AbstractsMedical & Health Science

The general aim of this thesis was to investigate how delegation of medication is handled in municipal home care. Specific aims were to 1) explore the prevalence of medication use in older adults over time; 2) describe district nurses’ experiences of the delegation of medication management to municipal home care personnel; 3) explore and describe how home care assistants experience receiving the actual delegation of the responsibility of medication administration; and 4) to describe how older adults, living at home, perceive receiving assistance from home care assistants to manage their own medication. Study I: Changes were explored in medication use over a period of 20 years among three cohorts of older adults aged 78+ years and living in Stockholm, Sweden (1517 participated in 1987; 1581 in 2001; and 1206 in 2007). All were included, whether living at home or in an institution. Univariate analysis was carried out, as well as multivariate logistic regression models. The mean number of drugs increased for both genders in all age groups: from 2.8 in 1987 to 5.8 in 2007 for those aged 78+ years, the corresponding figures for 96+ years was 3.6 and 7.7. Overall (1987, 2001 and 2007), drugs for the cardiovascular system were most frequent (53.1%, 60.8% and 68.7% respectively). Prevalence of polypharmacy (concurrent use of five drugs or more) increased from 27.0% (1987) to 53.9% (2001), and 65.3% (2007). Adjusting for age, gender, education and cognition, the odds of using analgesics and psychotropics were significantly higher in 2007 compared to 1987; OR (95% CI) of 3.3 (2.8-4.0) and 1.3 (1.1-1.6) respectively. Cognitively intact elderly primarily used hypnotics, whereas cognitively impaired elderly used hypnotics, sedatives and antidepressants. People living at home used fewer drugs. For those living in institutions, polypharmacy increased from 24.4% in 1987 to 95.3% in 2007. Corresponding figures for those living in service buildings were 44.6% to 82.4%. Study II: District nurses’ (DNs) perceptions of the concept of delegating the administration of medication to unlicensed personnel (home care aides, HCAs) working in municipal social care were described. Twenty DNs were interviewed and the interviews were audio taped. Data were collected from April 2009 to August 2010 and analysed using content analysis. Findings revealed that the statutes of delegation were outdated and appeared to be incompatible with day to day practice. Communication between DNs and HCAs, as well as tutoring, was regarded as important. The DNs found it imperative to be available to the HCAs and made an effort to create a trusting atmosphere. Delegation of administration of medication to a person, who lacked knowledge of medication, for example when it is proper to mix pills or blend them in a thick liquid, was reported by the DN as being stressful. This was explained by various responsible authorities and the growing number of social service groups. Despite this, the DNs did not see any major problems with the fact that the HCAs work for a…