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Simon Read, Heather Waterman, James Morgan, Robert Harper, Fiona Spencer, Penelope Stanford, Premal Shah; Glaucoma, Dementia and the Precipice of Care: Transitions between States of Medication Adherence. Invest. Ophthalmol. Vis. Sci. 2018;59(9):3911.
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“She wouldn’t remember. Even when I go through, and she’s decided to go to bed, I’ll say I’ll come and do her drops. If I didn’t say that, they wouldn’t be done.”Dementia is widely considered a key factor in whether patients take their medication as prescribed. However, few studies have examined the effect of dementia upon medication management strategies for the treatment of glaucoma including how patient and carer needs impact on adherence, and long term prognosis in relation to these conditions. We report findings from a qualitative grounded theory study incorporating the views of patients, carers and healthcare professionals.
83 semi-structured interviews were carried out with 35 patients, 22 lay carers and nine healthcare professionals across two sites in Wales and Scotland. These explored management and understanding of eye drop regimens, barriers and facilitators to drop administration, as well as attitudes towards glaucoma, dementia and other comorbidities.
Using Pandora Pound’s synthesis of adherence behaviour for chronic conditions, we identified categories of active and passive acceptance of medicines, as well as modification or rejection of eye drop regimens. In relation to dementia, participants discussed the importance of transitions between such categories with a shift from active to passive acceptance commonly reported, often triggered by changes in memory function. This loss of ability to actively self-medicate was referred to in our study as the precipice of care, where the entwinement of multiple conditions (e.g. heart disease, glaucoma and dementia) and other socio-cultural influences (e.g. living alone) contributed to accelerated declines in health. That said, numerous factors were identified as mitigating this, with a key role being that of the lay carer. Individuals such as spouses and family members often acted as monitor or administrator of eye drops for patients, seeking intervention when any noticeable changes in behaviour influenced their instillation.
Though dementia was associated with progression towards the precipice of care, factors such as communication with healthcare professionals appeared to affect levels of adherence for patients and guided recommendations for glaucoma care. Recommendations for healthcare practice include better recording of dementia diagnoses and the integration of eye drops into pre-existing routines.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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