school of nursing health literacy among informal caregivers of persons with memory loss judith a....
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School of Nursing Background Caregivers of persons with memory loss face increasing challenges over time Medication management is one such issue Of concern is the caregivers’ level of understanding of medication management Assessing health literacy is important Research describing the relationship between health literacy and correct medication management is limitedTRANSCRIPT
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School of Nursing
Health Literacy AmongInformal Caregivers of Persons With Memory Loss Judith A. Erlen, PhD, RN, FAAN; Jennifer H. Lingler, PhD, RN; Lisa K. Tamres, MS; Kidane B. Ghebrehawariat, MS; and Susan M. Sereika, PhD
University of Pittsburgh School of NursingSupported by NIH NINR P01NR010949
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School of Nursing
Acknowledgements• Supported by NIH NINR P01NR010949 • Patients and their caregivers• Research Staff• Students• Community Advisory Board• Community liaisons
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School of Nursing
Background• Caregivers of persons with memory loss face
increasing challenges over time
• Medication management is one such issue
• Of concern is the caregivers’ level of understanding of medication management
• Assessing health literacy is important
• Research describing the relationship between health literacy and correct medication management is limited
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School of Nursing
Purpose
• To examine the relationships among
selected demographic variables, medication
taking deficiencies, and health literacy in a
sample of family caregivers of persons with
memory loss
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School of Nursing
Methods: Overall Study• RCT designed to increase problem
solving related to medication management– Recruited patients with memory loss and
their informal caregivers from multiple community sites
– Eligible dyads were randomized to intervention and control following baseline data collection
– Intervention dyads were randomly assigned to either a nurse or a social worker
– All interventions and data collections occurred in the home or via telephone
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School of Nursing
Methods: Current Study•Descriptive study
– Used baseline data •Analysis: •Descriptive statistics of caregiver and
patient data– Spearman correlation coefficient to
examine relationships
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School of Nursing
Variables of Interest• Sociodemographic characteristics
– Gender, age, race, education, relationship to patient
• Number of co-morbidities• Health literacy
– Newest Vital Sign (NVS)• Medication errors
– Medication Management Instrument for Deficiencies in the Elderly (MedMAIDE)
– Medication Deficiency Checklist
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School of Nursing
Newest Vital Sign (NVS)(Weiss et al (2005), Annals of Family Medicine)
• A brief health literacy screening instrument – uses a nutrition label accompanied by 6 questions – assesses numeracy and comprehension.
• Administration time is about 3 minutes. • NVS psychometrics:
– Cronbach’s alpha= .76– Correlates with the TOFHLA (r= 0.59, p< .001)
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School of Nursing
Medication Management Instrument for Deficiencies in the Elderly (MedMAIDE)(Orwig et al (2006), The Gerontologist)
• Brief assessment of medication taking behavior using observation and interview to examine potential issues of compliance and medication management in the home.
• Consists of 20 items addressing:– Knowledge of medications– Appropriate administration– Knowledge of how to obtain refills.
• Psychometrics: – Cronbach’s alpha= .71– Test-retest: (intraclass correlation coefficient) ICC= 0.93. – Interrater reliability: ICC=0.74
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School of Nursing
Medication Deficiency Checklist• Investigator developed
• Based on the literature, observations, and interview data
• List of possible errors related to medication preparation and administration– Response format: yes or no
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School of Nursing
Sample CharacteristicsCaregivers (n=76)Gender: Race:Males: 22 (28.95%)White: 66 (86.84%)Females: 54 (71.05%) Non-white: 10 (13.16%)
Age: Mean = 67.38 yrs; Range = 42-93 yrsEducation: Mean = 14.97 yrs; Range = 9-30 yrsCo-morbidities: Mean = 6.81; Range = 1-17Relationship to patient:
Spouse:45 (59.21%) Other: 6 (7.91%)Child: 25 (32.89%)
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School of Nursing
Gender: Race:
Males: 31 (40.79%)White: 66 (86.84%)
Females: 45 (59.21%) Non-white: 10 (13.16%)
Age: Mean = 80.07 yrs; Range = 60-97 yrs
Education: Mean = 13.45 yrs; Range = 3-22 yrs
Co-morbidities: Mean = 8.53; Range = 1-20
Sample CharacteristicsPatients (n=76)
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School of Nursing
Summary Statistics: Instruments
• Newest Vital Sign– Mean = 4.08; Range = 0.00 - 6.00; SD =
1.81
• MedMAIDE– Mean = 0.69; Range = 0.00 - 2.00; SD =
0.71
• Medication Deficiency Checklist– Mean = 2.80; Range = 0.00 - 8.00; SD =
1.75
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School of Nursing
Associations•Health Literacy
– Age: -0.38 (p=.00)– Education: 0.38 (p=.00)– Med. Deficiencies: 0.20 (p=.10)
•Co-morbidities– Age: 0.23 (p=.05)– Med. Deficiencies: 0.27 (p=.02)
•All other associations were not statistically significant
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School of Nursing
Conclusions
• Caregivers with higher health literacy were younger and had more education.
• Fewer medication deficiencies were seen among older caregivers
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School of Nursing
Limitations
• Only baseline data
• Small sample size
• Limited diversity within the sample
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School of Nursing
Implications• There is a need to assess health literacy and
understanding of instructions
• Health care providers cannot assume that caregivers with adequate health literacy will be able to correctly follow instructions when managing medications of family members