Date Presented 04/200/21
Older adults in the United States are at high risk for polypharmacy, which is related to increased falls, confusion, constipation, weakness, and tiredness. OTs are uniquely prepared to notice function-related impairments due to polypharmacy but do not routinely screen for or address it. This study found that an infographic increased OTs' knowledge of and willingness to intervene regarding polypharmacy and may be cost effective and time efficient in encouraging OTs to attend to polypharmacy side effects.
Primary Author and Speaker: Anna M. Quigg
Contributing Authors: Jennifer Gordon, Allison Bigg, Kathleen Graser, and Victoria Fichter
PURPOSE: The population of older adults continues to grow as life expectancy increases in the United States. Older adults are at higher risk for polypharmacy (prescribing multiple medications to address a single health issue, the cumulative side effects associated with being on multiple medications, prescribing potentially inappropriate medications, and the use of five or more medications at one time for a single patient) compared to younger age groups.1-3 All health care providers should screen for potential side effects and interactions of medications to monitor polypharmacy. Occupational therapists (OTs) are in a unique position to notice functional impairments due to polypharmacy, but do not routinely screen for it.4 The purpose of this study was to examine whether H1.) OTs' Knowledge of polypharmacy side effects increased after viewing an infographic compared to before viewing; H2.) OTs reported higher Willingness to attend to polypharmacy side effects after viewing an infographic than before; and H3.) Knowledge and Willingness were correlated.
DESIGN/METHOD: This was a quantitative, pretest-posttest survey study, using a cross-sectional convenience sample and was approved by the Cox Health IRB. Participants were recruited via social media and had to be 18 years of age or older, an OT or COTA, and have experience working with geriatric clients to be included. Participants completed an anonymous pre-test 12-item survey, viewed an infographic, and completed a post-test survey (identical to the first). Knowledge and Willingness were measured on multiple-choice and Likert-type scales.
RESULTS: Participants who completed the survey (N = 136) and met inclusion criteria (N = 124) were predominantly female (96.8%, n = 120), occupational therapists (79.8%, n = 99), with five or more years' experience (51.6%, n = 64). A Wilcoxon signed-rank test revealed H1.) statistically significant change in median Knowledge score from pre-test (Mdn = 2.00) to post-test (Mdn = 5.00), z = -9.05, p < 0.001. H2.) A statistically significant difference in median score of Willingness from pre-test (Mdn = 9.00) to post-test (Mdn = 9.00), z = -4.91, p < 0.001, was also detected. H3.) Spearman's rank-order correlation analysis failed to detect a statistically significant relationship between the Knowledge and Willingness, Rs = -0.055, p = 0.545.
CONCLUSION: H1.) OTs' Knowledge of polypharmacy side effects would increase after viewing an infographic compared to pre-test Knowledge was supported and statistically significant. H2.) OTs' Willingness to attend to polypharmacy side effects will be higher after viewing an infographic than before viewing the infographic was also supported and statistically significant. Taken together, these results suggest that a brief infographic could be a cost-effective and time-efficient way to increase both Knowledge about polypharmacy and OTs' Willingness to attend to polypharmacy side effects. Lastly, H3.) Knowledge and Willingness would be positively correlated was not supported in this study. Other factors may influence a relation (if there is one) between Knowledge and Willingness such as work culture or situational barriers. These findings correspond with previous research that behavior change around polypharmacy is complex.
IMPACT STATEMENT: This is the first study, to our knowledge, to examine the role of OTs with polypharmacy. Given that this was a self-report study, future research might replicate it and expand understanding of barriers to polypharmacy screening and intervention, Knowledge about polypharmacy and of OT role; and Willingness to intervene. OTs can apply findings to practice by completing brief educational activities to enhance their practice and screening for polypharmacy during client care.
References
1. Dagli, R. J., & Sharma, A. (2014). Polypharmacy: A global risk factor for elderly people. Journal of International Oral Health, 6(6), i-ii. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=mdc&AN=25628499&site=eds-live&scope=site
2. Coleman, B. (2019). Polypharmacy: Is It the new normal for the elderly patient? CEUfast Nursing CE, Retrieved from https://ceufast.com/course/is-polypharmacy-the-new-normal-for-the-elderly-patient.
3. Farrell, B., Shamji, S., Monahan, A., & French Merkley, V. (2013). Reducing polypharmacy in the elderly: cases to help you ‘rock the boat'. Canadian Pharmacists Journal (Ott),146(5): 243–244. https://doi.org/10.1177/1715163513499530
4. Schwartz, J. K., & Smith, R. O. (2017). Integration of medication management into occupational therapy practice. American Journal of Occupational Therapy, 71(4), 1–7. https://doi.org/10.5014/ajot.2017.015032
