Managing medications together: a qualitative study of collaboration between primary and secondary caregivers of older adults

BACKGROUND: Medication management is among the most complex tasks faced by dependent older adults and requires substantial physical and cognitive effort from their family caregivers. Although prior research has described the roles of primary caregivers (PCGs) and secondary caregivers (SCGs) in caring for older adults, limited attention has been paid to how these caregivers collaborate in daily caregiving activities. This study aimed to explore PCGs' experiences of collaborating with SCGs in managing medications for older adults and to understand the contextual factors that shape this collaboration. METHODS: Using a qualitative descriptive design, this study analyzed 28 semi-structured interview transcripts from PCGs. A combination of deductive and inductive content analysis was used to identify medication management activities performed by PCGs and SCGs, as well as the factors shaping their collaboration. The findings were then integrated to categorize and characterize distinct collaboration styles for medication management. RESULTS: Primary caregivers were predominantly adult children or children-in-law, who reported collaborating with SCGs including family members, paid home care aides, or both. Primary caregivers primarily handled medication management activities requiring higher cognitive effort, whereas SCGs often assisted with activities requiring greater physical effort and co-presence with care recipients. Two main categories emerged as shaping collaboration in medication management: (1) conferring decision-making authority and (2) positioning the SCG as an active or passive supporter. Contextual factors influencing collaboration were largely caregiver-related and included kinship ties between PCGs and SCGs, caregivers' knowledge of the care recipient's medications, geographic proximity to the care recipient, marital status, and employment status. Four distinct styles of collaboration between PCGs and SCGs were identified and categorized as Partnering, Operating, Bench-Playing, and Intervening. CONCLUSIONS: This study provides valuable insights into how multiple family caregivers collaborate to manage medications for older adults, highlighting differences in task responsibility allocation and degrees of collaboration. Future research should systematically investigate the social and demographic factors shaping these collaborative strategies to inform the development of tailored interventions that better support caregivers.