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Glaucoma, dementia, and the “precipice of care”: transitions between states of medication adherence

Simon Read, Heather Waterman, James Morgan, Robert Harper, Anne Fiona Spencer, Penelope Stanford

Patient Preference and Adherence, Volume: 12, Pages: 1315 - 1325

Swansea University Author: Simon Read

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DOI (Published version): 10.2147/ppa.s167080

Abstract

Purpose: “She wouldn’t remember. Even when I go through, and she’s decided to go to bed, I’ll say I’ll come and do her drops. If I didn’t say that, they wouldn’t be done.” Dementia is widely considered as a key factor in whether patients take their medication as prescribed. However, few studies have...

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Published in: Patient Preference and Adherence
ISSN: 1177-889X
Published: Informa UK Limited 2018
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URI: https://cronfa.swan.ac.uk/Record/cronfa57583
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However, few studies have examined the effect of dementia on medication management strategies for glaucoma including how patient and carer needs impact adherence and long-term prognosis. We report findings from a qualitative grounded theory study incorporating the views of patients, carers, and healthcare professionals.Methods: Eighty-three semistructured interviews were conducted with 35 patients, 22 lay carers, and nine healthcare professionals across sites in Wales and Scotland. These explored understanding of eye drop regimens, barriers, and facilitators to drop administration, as well as attitudes toward glaucoma, dementia, and other comorbidities.Results: Using Pound&#x2019;s synthesis of adherence behavior, we identified categories of active and passive acceptance of medicines, alongside modification or rejection of eye drop regimens. In relation to dementia, participants highlighted transitions between such categories, with a shift from active to passive acceptance commonly reported. This loss of self-medicating capability was referred to as the precipice of care, where entwinement of multiple conditions (eg, heart disease, glaucoma, and dementia) and sociocultural influences (eg, living alone) contributed to accelerated health declines. That said, numerous factors mitigated this, with a key role being the lay carer. Spouses and family members often acted as the monitor of eye drops for patients, seeking intervention when any behavioral changes influenced their administration.Conclusion: Though dementia was associated with progression toward the precipice of care, factors such as communication with healthcare professionals appeared to affect patient adherence. Recommendations for healthcare practice include better recording of dementia diagnoses and integrating eye drops into preexisting routines.</abstract><type>Journal Article</type><journal>Patient Preference and Adherence</journal><volume>12</volume><journalNumber/><paginationStart>1315</paginationStart><paginationEnd>1325</paginationEnd><publisher>Informa UK Limited</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint/><issnElectronic>1177-889X</issnElectronic><keywords>memory loss, compliance, eye drops, qualitative research, grounded theory</keywords><publishedDay>25</publishedDay><publishedMonth>7</publishedMonth><publishedYear>2018</publishedYear><publishedDate>2018-07-25</publishedDate><doi>10.2147/ppa.s167080</doi><url/><notes/><college>COLLEGE NANME</college><department>Public Health</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>PHAC</DepartmentCode><institution>Swansea University</institution><apcterm>Other</apcterm><funders>This research study was funded by the International Glaucoma Association in conjunction with the Royal College of Nursing</funders><lastEdited>2021-09-08T13:01:37.1962892</lastEdited><Created>2021-08-10T12:26:35.8771435</Created><path><level id="1">Faculty of Medicine, Health and Life Sciences</level><level id="2">School of Health and Social Care - Public Health</level></path><authors><author><firstname>Simon</firstname><surname>Read</surname><order>1</order></author><author><firstname>Heather</firstname><surname>Waterman</surname><order>2</order></author><author><firstname>James</firstname><surname>Morgan</surname><order>3</order></author><author><firstname>Robert</firstname><surname>Harper</surname><order>4</order></author><author><firstname>Anne Fiona</firstname><surname>Spencer</surname><order>5</order></author><author><firstname>Penelope</firstname><surname>Stanford</surname><order>6</order></author></authors><documents><document><filename>57583__20782__22652dab2d1f4e4b8c373b1e5b12eadc.pdf</filename><originalFilename>57583.pdf</originalFilename><uploaded>2021-09-08T12:59:16.3535712</uploaded><type>Output</type><contentLength>405793</contentLength><contentType>application/pdf</contentType><version>Version of Record</version><cronfaStatus>true</cronfaStatus><documentNotes>&#xA9; 2018 Read et al. 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spelling 2021-09-08T13:01:37.1962892 v2 57583 2021-08-10 Glaucoma, dementia, and the &ldquo;precipice of care&rdquo;: transitions between states of medication adherence a5fdd0f9bc9dd4b6716fc42cb1ee8a30 Simon Read Simon Read true false 2021-08-10 PHAC Purpose: “She wouldn’t remember. Even when I go through, and she’s decided to go to bed, I’ll say I’ll come and do her drops. If I didn’t say that, they wouldn’t be done.” Dementia is widely considered as a key factor in whether patients take their medication as prescribed. However, few studies have examined the effect of dementia on medication management strategies for glaucoma including how patient and carer needs impact adherence and long-term prognosis. We report findings from a qualitative grounded theory study incorporating the views of patients, carers, and healthcare professionals.Methods: Eighty-three semistructured interviews were conducted with 35 patients, 22 lay carers, and nine healthcare professionals across sites in Wales and Scotland. These