Table 2 Tool properties
From: Tools to measure barriers to medication management capacity in older adults: a scoping review
Tools | Purpose | Number of Items | Scoring scale | Administration time | Type of instrument | Type of Medication regimen used | Medication management skill assessed | Psychometric properties -Study | Validity | Reliability | |||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Content | Construct | Inter-rater | Test-retest | Internal consistency | |||||||||
Physical + Cognition + Sensory + Motivation | |||||||||||||
ManageMed Screening (MMS) [59] | To quickly determine if someone can handle a moderately difficult medication routine | 33 item | 0-39 | 15-20 minutes | Performance-based | Simulated medication regimen | Read Rx label, recall information, open/close vials, perform calculations, organize pillbox | [59] | + | Neurocognitive function (Cognistat) (Pearson Correlation Coefficient of .696) | (0.86- 0.96) | 0.89 | |
Self-Medication Risk Assessment Tool (RAT) [34] | To assess elderly patients' needs for additional support in managing their medicines | 13 item | 0-26 | 5-20 minutes | Performance-based | Simulated and patient’s medication regimens | Read Rx labels, open different medication packaging, manipulate with 5 ml spoon and eye or ear drop bottles | [67] | + | Patient’s comprehension and dexterity of handling the medications | (≥0.79) | ||
Cognitive Screen for Medication Self-Management (CSMS) [30] | To assess the sensory and cognitive constructs associated with medication adherence | 8 item | 15 | NR | Performance-based | Simulated medication regimen | Bottle opening, label reading, clock reading, dose calculations, arrangement time, study time, immediate recall, delayed, recall, cued recall, prospective memory and dose planning | [30] | + | Cognitive status and age | -0.08-0.84 | ||
Physical + Cognition + Sensory + Environmental | |||||||||||||
To assess geriatric mental health patients’ ability to independently manage medications | 4 item | 0-25 | 45-60 minutes | Performance-based | Simulated medication regimen | Recall information, describe full regimen, open/close, remove the dose from vials, differentiate tablet by color | [68] | + | Cognitive function (neuropsychological l battery test) Adherence | 0.96 | |||
To screen for medication self-management deficits in older adults and to facilitate targeted interventions | 44 item | Multiple scale | 45-60 minutes | Performance-based | Patient's own medication regimen Simulated medication regimen | Read Rx labels, recall information, interpret medication instructions, open vials, remove tablets form packaging, differentiate tablets by color, organize pillbox | [69] | + | Cognitive function (MMSE, CDT, CCT), Medication regimen complexity, Self-reported adherence | +(≥0.79) | +(≥0.83) | +(≥0.81) | |
Physical + Cognition + Motivation + Environmental | |||||||||||||
HOME-Rx revised [20] | To assess ability to manage medication routines in context, identify risk factors for medication management problems, and identify the environmental barriers influencing medication management ability | 4 subscales | Multiple scale | 25 to 35 minutes | Performance-based | Patient's own medication regimen | Knowledge of medications, Recall information, maniple of medication bottles and/or syringe, and calculate medication doses, storing and retrieving pills; reading labels; verbalizing the dosage instructions, special instructions, and purpose; following dosing directions correctly and recognizing when one has missed doses; opening containers; setting up medications; taking out medications; and physically administering medications. | [20] | + | PASS (positively correlated with the HOME–Rx Performance subscale (r = .57, p < .001) and Safety subscale (r = .49, p < .001)) MedMaIDE (negatively correlated with the HOME–Rx Performance subscale (r = −.69, p < .001) and positively correlated with the HOME–Rx Barriers subscale (r = .70, p < .001)) , I–HOPE Assist | .87 to 1.00 | ||
