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Glaucoma, dementia and the 'precipice of care': transitions between states of medication adherence

Read, Simon, Waterman, Heather ORCID:, Morgan, James ORCID:, Harper, Robert, Spencer, Anne Fiona and Stanford, Penelope 2018. Glaucoma, dementia and the 'precipice of care': transitions between states of medication adherence. Patient Preference and Adherence 12 , pp. 1315-1325. 10.2147/PPA.S167080

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Purpose: “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 glaucoma including how patient and carer needs impact adherence and long term prognosis. We report findings from a qualitative grounded theory study incorporating the views of patients, carers and healthcare professionals. Patients and methods: 83 semi-structured interviews were conducted with 35 patients, 22 lay carers and nine healthcare professionals across sites in Wales and Scotland. These explored understanding of eye drop regimens, barriers and facilitators to drop administration, as well as attitudes towards glaucoma, dementia and other comorbidities. Results: Using Pandora Pound’s synthesis of adherence behaviour, we identified categories of active and passive acceptance of medicines, alongside modification or rejection of eye drop regimens. In relation to dementia, participants highlighted transitions between such categories, with a shift from active to passive acceptance commonly reported. This loss of self-medicating capability was referred to as the precipice of care, where entwinement of multiple conditions (eg heart disease, glaucoma and dementia) and socio-cultural influences (eg living alone) contributed to accelerated health declines. That said, numerous factors mitigated this, with a key role being the lay carer. Spouses and family members often acted as the monitor of eye drops for patients, seeking intervention when any behavioural changes influenced their administration. Conclusion: Though dementia was associated with progression towards the precipice of care, factors such as communication with healthcare professionals appeared to affect patient adherence. Recommendations for healthcare practice include better recording of dementia diagnoses and integrating eye drops into pre-existing routines.

Item Type: Article
Date Type: Published Online
Status: Published
Schools: Healthcare Sciences
Optometry and Vision Sciences
Publisher: Dove Medical Press
ISSN: 1177-889X
Date of First Compliant Deposit: 17 July 2018
Date of Acceptance: 14 April 2018
Last Modified: 05 May 2023 02:14

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