PICOT Statement
In Elderly populations of over 50 years of age, do patient-centered interventions compared with standard treatments improve the adherence to medication therapy?
Quantitative Research Critique
The quantitative research critiqued in this essay is Medication Use among Older Adults in a Home Care Setting completed by Mager and Madigan (2010). The study was conducted to investigate the extent of non- compliance in sticking to the dosage among the aged. The participation of the elderly patients in the study could have different effects on them. One benefit they would gain from taking part in the research is that their problem of medical non-compliance was to be solved. One risk would be the fact that the participants are likely to develop low self-esteem due to the feeling of being singled out with a particular problem. Informed consent was obtained from the participants before conduction of the research. The approval acted as the bridge linking the investigation to the problem identified. Furthermore, the informed consent from the respondents served as a platform for them to freely participate in the research (Burns, & Grove, 2011). They did not have to be coerced or forced to be part of the study.
Delegate your assignment to our experts and they will do the rest.
In the study, the independent variable is the age of the participants while the dependent variable is their ability to comply with the dosages of the medicine prescribed at the hospital. Data was collected through a survey conducted on 30 elderly participants aged over 65. The investigation involved questions that targeted the adherence to medical dosages among the patients (Mager & Madigan, 2010). The survey method of data collection was an appropriate method of collecting quantitative data as it considered the age of the participants. The study was conducted over a short period owing to the small number of participants. Questions that formed the survey were administered to the respondents. They were prompted to respond to them. Analysis of numerical data collected from the research indicated that almost half of the patients were affected by medical non-compliance. To get rid of bias in the study, researchers analyzed data differently, and then an overall comparison was conducted (Mager & Madigan, 2010).
It was found out that the failure involved is the lack of adherence to medication among the elderly patients. Furthermore, almost half of the respondents to the survey were faced with non-compliance with medical dosages. The number suggests that a considerable proportion of patients advanced in age are affected by non-compliance with therapeutic dosages. The non-compliance could be brought about by the forgetfulness brought about by age, and the lack of adequate home care for the elderly.
The findings are valid as related studies indicate that most of the older adults are affected by lack of adherence to dosages ( for example, Wick, 2011). The study had several limitations. The first barrier is the extremity in the age for the participants eligible for the research. Non- compliance is also standard among the patients below 65 years of age and there could be more reasons surrounding the lack of adherence. The second limitation is that the non-adherence to dosage was explained using medical-inclined factors, but there were more factors including the lifestyles of the aging patients. Logic coherence in the presentation of findings was evident in the paper. The research was outlined in an organized way to enable the identification of the causes and effects. For instance, one of the reasons for medical non-compliance among the aged patients is the forgetfulness in taking dosages. One result is the potential deterioration in the health of the patients (De Leeuw, Fagard, & Kroon, 2017).
The findings of the research could be applied to nursing. The results could be used to the care of the elderly patients especially at home. The application is based on the increased understanding that the nurses will have at the end of the study regarding the extent and effects of medical non-adherence of the patients. In the subsequent study, the researchers would target a broader participant age range. The more vast difference will provide a variety of the possible reasons and effects of non-compliance in medication. In addition, the causes of non-adherence could consider the other aspects of a life of the elderly beyond their health and mental wellbeing.
The study does not mention about its approval by an Institutional Review Board. In such cases, the moral concerns come up, as the study will lack of approval by the board to research the elderly. The non-approval goes against the set ethical requirements for studies to be conducted. The study protected the participants' privacy. For instance, the names of the participants were not included in the description of data collection. Their locations were also not mentioned (Burns, & Grove, 2011). The age was displayed but did not negatively affect patients' privacy. Ethical considerations regarding the treatment or lack of treatment of the patients were present. Due to the omission of the doses reported in some of the patients, it was necessary to consider treatment to ensure they were safe. The treatment or lack of it was based on the patients' consent to medication and the need to stick to a given dosage.