Medication Management Instrument for Deficiencies in the Elderly (MedMaIDE) [20, 35] | To identify the deficiencies in older adults’ ability to take their medication at home. | 20 item | 0-13 | 30 minutes | Performance-based | Patient's own medication regimen | Medication knowledge (name all drugs and describe full regimen including indication, rout of administration, dose and time), Medication taking ability (filling a glass of water, sip enough water, open bottles/vials, remove dose from package, and demonstrate admiration method for oral and non-oral dosage form),Knowledge about ongoing supplies (identify existing refills, name of pharmacy or physician office, and available resources) | [70] | + | Cognitive function (MMSE) Functional status (ADL) Med. adherence (pill count) | 0.74 | 0.93 | 0.71 |
Physical + Cognition+ Motivation | |||||||||||||
Show Back [66] | To assess older adult medication self-management proficiency | 5 item | 0-100 | 22 minutes | Performance-based | Simulated medication regimen | Identify medications, explaining the indication, organizing pillbox, describing the administration process for injectables and inhaled medications, describing the timing of doses | [66] | + | Medication Discrepancy Tool (MDT) | 0.83-1 | ||
MedTake test [53] | To quantify seniors’ ability to take oral drugs safely, standardize the brown bag review | 4 item | 0-100 | 30-45 minutes | Performance-based | Patient's own medication regimen | Identify meds & recall med names, open bottles/vials & remove dose from package, state indication, food/water congestion, and timing | [53] | + | Cognitive function (MMSE) Educational level | |||
HOME-Rx [48] | To assess an older adult’s ability to manage medication routines in the home and to identify at-risk behaviors by home health occupational therapists | 16 item | 1-16 | 30-45 minutes | Performance-based | Patient's own medication regimen | Knowledge of medications, recall information, maniple of medication bottles and/or syringe, and calculate medication doses | [48] | + | Cognitive function (MoCA) MMC (MangeMed) | .87 to 1.00 | ||
To test older adults’ ability to understand and implement a routine prescription medication | 2 item | 0-11 | 15-30 minutes | Performance-based | Simulated medication regimen | Read Rx labels, comprehend medication regimen, plan a schedule for meds regimen, open & close vails, remove dose from vials, organize pillbox. | [71] | + | Cognitive function (MMSE) Functional status (IADL) | 0.38 | |||
Cognition + Sensory + Motivation | |||||||||||||
Performance Assessment of Self-care Skills (PASS-IADL) [48] | To measure occupational performance of daily life tasks | 26 (four domains) | NR | 1.5-3 hour | Performance-based | NA | NA | [72] | + | 0.29-0.43 | 0.82-0.97 | 0.94-0.96 | |
Physical + Cognition | |||||||||||||
Drug Regimen Unassisted Grading Scale (DRUGS) [15, 29, 49, 59] | To assess Medication self-management ability | 4 item | 0-100 | 5-15 minutes | Performance-based | Patient's own medication regimen | Identification: showing the appropriate medications, access: opening the appropriate containers, dosage: dispensing the correct number per dose, and timing: demonstrating the appropriate timing of doses | [73] | + | Cognitive function (MMSE) Functional status (ADL & IADL) Self‐reported MMC Health literacy | 0.83 | 0.81 | |
Cognition + Motivational | |||||||||||||
Short Test of Functional Health Literacy in Adults (S-TOFHLA) [41] | To measure patients’ ability to read and understand the things they commonly encounter in the health care setting using actual materials like pill bottles and appointment slips | 4 Numeracy items and 2 prose passages | 0-100 | 12 minutes | Performance-based | Patient's own medication regimen | [74] | + | REALM | 0.68-0.97 | |||
Test of Functional Health Literacy in Adults (TOFHLA-R) [45, 46, 65] | To measure the functional health literacy of patients. | 50-item reading comprehension and 17-item numerical ability test | 0-50 | 22 minutes | Performance-based | Patient's own medication regimen | Reading comprehension and numeracy | [75] | + | REALM WRAT-R | 0.92 | 0.98 | |
To measure health literacy skills | 45 item | 0-100 | 60 minutes | Performance-based | Simulated medication regimen | organizing and dosing medication | [76] | + | TOFHLA and the NVS, REALM and the MMSE | > 0.80 | |||