explored understanding of eye drop regimens, barriers, and facilitators to drop administration, as well as attitudes toward glaucoma, dementia, and other comorbidities.Results: Using Pound’s synthesis of adherence behavior, we identified categories of active and passive acceptance of medicines, alongside modification or rejection of eye drop regimens. In relation to dementia, participants highlighted transitions between such categories, with a shift from active to passive acceptance commonly reported. This loss of self-medicating capability was referred to as the precipice of care, where entwinement of multiple conditions (eg, heart disease, glaucoma, and dementia) and sociocultural influences (eg, living alone) contributed to accelerated health declines. That said, numerous factors mitigated this, with a key role being the lay carer. Spouses and family members often acted as the monitor of eye drops for patients, seeking intervention when any behavioral changes influenced their administration.Conclusion: Though dementia was associated with progression toward the precipice of care, factors such as communication with healthcare professionals appeared to affect patient adherence. Recommendations for healthcare practice include better recording of dementia diagnoses and integrating eye drops into preexisting routines. Journal Article Patient Preference and Adherence 12 1315 1325 Informa UK Limited 1177-889X memory loss, compliance, eye drops, qualitative research, grounded theory 25 7 2018 2018-07-25 10.2147/ppa.s167080 COLLEGE NANME Public Health COLLEGE CODE PHAC Swansea University Other This research study was funded by the International Glaucoma Association in conjunction with the Royal College of Nursing 2021-09-08T13:01:37.1962892 2021-08-10T12:26:35.8771435 Faculty of Medicine, Health and Life Sciences School of Health and Social Care - Public Health Simon Read 1 Heather Waterman 2 James Morgan 3 Robert Harper 4 Anne Fiona Spencer 5 Penelope Stanford 6 57583__20782__22652dab2d1f4e4b8c373b1e5b12eadc.pdf 57583.pdf 2021-09-08T12:59:16.3535712 Output 405793 application/pdf Version of Record true © 2018 Read et al. This work is released under the Creative Commons Attribution – Non Commercial (unported, v3.0) License true eng http://creativecommons.org/licenses/by-nc/3.0/
title Glaucoma, dementia, and the &ldquo;precipice of care&rdquo;: transitions between states of medication adherence
spellingShingle Glaucoma, dementia, and the &ldquo;precipice of care&rdquo;: transitions between states of medication adherence
Simon Read
title_short Glaucoma, dementia, and the &ldquo;precipice of care&rdquo;: transitions between states of medication adherence
title_full Glaucoma, dementia, and the &ldquo;precipice of care&rdquo;: transitions between states of medication adherence
title_fullStr Glaucoma, dementia, and the &ldquo;precipice of care&rdquo;: transitions between states of medication adherence
title_full_unstemmed Glaucoma, dementia, and the &ldquo;precipice of care&rdquo;: transitions between states of medication adherence
title_sort Glaucoma, dementia, and the &ldquo;precipice of care&rdquo;: transitions between states of medication adherence
author_id_str_mv a5fdd0f9bc9dd4b6716fc42cb1ee8a30
author_id_fullname_str_mv a5fdd0f9bc9dd4b6716fc42cb1ee8a30_***_Simon Read
author Simon Read
author2 Simon Read
Heather Waterman
James Morgan
Robert Harper
Anne Fiona Spencer
Penelope Stanford
format Journal article
container_title Patient Preference and Adherence
container_volume 12
container_start_page 1315
publishDate 2018
institution Swansea University
issn 1177-889X
doi_str_mv 10.2147/ppa.s167080
publisher Informa UK Limited
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str School of Health and Social Care - Public Health{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}School of Health and Social Care - Public Health
document_store_str 1
active_str 0
description Purpose: “She wouldn’t remember. Even when I go through, and she’s decided to go to bed, I’ll say I’ll come and do her drops. If I didn’t say that, they wouldn’t be done.” Dementia is widely considered as a key factor in whether patients take their medication as prescribed. However, few studies have examined the effect of dementia on medication management strategies for glaucoma including how patient and carer needs impact adherence and long-term prognosis. We report findings from a qualitative grounded theory study incorporating the views of patients, carers, and healthcare professionals.Methods: Eighty-three semistructured interviews were conducted with 35 patients, 22 lay carers, and nine healthcare professionals across sites in Wales and Scotland. These explored understanding of eye drop regimens, barriers, and facilitators to drop administration, as well as attitudes toward glaucoma, dementia, and other comorbidities.Results: Using Pound’s synthesis of adherence behavior, we identified categories of active and passive acceptance of medicines, alongside modification or rejection of eye drop regimens. In relation to dementia, participants highlighted transitions between such categories, with a shift from active to passive acceptance commonly reported. This loss of self-medicating capability was referred to as the precipice of care, where entwinement of multiple conditions (eg, heart disease, glaucoma, and dementia) and sociocultural influences (eg, living alone) contributed to accelerated health declines. That said, numerous factors mitigated this, with a key role being the lay carer. Spouses and family members often acted as the monitor of eye drops for patients, seeking intervention when any behavioral changes influenced their administration.Conclusion: Though dementia was associated with progression toward the precipice of care, factors such as communication with healthcare professionals appeared to affect patient adherence. Recommendations for healthcare practice include better recording of dementia diagnoses and integrating eye drops into preexisting routines.
published_date 2018-07-25T04:13:26Z
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