Catching carers views to address gaps

The findings of an Australian study highlight an improved role aged care homes can play in providing guidance on medications to residents with dementia and their caregivers and addressing any gaps after hospital discharge.

The findings also indicate there is room to improve opportunities to share decisions about medications in aged care, says study lead Dr Mouna Sawan – a pharmacist and NHMRC Dementia Centre Research Collaboration research fellow based at the University of Sydney.

“Transitioning out of the hospital is a crucial period for individuals living with dementia, as admission to hospital often leads to adjustments in medications doses and administration schedules, compounded by the complexity of managing multiple medications,” Sawan tells Australian Ageing Agenda.

In recognition of the essential role that carers play in managing medications safely during this journey, Sawan and her colleagues developed the Carer Assessment of Medication Management Guidance for People Living with Dementia at Hospital Discharge tool, known as the CATCH tool, to evaluate aspects of person-centred medication management guidance provided to carers of people with dementia at discharge.

“The CATCH tool focuses on assessing two key factors: shared and supported decision making in medication management and provision of medication management guidance that is easy to understand. This is the first tool internationally to engage carers’ understanding of medication decision making,” says Sawan.

The team conducted a national survey of 185 paid and unpaid carers of older people with dementia to characterise their experiences of medication management guidance provided at hospital discharge.

Less than half of the respondents reported receiving medication management guidance on the day of discharge (43 per cent).

A third of participants said there was room for improvement when asked if the management guidance provided for carers of people with dementia at hospital discharge could be better (33 per cent).

Almost one in five carers reported that hospital staff did not include them in decisions about medications for persons with dementia (18 per cent).

“Routine involvement of carers is a vital aspect of person-centred care and shared decision-making,” says Sawan. “The findings show there is room to improve carer provision of tailored information and opportunities to share decisions about medications.”

She says the tool can provide hospital staff with a practical assessment of the delivery of medication management guidance, for example during a comprehensive geriatric assessment to obtain feedback from the patient and carer to evaluate practices and highlight areas that need improvement.

“Carers can utilise the tool to obtain adequate support in managing medication complexities and decision-making during transitions of care.”

The findings also have implications for people working in aged care.

“For residents transitioning from hospital to aged care homes, the findings show aged care homes could continue providing guidance on medications to the person and their carer and any gaps could be addressed after discharge. Aged care staff members need to ensure that carers are well-informed about the medications the resident is taking and discuss benefits and risks,” Sawan tells AAA.

“There is also room to improve opportunities to share decisions about medications,” she says.

Medication reviews conducted by the prescriber and other healthcare professionals, such as pharmacists, at the time individuals move from hospital to the home are an important opportunity to ensure medications are optimised for the individual’s needs and involve a collaborative approach with the resident and their carer – their supported decision maker – to establish their goals and preferences for medication use, Sawan says.

“The CATCH tool can be integrated into medication reviews as a quality indicator of collaborative medication reviews with the individual and their carer.”

On why shared decision-making is important, Sawan says it is recognised globally as an essential part of person-centred care and optimisation of medications.

It requires a partnership between the individual, their carer or representative and healthcare professionals and entails an exchange of information, active participation in the decision-making process, and reaching an agreed upon course of action.

“Central to this process is a comprehensive discussion of the benefits and risks of treatment, and consideration of the person’s goals of care, values, and needs,” she says.

“By implementing shared decision-making, autonomy for the individual is upheld, ensuring their voices are heard and their goals and values are respected.”  

Sawan encourages aged care homes to play their part.

“Continuity of care for residents transitioning from hospitals to aged care facilities entails ongoing provision of medication information to the individual and their carers,” she says. “It is essential to facilitate meaningful discussions between residents, their carers and healthcare providers regarding medication options and the rationale behind treatment decisions.”

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