Occupational Therapy
Medication Adherence
Environment
Altering the medication environment can be an effective strategy for medication adherence. Persons with a chronic health conditions may have to manage several medications in addition medical equipment. Having pills out on the counter can create a overly medical appearance that may cause people to hide their medications in drawers or cabinets. Unfortunately, when people cannot see their medications, they do not receive a visual cue to take their medications. Moving medications to safe visible areas can help client's remember to take their medications. In Sanders and Van Oss's 2013 study, they found that most older adults store their medication in plain sight (52%), with most people storing their medication in the kitchen or bathroom so that they can associate their medications with meals and self-hygiene. See the table below from the manuscript for more information.
In this intervention strategy, the goal is for interventionist to help identify medication storing locations that enhance adherence. Any client who reports storing their medication in a hidden or cluttered area during the Home Environment Medication Screen or in the Occupational Profile Interview may benefit from this intervention. As usual, you should help the client brainstorm and come up with changes, and only make direct suggestions when necessary. There are no handouts for this intervention strategy, so make sure to take simple easy to read notes on strategies agreed on by you and the client. Because we are talking about changes to the home environment, and you are meeting with the client in the clinic, you must give the client the resources to go home and implement change on their own.
When thinking about environmental adaptations, the interventionist should consider the following five sub-strategies when thinking about the medication environment.
Medication Visibility
Does the client store their medication in a hidden or out of the way location? If hidden, can the mediation be moved to a location where the medication is in plain sight? This will provide visual cues to the client to take his medications.
Routine Based Storage
One of the previous intervention strategies is associating medications with different activities. Routine based storage builds on the concept of activity-based reminders and asks that a client not only associates taking medication with an activity, but also stores their medication near that activity. For example, if a medication is to be taken daily in the morning after oral hygiene, then can the medications be stored near the toothbrush?
Clutter
Sometime clients may leave medications out on a counter or table, but the area is too cluttered to prove a visual cue. Also, If the client uses a Pillbox and must perform weekly medication sorting, does the sorting take place in a cluttered area? Cluttered areas during medication management means it is harder to track all of the pill bottles amongst the mess. The goal of this intervention strategy is to encourage the client to complete medication tasks in areas that are free of clutter. This means that they can move the task to get away from a cluttered space or they can de-clutter an area.
In the intervention, if clutter is an issue, it will be flagged in the Home Environment Medication screen. Note that while the evaluating therapist may consider an area "cluttered," a client may just think that is regular and how his or her house looks. Be careful to select the right words when talking about clutter as to not offend the client.
Lighting
Medication sorting and medication taking are visually demanding tasks. As people get older, changes to the eye occur making it harder to see. As a result, older adults often need more light. Given the high visual demands of the task (reading small print, manipulating small pills, noting pill color), it is very important for all medication areas to be well lit. If the baseline evaluation notes that the are is dark, encourage the client to add more light (move a lamp) or change the location of the task to a brighter location.
Safety & Other Residents
If medications are moved to new locations during the course of this intervention strategy, consider the other residents of the home. Does the client have a significant other? Does the client have young children? This may change your recommendations. For example, a client may hide their medications so that their children do not play with them. Do consider all individuals that live in the home when making recomendations.