Review of instruments used in clinical practice to assess patients' ability to manage medications

Background: Managing medications can be challenging, especially in the presence of cognitive and physical impairments that are common in older age.Aim: To identify instruments used in clinical practice to assess patients' ability to manage medications; to determine whether they have been tested for reliability and validity; and to compare unvalidated and validated instruments.Method: A sample of health professionals involved in geriatric practice or research in Australia, the UK and USA were asked to provide copies of medication management assessment instruments that they had developed or used. A literature search was conducted to identify published instruments. The instruments were then categorised into 2 groups based on whether or not they had been tested for reliability and validity. The medication management skills assessed by each instrument were also categorised.Results: Of the 69 (33 published, 36 unpublished) instruments located, 44 (26 unvalidated, 18 validated) instruments met the inclusion criteria and were reviewed. None of the instruments used in clinical practice had been validated. Skills assessed, and methods for assessment, were highly variable. Skills most commonly assessed were: ability to open at least one type of medication packaging (96%), ability to read a standard medication label without interpreting meaning (75%), ability to remove medication from at least one type of packaging (73%), and ability to either comprehend and explain medication instructions or demonstrate setting out a medication regimen (52%). Most validated instruments used a standardised, simulated medication regimen, whereas unvalidated instruments mostly used patients' own medications with inadequate detail or instructions to enable standardised administration.Conclusion: Numerous instruments have been developed to assess patients' ability to manage medications. Instruments used in clinical practice have not been validated and are generally not standardised, leading to potential for poor reliability.