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a The Henry L. Schwartz Department of Geriatrics and Adult Development, Mount Sinai School of Medicine, New York
b Division on Aging, Harvard Medical School and Gerontology Division, Beth Israel Deaconess Medical Center, Boston, Massachusetts
Helen K. Edelberg, The Henry L. Schwartz Department of Geriatrics and Adult Development, Box 1070, Mount Sinai School of Medicine, 1 Gustave L. Levy Place, New York, NY 10029-6574 E-mail: helen.edelberg{at}mssm.edu.
William B. Ershler, MD
Background. We tested the hypothesis that impairment in the ability to take medication independently predicts early functional decline.
Methods. A 12-month, prospective cohort study was performed at two continuing-care retirement facilities using the Drug Regimen Unassisted Grading Scale (DRUGS). This geriatric screening tool utilizes a stepwise progression of four tasks: (i) identification, (ii) access, (iii) dosage, and (iv) timing.
Results. Forty-seven (86%) of the eligible participants completed the 12-month follow-up assessment; three were transferred to skilled nursing facilities. The mean age at study entry was 84.2 ± 5.1 years; 72% of the participants were women, and 68% were college educated. At 12 months there was a decline in the Mini-Mental State Examination (MMSE) score ( p = .029), an increase in the timed "Up and Go" test ( p = .023), and a decline in the DRUGS score ( p = .029). Nine (18%) of the participants resided in assisted- versus independent-living situations compared with three participants (5%) at study entry ( p = .031). Both 12-month DRUGS score and 12-month self-reported medication management capacity were associated with 12-month MMSE ( p = .0001 and p = .019, respectively). Baseline DRUGS score was associated with 12-month MMSE and Geriatric Depression Scale scores ( p = .0002 and p = .002, respectively). Both baseline DRUGS score and self-reported medication management capacity were also associated with residence in assisted-living communities at 6 months ( p = .029 and p = .040, respectively). MMSE was not associated with any of the clinical outcomes.
Conclusions. The DRUGS tool may predict functional decline in highly functioning older adults.
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