Resident and family engagement in medication management in aged care facilities: a systematic review

ABSTRACT

Introduction: Medication-related harms may occur if residents and families are not involved when important medication decisions are made. We examined how residents and families engage in the management of residents’ medications in aged care facilities.

Areas covered: A systematic review was undertaken, which was registered with PROSPERO (CRD42020152700). Electronic databases were searched from inception until 27 August 2020 using MEDLINE/PubMed, CINAHL, PsycINFO and EMBASE. Data synthesis was undertaken using thematic analysis.

Expert opinion: Forty studies were included. Communication tended to be unidirectional comprising consultations where residents and families provided medication information to health care providers or where health care providers provided medication information to residents and families. Many challenges prevailed that prevented effective engagement, including families’ hesitation about making decisions, and the lack of adequately-trained health care providers. Testing of interventions often did not include residents or families in developing these interventions or in examining how they participated in medication decisions following implementation of interventions. Areas for improvement comprise actively involving residents and families in planning interventions for resident-centered care. Health care providers need to have greater appreciation of families’ ability to detect dynamic changes in residents’ behavior, which can be used to enable optimal alterations in medication therapy.

KEYWORDS:

• Aged care
• clinical decision-making
• engagement
• health communication
• medication therapy management
• residential facilities

Article highlights

• Information exchange between residents, families and health care providers was the most common form of engagement about managing medications, but there were obstacles preventing residents and families from obtaining the information they needed or wanted.

• While residents and families perceived they lacked authority to manage medications, they contributed to complex medication decisions related to understanding residents’ changes in disease experiences, and therapeutic and unwanted responses of medications.

• Insufficient attention was placed on how residents and families participated in medication decisions in intervention studies, where the main focus was on reducing medication prescribing rather than on understanding residents’ goals of care and preferences.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was funded by Deakin University, Institute for Health Transformation.