Qualitative Research Critique
The article The use of adherence aids by adults with diabetes: A cross-sectional survey examines the way the adherence aids in ensuring that there is enhanced compliance of medication among the elderly people who are living with diabetes (Littenberg, MacLean & Hurowitz, 2006). The authors of this study use the cross-sectional analysis in finding out if the use of the various adherence aids would help the patients in taking their medication. According to the background study of this research, the adherence with the taking of medication is one of the primary barriers in the physiologic control of the diabetes diseases and the strategies that are developed to ensure that the there is an improved adherence. Lack of adherence to medication is seen as a significant problem to nursing.
The researchers adopt a cross-sectional survey approach on older adults who have diabetes. The elderly participants were selected randomly from the primary care practices in the Vermont Diabetes Information System. The study makes use of linear regression to conduct an examination of the different aids and the physiologic controls among the participants of the study who used the oral agents. The oral agents that were used in this analysis were hyperglycemia agent, hypercholesterolemia agent, and the hypertension agent. There were 289 participants of in the study and the mean age of the participants was 65.4 years, and 51 percent of the participants were female. The results obtained from all the participants were based on the medications given for all three types of conditions.
The results found out that 80 percent reported the adherence aids. Taking the medication with events that take place daily such as watching news on TV, eating a meal, or going to bed was reported by 11 percent. After an adjustment for the sex, age, marital status, the income and the education levels, the participants who used a particular place had better glycemic control (A1C 0.36%; P=.04). The systolic pressure of the blood was also better (-5.9 mm Hg; P=.05), this is when the results are compared to those participants who did not use any aids. The results also found out that the participants who used the daily events as their adherence aids were having a better A1C (-0.56 percent; P=.01), this was when it was compared to those participants who did not use any aids.
Several ethical factors were considered. The first issue considered in this research was the informed consent of the participants. The participants were informed about the study that was being done and the way that they will be involved (Russell, Conn & Jantarakupt, 2006). The researchers also needed to ensure that the anonymity of the people taking part in the study is protected.
Proposed Evidence-Based Practice Change
The PICOT question relates to the research articles reviewed in this essay as well as the nursing problem concerning caring for the elderly patients in home-based settings. For instance, the studies indicate that the elderly patients have issues with adhering to their medications, which could result in adverse outcomes on their statuses of health. Several reasons are given in literature to indicate why the elderly patients have issues in adhering to their medication. For example, one of the reasons for medical non-compliance among the aged patients is the forgetfulness in taking dosages (De Leeuw, Fagard, & Kroon, 2017). Therefore, the fundamental role played by the nurse is to devise approaches that would improve the adherence to medications among the elderly patients such as taking the medication with events that take place daily such as watching the news on TV, eating a meal, or going to bed was reported.
References
Burns, N., & Grove, S. (2011). Understanding nursing research (5th Ed.). St. Louis, MO: Elsevier.
De Leeuw, P. W., Fagard, R., & Kroon, A. A. (2017). The effects of missed doses of amlodipine and losartan on blood pressure in older hypertensive patients. Hypertension Research , 40 (6), 568-572.
Littenberg, B., MacLean, C. D., & Hurowitz, L. (2006). The use of adherence aids by adults with diabetes: A cross-sectional survey. BMC Family Practice , 7 (1).
Mager, D. D., & Madigan, E. A. (2010). Medication Use Among Older Adults in a Home Care Setting. Home Healthcare Nurse: The Journal for the Home Care and Hospice Professional , 28 (1), 14-21.
Russell, C. L., Conn, V. S., & Jantarakupt, P. (2006). Older Adult Medication Compliance: Integrated Review of Randomized Controlled Trials. American Journal of Health Behavior , 30 (6), 636-650.
Wick, J. Y. (2011, January 12). Adherence Issues in Elderly Patients. Pharmacy Times . Retrieved from http://www.pharmacytimes.com/publications/issue/2011/january2011/rxfocus-0111
