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.