The journal of nutrition, health & aging

, Volume 18, Issue 1, pp 44–49 | Cite as

Medication management capacity in relation to cognition and self-management skills in older people on polypharmacy

  • Carolien G. M. SinoEmail author
  • M. Sietzema
  • T. C. G. Egberts
  • M. J. Schuurmans



To determine the medication management capacity of independently living older people (≥75 years) on polypharmacy (≥ 5 medications) in relation to their cognitive- and self-management skills.


Cross-sectional study.


Two homecare organizations in the Netherlands.


Homecare clients aged 75 and older on polypharmacy (N=95).


The primary outcome measure was medication management capacity, quantified as the number of ‘yes’ answers (range = 0–17) on the Medication Management Capacity (MMC) questionnaire. Other measures included self-management ability (assessed with the SMAS30) and cognitive skills (assessed with the clock drawing test).


Overall, 48.4% (n= 46) of the participants were able to manage their medication by themselves at home. About 40% of the participants were unable to state the names of their medications, even with the aid of a medication list, and about 25% reported having problems with opening medication packages. Correlations were found between self-management ability (Rs = 0.473; p < 0.001), cognitive skills (Rs = 0.372; p < 0.001), and age (Rs = 0.216; p < 0.005) and Medication Management Capacity score. Self-management ability and medication management support were significantly associated with medication management capacity.


A considerable proportion of independently living older people who receive home care and regularly use five or more medications lack the knowledge and skills needed to independently manage their own medications. Cognition and self management ability were related to medication management capacity. Self-management ability and medication management support were predictors of medication management capacity.

Key words

Older people cognition self-management medication management medication management capacity 