Functional, communicative and critical health literacy scales (FCCHL) [62] | Three newly developed scales for measuring functional, communicative, and critical HL among patients with type 2 diabetes in order to propose a measure of HL | 14 item | 4-point Likert scale ranging from ‘‘never’’ (1) to ‘‘often’’ (4) | NR | Self-reported | Patient's own medication regimen | NR | [77] | + | 0.67-0.72 | 0.87 | ||
Motivation + Environmental | |||||||||||||
Long-Term Medication Behavior Self-Efficacy Scale (LTMBSES) [14] | To measures self-efficacy in relation to medication compliance | 22 item | Multiple scales | NR | Self reported | NA | NA | [78] | + | Various levels of adherence | 0.88 | ||
Self-efficacy for Appropriate Medication Use Scale (SEAMS) [15, 38, 42, 44, 54] | To assess self-efficacy for appropriate medication use | 21 item | 21-63 | 5-10 minutes | Self-reported | Patient's own medication regimen | NR | + | REALM Various disease Various literacy levels | 0.62 | 0.90 | ||
Cognition | |||||||||||||
Mini-Mental State Examination (MMSE) [31, 36, 39, 47, 49, 51, 53, 64] | To check for cognitive impairment (problems with thinking, communication, understanding and memory) | 11 item | 0-30 | 10 minutes | Performance-based | NA | Cognitive ability to manage medications | [79] | + | Mattis Dementia Rating Scale Wechsler Adult Intelligence Test, Functional Independence Measure, Montgomery Asberg Depression Rating Scale . Zung Depression Scale. | 0.69 | 0.96 | 0.96 |
Wisconsin Card Sorting Test (WCST) [31] | To assess abstract reasoning ability and the ability to shift cognitive strategies in response to changing environ-mental contingencies and also considered a measure of the executive functions. | 14 item | 12–20 minutes | Performance-based | NA | Cognitive ability to manage medications | [80] | + | 0.93 | ||||
Digit Span Backward (DSB) [31] | To assess working memory | 8 item | 0-16 | Less than 5 minutes | Performance-based | NA | Cognitive ability to manage medications | [81] | + | Wechsler Adult Intelligence Scale | 0.76-0.95 | ||
California Verbal Learning Test (CVLT) [31] | To assesses encoding, recall and recognition | 16 item | 30 minutes | Performance-based | NA | NA | [82] | + | 0.80–0.84 | ||||
To evaluate cognition in older adults | 4 item | 0-5 | 3 minutes | Performance-based | Pillbox | Read Rx labels, interpret medication instructions, organize pillbox | [83] | + | Abbreviated mental test score (AMTS), the Geriatric Depression Scale | 0.76 | 0.86 | 0.83 | |
To assess patients’ ability to fill their own prescribed medications into a pillbox | 3 item | 0-10 | 7-8 minutes | Performance-based | Pillbox | Read Rx labels, interpret medication instructions, organize pillbox | [84] | + | Cognitive function Correctly filled pills | ||||
To assess patients’ ability to fill their own prescribed medications into a pillbox | 4 item | 5 | 5 minutes | Performance-based | Pillbox | Read Rx labels, interpret medication instructions, organize pillbox | [84] | + | Cognitive function Correctly filled pills | ||||
It assesses different cognitive domains: attention and concentration, executive functions, memory, language, visuoconstructional skills, conceptual thinking, calculations, and orientation | 30 item | 0-30 | 10 minutes | Performance-based | NA | NA | [85] | Age, educational levels, economic status, and sex, MMSE | 0.92 | 0.82 | |||
Short Blessed Test (SBT) [37] | This test addresses cognitive concerns in the areas of orientation, memory, and concentration. | 6 item | 0 – 28 | 5-10 minutes | Performance-based | NA | NA | [86] | MMSE | 0.52-0.58 | |||
To assess executive function | 25 item | Part A- 1-39 sec Part B-1-91 sec | 5-10 minutes | Performance-based | NA | NA | [87] | Category Test (CAT), Wisconsin Card Sort Test (WCST), Paced Auditory Serial Addition Task (PASAT), Visual Search and Attention Test (VSAT). | Part A-0.78 Part B- 0.67 | ||||
Measure of Drug Self Management (MeDS) [52] | An assessment of medication self-management skills | NR | 0-12 | NR | Self-reported | Patient's own medication regimen | NR | [52] | + | Morisky Medication Adherence Scale and relevant clinical measures (HbA1c, blood pressure, and low-density lipoprotein cholesterol) | 0.72 | ||
