Medication risk checklist for older adults (LOTTA) – development and validation of a self-assessment tool

Figures & data

Figure 1. The development process of the medication risk checklist (LOTTA) for older adults.

*) multicomponent items are denoted as one item.

Table 1. The ten most important medication risk assessment items rated by the panellists (n = 16) during the third Delphi round.

Item/subitem	Number of ratings for each item/sub-item n(%) n(%)
1. Do you have a medication list containing all medicines that you use, with doses? The list should contain all prescription medicines, over-the-counter (OTC) medicines, vitamins, minerals, and natural and herbal products that you are using.		15 (94)
2. In the last four weeks, have you had any of the following symptoms repeatedly interfering with your everyday life?		12 (75)
a) Feeling unusual tiredness or drowsiness in the daytime	14(88)
b) Dizziness	14(88)
c) Falls	13(81)
d) Unusual dryness of the mouth	12(75)
e) Constipation or other gastrointestinal problems	12(75)
f) Confusion	11(69)
g) Urinary problems (urinary incontinence or difficulty with urination)	9(56)
h) Bruising easily or getting nosebleeds easily	9(56)
i) Nausea	8(50)
j) Memory problems	8(50)
3. Do you have problems or is it unclear to a) remember to take your medicines on time, b) take medicines according to the instructions, c) know the purpose of the medicine, d) know how long period you take medicine, e) know the goals of your medication treatment, f) follow/monitor the effects of medication treatment, g) administer the medicines (e.g. to drop the eye-drops, to dose asthma medicines, to inject the injectable medicines or to open medicine packages), h) halve the tablets, i) swallow tablets or capsules?		12(75)
4. Do you sometimes take on purpose more or fewer medicines than the physician has prescribed or leave the medicine not taken at all?		12(75)
5. Do you have more than one physician involved in your care (e.g. general practitioners, specialists, private practitioners)?		11(69)
6. Do you use some of the following medicines without regular follow-up a) painkillers, b) diuretics, e.g. for hypertension or swellings, c) medicines for lowering high cholesterol (statins), d) anticoagulants (e.g. Marevan*, Xarelto*, Eliquis*), e) antidepressants, f) sedatives or medicines for treating anxiety, g) medicines which your physician is not aware of, h) heartburn or upper stomach disorders medicines (e.g. Somac*, Rennie*, Gaviscon*)?		11(69)
7. Have you continuously used prescribed sleeping pills for over three months (do not apply melatonin)?		10(62)
8. Has a physician or pharmacist, in cooperation with a physician, assessed the appropriateness and necessity of all the medicines you took during the last year?		9(56)
9. Are you sometimes forced to go short of your necessary medicines because of economic problems?		9(56)
10. Have you used any of the following products, without that a physician or pharmacist would have assessed their suitability to your other medicines or your illnesses a) over-the-counter medicines (e.g. painkillers, flu medicines, allergy medicines, heartburn, or constipation medicines), b) vitamins, minerals, herbal products/medicines?		8(50)

* Commonly used product names in Finland, which were used to help the identification of medicines.

Table 2. Key findings of the first round of the feasibility study.

Items(s) or themes of the content validated checklist	Feasibility	Modifications in the final checklist
Do you have a medication list containing all medicines and their doses that you use? The list should contain all prescription medicines, over-the-counter (OTC) medicines, vitamins, minerals, and herbal products that you are using (Table 1, item 1).	22 % (n = 18/80) of the respondents did not understand what was meant by a medication list	The item was modified to be more concrete. It was added that the list could be a paper or electronic listing of the medicines in use.
Items related to the use of potentially inappropriate medicines (PIM) or the use of certain medicines (e.g. diuretics, statins, anticoagulants, sleeping pills) without proper follow-up (Table 1; items 6, 7 and 10).	Respondents had difficulties answering whether they used medicines mentioned in the preliminary list. Furthermore, they needed help answering how the follow-up of medication therapy had been carried out.	Items related to the use of certain PIMs or follow-up of certain medicines were excluded. Instead, PIM use was assessed with an item of potential adverse effects of these medicines. Items related to the follow-up of certain medication therapy were modified to a more general form.
Item related to medication review (Table 1, item 8).	Item was too difficult to understand. Of the respondents, 6.5 % (n = 5) did not understand what was meant by medication review.	The item was removed because the respondents did not know how to answer it. They did not know what the medication review meant and whether such had been done. Other items on the checklist indicate whether there is a need for a medication review.
Items were added based on the findings of the feasibility study, recommendations of the research group, and published literature.	Items were tested in the second round, and they were understandable.	The added items: Do you feel that the medicine prescribed by your physician is not suitable for you? Do you have to compromise on necessary medicines because you can’t afford to buy them?

Table 3. The final medication risk checklist (LOTTA) (assessed by the Finnish Centre for easy language (Selkokeskus) [33]).

Please answer the items below. Tick the box next to the option that best describes your situation. If you answer "yes" or "I can’t say" in multiple items, please contact your pharmacy, physician, or nurse. Also, contact them if you have any questions when completing the checklist.
1. Are you missing an up-to-date paper-based or electronic medication list containing all the medicines that you are using at the moment? Such a list should contain all prescription medicines, over-the-counter (OTC) medicines, vitamins, minerals, and natural and herbal products that you are using. Yes □ No□ I can’t say □
2. Do you have more than one physician involved in your care (e.g. general practitioner, specialist, private practitioner)? Yes □ No□ I can’t say □
3. Are you lacking regular follow-up of your medication therapy (e.g. control visits in health care or home-based testing/measurements)? Yes □ No□ I can’t say □
4. In the last four weeks, have you had any of the following symptoms repeatedly interfering with your everyday life?
	Yes	No	I can’t say
• Feeling unusual tiredness or drowsiness in the daytime	□	□	□
• Dizziness	□	□	□
• Falls	□	□	□
• Urinary problems (urinary incontinence or difficulty with urination)	□	□	□
• Nausea	□	□	□
• Constipation or other gastrointestinal problems	□	□	□
• Memory problems	□	□	□
• Confusion	□	□	□
• Bruising easily or getting nosebleeds easily	□	□	□
• Unusual dryness of the mouth	□	□	□
5. Is it unclear to you for how long period you need to be taking your medicines? I.e. Are your medicines intended for regular use, for periodic courses, or are they to be taken ‘as needed’? Yes □ No □ I can’t say □
6. Have you had the following issues when using your medicines? a. You don’t know what exactly your medicines are for Yes □ No□ I can’t say □ b. You have difficulties in taking your medicines as instructed, e.g. You don’t understand the dosing instructions You don’t remember to take the medicines when instructed Taking medicines does not fit in with the schedule of your daily activities Yes □ No□ I can’t say □ c. You have difficulties in administering the medicines, e.g. You don’t know how to dose your eye drops, or it is difficult for you to dose eye drops. You don’t know how to dose your asthma medicines, or it is difficult for you to dose asthma medicines You don’t know how to inject your medicines yourself, or it is difficult for you to inject your medicines You have difficulties opening medicine bottles or packaging You have difficulties in halving tablets Yes □ No□ I can’t say □ d. You have difficulties swallowing tablets or capsules Yes □ No□ I can’t say □
7. Do you feel that any of the medicines prescribed to you is not suitable for you? Yes □ No□ I can’t say □
8. Are you sometimes forced not to get essential medicines for your care because of financial problems? Yes □ No□ I can’t say □

Selkokeskus. 2023. Available at: https://selkokeskus.fi/in-english/

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Data availability statement

Inquiries regarding the data of this study can be directed to the corresponding author (Maarit Dimitrow).