Medication management capacity in highly functioning community-living older adults: Detection of early deficits

OBJECTIVE: The Drug Regimen Unassisted Grading Scale (DRUGS) was developed and employed in testing the hypothesis that the inability to take medicatio n independently may correlate with the presence of cognitive impairment. DESIGN: Cross-sectional study. SETTING: Two continuing care retirement facilities in the Greater Boston ar ea. PARTICIPANTS: The study population included outpatients greater than or equ al to 70 years old. MEASUREMENTS: We developed a novel performance-based measure, the DRUGS too l, involving a step-wise progression of four tasks: (1) identification; (2) access; (3) dosage; and (4) timing. RESULTS: Fifty-nine participants aged 84.2 +/- 5.1 years (mean +/- SD) comp leted the study. The DRUGS tool score was inversely related to age (r = -.4 1, P = .001). Compared with independent-living, residence in assisted-livin g was associated with lower DRUGS tool scores (82.0% vs 93.8%, P = .009). T he DRUGS tool score was associated with self-reported Medication Management capacity (94.8% able vs 86.2% unable to take medications independently by self-report, P = .047). Both DRUGS tool score and self-reported Medication Management capacity were associated with MMSE (P = .0008 and P = .044, resp ectively). The multivariate model, with DRUGS tool Summary Score as the dep endent variable, adjusted for age and sex, included MMSE (P = .023) and sel f-reported IADL (P = .038). CONCLUSION: There is an association between performance on the DRUGS tool a nd level of cognitive function. The DRUGS tool represents a unique individu alized, yet standardized, assessment of the ability to function independent ly for ambulatory older persons. It may be useful for identifying those hig hly functioning older persons, at an early phase of cognitive decline, in w hom targeted intervention would likely be most effective and efficient.