INS NYC 2024 Program

Poster	Poster Session 06 Program Schedule 02/15/2024 04:00 pm - 05:15 pm Room: Shubert Complex (Posters 1-60) Poster Session 06: Aging \| MCI \| Neurodegenerative Disease - PART 2 Final Abstract #33 Medication Management Error Types: Associations with Mild Cognitive Impairment Subtype Alyssa De Vito, Brown University, Providence, United States Sheina Emrani, University of Pennsylvania, Philadelphia, United States Emily Hallowell, Miriam Hospital, Providence, United States Allyson Goldstein, Rhode Island Hospital, Providence, United States Jennifer Davis, Rhode Island Hospital, Providence, United States Seth Margolis, Rhode Island Hospital, Providence, United States Category: MCI (Mild Cognitive Impairment) Keyword 1: activities of daily living Keyword 2: mild cognitive impairment Keyword 3: ecological validity Objective: Medication management errors are suspected to be highly prevalent among older adults with mild cognitive impairment (MCI). However, subtype analyses are lacking across the MCI spectrum. The current study examined the types of medication errors made by cognitively normal older adults (CN) with subjective cognitive decline, individuals with single domain amnestic MCI (sdMCI), or multi-domain MCI (mdMCI) using the medication management ability assessment (MMAA). We hypothesized that CN older adults would outperform sdMCI patients who would outperform mdMCI patients. Participants and Methods: This cross-sectional, retrospective, chart review included 266 patients seen for neuropsychological evaluation (94.4% White, 57.9% female, average age = 72, average education = 14 years). MCI was determined psychometrically using previously published cognitive composites. A cognitive domain was considered impaired if its composite was ≤1.5 standard deviations below the demographically-adjusted mean: CN: n=131, 49.3%; sdMCI: n=91, 34.2%; mdMCI: n=44, 16.5%. Patients with dementia were excluded. There were no differences in age, sex, education or polypharmacy across cognitive classifications. The MMAA (version 4.1), an ecologically valid task of medication management capacity, was employed to investigate medication management errors between cognitive groups. The MMAA instructs participants to demonstrate how to take 4 mock medications, which vary in complexity. Group differences in MMAA total scores, medication taking accuracy, and error types (e.g., commissions, omissions) were evaluated using Kruskall-Wallis H tests. This study was also the first to operationalize/analyze a new error type, perseverations, which refers to commission errors caused by doubling back in time to take a specific dose ≥2 times during the task. Results: CN individuals (p < .001) and sdMCI participants (p=.007) had higher MMAA total scores than individuals with mdMCI, indicating better overall performance. CN participants were more accurate than those with mdMCI in the correct number of pills taken (p=.004). Regarding MMAA error types, the mdMCI group made a higher number of omission errors (i.e., missed pills) than other groups (p<.001), but no group differences were found for commissions (i.e., extra pills). sdMCI participants made more perseverative errors compared to the CN group (p=.020). Accuracy and error type analyses were subsequently analyzed by each of the four MMAA-medications to evaluate whether there were group differences due to regimen complexity. sdMCI participants were less accurate (p=.004) and made more perseverative errors (p=.027) on medication high in regimen complexity compared to CN participants; however, no differences were found for mdMCI. Conclusions: Although the present results should be replicated in a more diverse sample, our findings indicate that individuals with mdMCI make more simulated medication management errors than CN and individuals with sdMCI. Thus, mdMCI individuals appear to be most vulnerable to difficulties in medication management. Comparatively, those with sdMCI do not differ from CN individuals except on medications that involve complex medication-taking instructions. This finding implies that sdMCI patients may benefit from less cumbersome medication regimens in daily life to promote independence in medication self-management. Future studies should assess whether MMAA performance/error types are associated with similar patterns of real-world medication-taking behavior in older adults across the MCI spectrum.

Poster

02/15/2024
04:00 pm - 05:15 pm
Room: Shubert Complex (Posters 1-60)

Poster Session 06: Aging | MCI | Neurodegenerative Disease - PART 2

Final Abstract #33

Medication Management Error Types: Associations with Mild Cognitive Impairment Subtype

Alyssa De Vito, Brown University, Providence, United States
Sheina Emrani, University of Pennsylvania, Philadelphia, United States
Emily Hallowell, Miriam Hospital, Providence, United States
Allyson Goldstein, Rhode Island Hospital, Providence, United States
Jennifer Davis, Rhode Island Hospital, Providence, United States
Seth Margolis, Rhode Island Hospital, Providence, United States

Category: MCI (Mild Cognitive Impairment)

Keyword 1: activities of daily living
Keyword 2: mild cognitive impairment
Keyword 3: ecological validity

Objective:

Medication management errors are suspected to be highly prevalent among older adults with mild cognitive impairment (MCI). However, subtype analyses are lacking across the MCI spectrum. The current study examined the types of medication errors made by cognitively normal older adults (CN) with subjective cognitive decline, individuals with single domain amnestic MCI (sdMCI), or multi-domain MCI (mdMCI) using the medication management ability assessment (MMAA). We hypothesized that CN older adults would outperform sdMCI patients who would outperform mdMCI patients.

Participants and Methods:

This cross-sectional, retrospective, chart review included 266 patients seen for neuropsychological evaluation (94.4% White, 57.9% female, average age = 72, average education = 14 years). MCI was determined psychometrically using previously published cognitive composites. A cognitive domain was considered impaired if its composite was ≤1.5 standard deviations below the demographically-adjusted mean: CN: n=131, 49.3%; sdMCI: n=91, 34.2%; mdMCI: n=44, 16.5%. Patients with dementia were excluded. There were no differences in age, sex, education or polypharmacy across cognitive classifications. The MMAA (version 4.1), an ecologically valid task of medication management capacity, was employed to investigate medication management errors between cognitive groups. The MMAA instructs participants to demonstrate how to take 4 mock medications, which vary in complexity. Group differences in MMAA total scores, medication taking accuracy, and error types (e.g., commissions, omissions) were evaluated using Kruskall-Wallis H tests. This study was also the first to operationalize/analyze a new error type, perseverations, which refers to commission errors caused by doubling back in time to take a specific dose ≥2 times during the task.

Results:

CN individuals (p < .001) and sdMCI participants (p=.007) had higher MMAA total scores than individuals with mdMCI, indicating better overall performance. CN participants were more accurate than those with mdMCI in the correct number of pills taken (p=.004). Regarding MMAA error types, the mdMCI group made a higher number of omission errors (i.e., missed pills) than other groups (p<.001), but no group differences were found for commissions (i.e., extra pills). sdMCI participants made more perseverative errors compared to the CN group (p=.020). Accuracy and error type analyses were subsequently analyzed by each of the four MMAA-medications to evaluate whether there were group differences due to regimen complexity. sdMCI participants were less accurate (p=.004) and made more perseverative errors (p=.027) on medication high in regimen complexity compared to CN participants; however, no differences were found for mdMCI.

Conclusions:

Although the present results should be replicated in a more diverse sample, our findings indicate that individuals with mdMCI make more simulated medication management errors than CN and individuals with sdMCI. Thus, mdMCI individuals appear to be most vulnerable to difficulties in medication management. Comparatively, those with sdMCI do not differ from CN individuals except on medications that involve complex medication-taking instructions. This finding implies that sdMCI patients may benefit from less cumbersome medication regimens in daily life to promote independence in medication self-management. Future studies should assess whether MMAA performance/error types are associated with similar patterns of real-world medication-taking behavior in older adults across the MCI spectrum.