Empowering older adults in medication safety

Background Older adults are at a heightened risk of experiencing adverse drug events due to polypharmacy and the use of potentially inappropriate medications. Enhancing the knowledge and self-advocacy skills of patients and caregivers regarding safe medication practices through educational interventions is a critical strategy currently under investigation.Aims Using the Capability, Opportunity, & Motivation – Behavior (COM-B) model as a theoretical framework, this qualitative study aimed to assess how older adults perceived the ability of educational videos to promote self-advocacy and initiate patient-led medication management and deprescribing.Methods Utilizing a Community Based Participatory Research (CBPR) approach, focus groups were conducted (4 groups, n = 42) with community-dwelling older adults who participated in the development of the videos. The focus groups were held in a community setting and using the educational videos as a trigger, members were asked to evaluate the potential of these videos to promote behavior change around medication self-advocacy and specifically to encourage patient-led conversations addressing medication concerns with providers. The semi-structured questions were open ended and based on patient empowerment models and previous research assessing videos to increase knowledge and promote behavior change. Focus groups were recorded and transcribed verbatim. Data were initially analyzed deductively using the COM-B model of behavior change including capability, opportunity and motivation. It was then further categorized through a socio-ecological framework to accommodate the lived experiences and context of the individual.Results While capability and motivation were identified within the individual and interpersonal levels, members identified complex and multi-level barriers and facilitators to self-advocacy at each level in the socio-ecological framework: 1) Individual level: patient responsibilities, empowerment, and health literacy; 2) Interpersonal/Relationships level: patient and provider communication; 3) Systems: fragmentation, office visit time constraints, poor communication and lack of individualized health care; 4) Social and cultural: ageism, historical racism, and health system distrust. Videos were perceived to help with levels 1 and 2 only.Discussion Using a COM-B model mapped onto a socio-ecological framework, we identified variables to consider when assessing educational interventions for self-advocacy and patient-led deprescribing outcomes. While educational videos can potentially address Individual- and Interpersonal-level factors, overcoming higher-level factors (‘Systems’ and ‘Social and cultural’) will require interventions in the healthcare system and the broader community to overcome the identified challenges to patient empowerment.