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  1. 1.
    Garfield S, Barber N, Walley P, Willson A, Eliasson L. Quality of medication use in primary care—mapping the problem, working to a solution: a systematic review of the literature. BMC Med 2009 Sep 21;7:50.PubMedCentralPubMedCrossRefGoogle Scholar
  2. 2.
    SFK. Foundation for Pharmaceutical Statistics. Facts and Figures 2012. Available at: Accessed march 23, Accessed 2013.Google Scholar
  3. 3.
    Meredith S, Feldman PH, Frey D, Hall K, Arnold K, Brown NJ, et al. Possible medication errors in home healthcare patients. J Am Geriatr Soc 2001 Jun;49(6):719–724.PubMedCrossRefGoogle Scholar
  4. 4.
    Edelberg HK, Shallenberger E, Wei JY. Medication management capacity in highly functioning community-living older adults: detection of early deficits. J Am Geriatr Soc 1999 May;47(5):592–596.PubMedGoogle Scholar
  5. 5.
    Beijer HJ, de Blaey CJ. Hospitalisations caused by adverse drug reactions (ADR): a meta-analysis of observational studies. Pharm World Sci 2002 Apr;24(2):46–54.PubMedCrossRefGoogle Scholar
  6. 6.
    Skelton F, Kunik ME, Regev T, Naik AD. Determining if an older adult can make and execute decisions to live safely at home: a capacity assessment and intervention model. Arch Gerontol Geriatr 2010 May–Jun;50(3):300–305.PubMedCentralPubMedCrossRefGoogle Scholar
  7. 7.
    Maddigan SL, Farris KB, Keating N, Wiens CA, Johnson JA. Predictors of older adults’ capacity for medication management in a self-medication program: a retrospective chart review. J Aging Health 2003 May;15(2):332–352.PubMedCrossRefGoogle Scholar
  8. 8.
    Stilley CS, Bender CM, Dunbar-Jacob J, Sereika S, Ryan CM. The impact of cognitive function on medication management: three studies. Health Psychol 2010 Jan;29(1):50–55.PubMedCentralPubMedCrossRefGoogle Scholar
  9. 9.
    Hain DJ, Tappen R, Diaz S, Ouslander JG. Cognitive impairment and medication self-management errors in older adults discharged home from a community hospital. Home Healthc Nurse 2012 Apr;30(4):246–254.PubMedCrossRefGoogle Scholar
  10. 10.
    Bergman-Evans B. Evidence-based guideline. Improving medication management for older adult clients. J Gerontol Nurs 2006 Jul;32(7):6–14.PubMedGoogle Scholar
  11. 11.
    van Deelen BA, van den Bemt PM, Egberts TC, van’ t Hoff A, Maas HA. Cognitive impairment as determinant for sub-optimal control of oral anticoagulation treatment in elderly patients with atrial fibrillation. Drugs Aging 2005;22(4):353–360.PubMedCrossRefGoogle Scholar
  12. 12.
    Steverink N, Lindenberg S, Slaets J. How to understand and improve older people’s self-management of wellbeing. Eur J Ageing 2005;2:235–236 244.CrossRefGoogle Scholar
  13. 13.
    Elliott RA, Marriott JL. Standardised assessment of patients’ capacity to manage medications: a systematic review of published instruments. BMC Geriatr 2009 Jul 13;9:27.PubMedCentralPubMedCrossRefGoogle Scholar
  14. 14.
    Dutch Institute for Responsible Medication Use (in Dutch IVM). Medication Management Assessment Score MMAS (in Dutch BEM). 2012; Available at: Accessed may 23, 2012.
  15. 15.
    Shulman KI. Clock-drawing: is it the ideal cognitive screening test? Int J Geriatr Psychiatry 2000 Jun;15(6):548–561.PubMedCrossRefGoogle Scholar
  16. 16.
    Korner EA, Lauritzen L, Nilsson FM, Lolk A, Christensen P. Simple scoring of the Clock-Drawing test for dementia screening. Dan Med J 2012 Jan;59(1):A4365.PubMedGoogle Scholar
  17. 17.
    Schuurmans H, Steverink N, Frieswijk N, Buunk BP, Slaets JP, Lindenberg S. How to measure self-management abilities in older people by self-report. The development of the SMAS-30. Qual Life Res 2005 Dec;14(10):2215–2228.PubMedCrossRefGoogle Scholar
  18. 18.
    Hutchison LC, Jones SK, West DS, Wei JY. Assessment of medication management by community-living elderly persons with two standardized assessment tools: a cross-sectional study. Am J Geriatr Pharmacother 2006 Jun;4(2):144–153.PubMedCrossRefGoogle Scholar
  19. 19.
    Hayes TL, Larimer N, Adami A, Kaye JA. Medication adherence in healthy elders: small cognitive changes make a big difference. J Aging Health 2009 Jun;21(4):567–580.PubMedCentralPubMedCrossRefGoogle Scholar
  20. 20.
    Edelberg HK, Shallenberger E, Hausdorff JM, Wei JY. One-year follow-up of medication management capacity in highly functioning older adults. J Gerontol A Biol Sci Med Sci 2000 Oct;55(10):M550–553.PubMedCrossRefGoogle Scholar
  21. 21.
    Lui VW, Lam LC, Chau RC, Fung AW, Wong BM, Leung GT, et al. Capacity to make decisions on medication management in Chinese older persons with mild cognitive impairment and mild Alzheimer’s disease. Int Psychogeriatr 2012 Jul;24(7):1103–1111.PubMedCrossRefGoogle Scholar
  22. 22.
    Bodenheimer T, Lorig K, Holman H, Grumbach K. Patient self-management of chronic disease in primary care. JAMA 2002 Nov 20;288(19):2469–2475.PubMedCrossRefGoogle Scholar
  23. 23.
    Frieswijk N, Steverink N, Buunk BP, Slaets JP. The effectiveness of a bibliotherapy in increasing the self-management ability of slightly to moderately frail older people. Patient Educ Couns 2006 May;61(2):219–227.PubMedCrossRefGoogle Scholar
  24. 24.
    Anderson K, Jue SG, Madaras-Kelly KJ. Identifying patients at risk for medication mismanagement: using cognitive screens to predict a patient’s accuracy in filling a pillbox. Consult Pharm 2008 Jun;23(6):459–472.PubMedCrossRefGoogle Scholar
  25. 25.
    Westerbotn M, Hilleras P, Fastbom J, Aguero-Torres H. Factors influencing the handling of medicines among very old people living at home in an urban area. Aging Clin Exp Res 2006 Dec;18(6):497–502.PubMedCrossRefGoogle Scholar
  26. 26.
    Steverink N. Self-Management Ability Scale: SMAS-30/versie 2. Background, Guide And Scoring. 2012; Available at: Accessed may 23, 2012.Google Scholar
  27. 27.
    Cramm JM, Hartgerink JM, Steyerberg EW, Bakker TJ, Mackenbach JP, Nieboer AP. Understanding older patients’ self-management abilities: functional loss, self-management, and well-being. Qual Life Res 2013 Feb;22(1):85–92.PubMedCentralPubMedCrossRefGoogle Scholar
  28. 28.
    Arnold GJ. Avoiding inappropriate drug prescribing: fundamental principles for rational medication management. Clin Nurse Spec 1999 Nov;13(6):289–295.PubMedCrossRefGoogle Scholar
  29. 29.
    Kovner C, Menezes J, Goldberg JD. Examining nurses’ decision process for medication management in home care. Jt Comm J Qual Patient Saf 2005 Jul;31(7):379–385.PubMedGoogle Scholar
  30. 30.
    Mehuys E, Dupond L, Petrovic M, Christiaens T, Van Bortel L, Adriaens E, et al. Medication management among home-dwelling older patients with chronic diseases: possible roles for community pharmacists. J Nutr Health Aging 2012 Aug;16(8):721–726.PubMedCrossRefGoogle Scholar
  31. 31.
    Leendertse AJ, Egberts AC, Stoker LJ, van den Bemt PM, HARM Study Group. Frequency of and risk factors for preventable medication-related hospital admissions in the Netherlands. Arch Intern Med 2008 Sep 22;168(17):1890–1896.PubMedGoogle Scholar

Copyright information

© Serdi and Springer-Verlag France 2014

Authors and Affiliations

  • Carolien G. M. Sino
    • 1
    • 6
    Email author
  • M. Sietzema
    • 1
    • 2
  • T. C. G. Egberts
    • 4
    • 5
  • M. J. Schuurmans
    • 1
    • 3
  1. 1.Research Centre for Innovation in HealthcareHU University of Applied Science UtrechtUtrechtthe Netherlands
  2. 2.University Medical Center GroningenGroningenthe Netherlands
  3. 3.Department of Rehabilitation, Nursing Science & SportsUniversity Medical Center UtrechtUtrechtthe Netherlands
  4. 4.Faculty of Science, Department of Pharmacoepidemiology and Clinical PharmacologyUtrecht UniversityUtrechtthe Netherlands
  5. 5.Department of Clinical PharmacyUniversity Medical Center UtrechtUtrechtthe Netherlands
  6. 6.Research Centre for Innovation in Health CareUniversity of Applied Science UtrechtUtrechtThe Netherlands

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