“the needs of the many versus the needs
of the few.”

6. Mitigation
• telehealth approaches
• developing specific hours for older adult
shopping by some commercial stores
• increasing penalties
• individualized safety plan
• Additional means of support and
guidance
• the perspective of older adults can be
elevated by increasing representation
• who have a substantial social media
footprint can be of particular help

8. Background
• potentially inappropriate medication (PIM)
25% over the age of 65 receive at least one prescription for PRISCUS
drugs
Adverse drug reactions (ADRs) up to 30% over the age of 75
• patient- physician relationship and the treatment process
are viewed as dyadic as long as the patient is still
independent.
• Health behavior
under the influence of patients’ social groups,
e.g., family, friends, and others

10. • dependent adults and older adults with dementia
• medication management is a very complex task burdening
informal caregivers.
• Not all oldest-old people require help with their everyday
needs
• There is a significant lack of data from qualitative studies on
the informal caregivers’ perspectives
on relatively independent oldest-old adults without dementia
regarding (long-term) prescriptions and use of PIM
focus on informal caregivers’ perspectives
identifying starting points for deprescription and safer
handling of PIM.

11. Methods
exploratory qualitative interview study
Interviews were conducted with
GP patients’
their informal caregivers’
and their GPs’
from the AgeCoDe-Cohort
(“German Study on Ageing, Cognition and Dementia in Primary Care
Patients”)

12. Researcher characteristics
Participants and recruitment
• Identification of eligible patients from the AgeCoDe-Cohort
• Snowball sampling approach
• Eligible patients were defined by age ≥ 85 years,
not having been diagnosed with dementia
long-term use of PIM according to PL
• Inclusion criteria for informal caregivers:
1) must be a relative, partner or friend of an eligible patient
2) the patient’s written consent for the informal caregiver to be
interviewed.

13. Sample
• included 52 patients and 45 informal caregivers
• The patients’ mean age was 89 years.
• Living arrangement
Pt 自家
獨居
自家
與伴侶
自家
與親人
Assisted
accommodations
護理
之家
獨居sheltered
accommodation
與伴侶sheltered
accommodation
20 7 5 7 3 2 1
interviewees 與病人同住 同城市不
同家戶
不同
城市
9 23 13

14. • Interviews lasted Ø 34 min

15. Interview guideline, data collection and
transcription

16. Data analysis
• The directed approach (inductive coding) and the
conventional approach (deductive coding) were combined.
• Main focus was placed on inductive category formation, as
our study was of explanatory nature and ensured that the
categories

17. Results
• Informal caregivers’ knowledge of and role in managing
patients’ medication
只要病人還能照顧自己，就不介入處理疾病和藥物
但有發現觀察病人的能力會隨時間改變
並不清楚病人在吃什麼藥
透過仿單了解病人吃的藥，或認為關於藥物是醫師的責任
不知道藥是誰開的，通常假定來自GPs

18. • Informal caregivers’ knowledge of and role in managing
patients’ medication
去藥局領藥，除非必要，不幫忙處理藥
親子關係中，有不同的角色
宿命論(fatalistic)的病人
只有在病人接受需要幫助的需求，才有責任並影響服藥行為，且有時需要
專業協助

19. • Informal caregivers’ opinion about patients’ (potentially
inappropriate) medication
考慮藥物對病人的好處，比副作用重要，必要性很少被質疑
作為常民(medical laypeople)，通常都滿意病人接受的醫療
基於病人福祉，對於藥物成癮沒意見，也沒聽過PIM
長期使用的精神用藥，適切性也很少被質疑

20. • Dyadic and triadic communication
病人持續對疾患的哀嘆，會吸引注意，讓家庭照顧者接納病人的PIM，但
也會讓他們抗拒關心病人的健康
病人對分享自己的健康狀態很保留
提出即將面對的協助需求，常被當成家父長主義或限制病人的自主
家庭照顧者和GPs幾乎不曾溝通過，除非病人越來越失能

22. • 受訪者並未扮演決定性角色
• 反映出病人高程度的獨立，但有些家庭照顧者也涉入領藥和安排藥物
• 大多家庭照顧者掙扎於藥物的恰當性
• 老老人的用藥能力需要定期評估
• （非正式）照顧者的教育、訓練、支持需求
• 與GPs之間有效的溝通策略
• GPs要激勵病人盡早和家庭照顧者溝通、要有能力幫忙家庭照顧者管
理藥物
• 納入藥師居家用藥諮詢
• 在過渡時期，協助的需求，可能會被家庭照顧者忽略，或被病人掩蓋