Fuld Object-Memory Evaluation (FOME) [63] | To assess memory | 10 item | 0-10 | 15 minutes | Performance-based | NA | NA | [88] | + | 0.71 | 0.84 | ||
Sensory | |||||||||||||
National Eye Institute Visual Function Questionnaire -25 | To measures the dimensions of self-reported vision-targeted health status that are most important for persons who have chronic eye diseases. | 25+1 item | 0-100(Multiple scale) | 10 minutes | Self-reported | NA | NA | [89] | + | Various eye disease 51-item NEI VFQ | 0.71-0.85 | ||
Daily Living Tasks associated with Vision (DLTV) [16] | To assess functional impairment among patients with age-related macular degeneration (AMD) | 24 item | 0-100 | 6-10 minutes | Self-reported | NA | NA | [90] | + | 0.97 | |||
Pelli-Robson letter sensitivity chart (PR test) [58] | To measures a patient's contrast sensitivity (CS) by finding the lowest contrast letters he/she can read correctly | NR | NR | NR | Self-reported | NA | NA | [91] | |||||
Randot Circles [58] | To test the patient depth perception along with normal stereo vision. | NR | NR | NR | Self-reported | NA | NA | ||||||
Early Treatment Diabetic Retinopathy Study eye chart (ETDRS) [58] | To measure visual acuity | 5 letters of equal difficulty on each row, with standardized logarithmic spacing between letters and rows: a total of 14 lines (70 letters) | NR | NR | Performance-based | NA | NA | [91] | Accuracy-0.12±0.14 | Test -retest variability-0.23±0.17 | |||
Whisper test [53] | To assess hearing | 6 steps | Threshold for hearing impairment <50% correct | 5 minutes | Self-reported | NA | NA | [92] | Sensitivity (%; 95% CI) 100 (96-100) ,) Specificity (%; 95% CI) 87 (80-92 | ||||
Motivation | |||||||||||||
To identify patients at risk for low health literacy. | 6 item | 0-6 | 3 minutes | Performance-based | Patient's own medication regimen | Read Rx labels, interpret medication instructions | [93] | + | TOFHLA | 0.76 | |||
Rapid Estimate of Adult Literacy in Medicine (REALM) [32, 35, 38, 45, 46, 55, 60] | To assess an adult patient's ability to read common medical words and lay terms for body parts and illnesses | 7 item | 0-66 | 2-3 minutes | Performance-based | NA | NA | [94] | + | Peabody Individual Achievement Test-Revised (PIAT-R) Wide Range Achievement Test-Revised (WRAT-R), Slosson Oral Reading Test-Revised (SORT-R) | 0.99 | 0.97 | |
Medication Administration Self-Efficacy Scale (MASES) [65] | To identify levels of self-efficacy, self-care, trust, levels of support from the community and organizations, and satisfaction levels related to self-administration of medications | 26 item | 0-3 | NR | Self-reported | Patient's own medication regimen | NA | [65] | + | 0.95 | |||
Martin and Park Environmental Demands Questionnaire (MPED) [14] | To measure two dimensions of environmental demand: (1) busyness and (2) routine | 13-item | Likert scale 1 through 5. | 5-10 minutes | Self-reported | NA | NA | [95] | + | Age Household size Medication-taking errors. (External validity) | 0.88 for the busyness scale and 0.74 for the routine scale | ||
Environmental | |||||||||||||
Medication-Specific Social Support Questionnaire (MSSS) [44] | To identify how often participants received help for their medication taking over a three-month period | 8 items | 0-4 | NR | Self-reported | NA | NA | [96] | + | Various diseases, drugs | 0.92 | ||
Multidimensional Scale of Perceived Social Support (MSPSS) [57] | To assess an individual’s perception of the social support he or she receives from family, friends and significant others | 12 item | 7-point Likert type scale | 5-10 minutes | Self-reported | NA | NA | [97] | + | 0.91 | 0.95 | ||
Perceived Social Support from Friends (PSS-Fr) and the Perceived Social Support from Family (PSS-Fa) [14] | To measure the extent to which an individual perceives that his/her needs are fulfilled by friends and family | 20 item | 0-20 | NR | Self-reported | NA | NA | [98] | + | Various symptoms of distress and psychopathology, mood states | 0.88 for PSS-FR and 0.90 for PSS-FA | ||