title: Help needed in medication self-management for people with visual impairment: case-control study.
abstract: BACKGROUND
  Visual impairment (VI) is rising in prevalence and contributing to increasing morbidity, particularly among older people. Understanding patients' problems is fundamental to achieving optimal health outcomes but little is known about how VI impacts on self-management  of medication.
  
  
  OBJECTIVE
  To compare issues relating to medication self-management between older people with and without VI.
  
  
  METHODS
  Case-control study with participants aged ≥65 years, prescribed at least two long-term oral medications  daily, living within the community.
  
  
  METHODS
  The study recruited 156 patients with VI (best corrected visual acuity [BCVA] 6/18 to 3/60) at low-vision clinics; community optometrists identified 158 controls (BCVA 6/9 or better). Researchers visited participants in their homes,  administered two validated questionnaires to assess medication adherence (Morisky; Medication Adherence Report Scale [MARS]), and asked questions about medication self-management, beliefs, and support.
  
  
  RESULTS
  Approximately half of the participants in both groups reported  perfect adherence on both questionnaires (52.5% Morisky; 43.3%, MARS). Despite using optical aids, few (3%) with VI could read medication information clearly; 24% had difficulty distinguishing different tablets. More people with VI (29%) than controls (13%) (odds ratio [OR] = 2.8; 95% confidence  interval [CI] = 1.6 to 5.0) needed help managing their medication, from friends (19% versus 10%) or pharmacists (10% versus 2.5%; OR = 4.4, 95% CI = 1.4 to 13.5); more received social service support (OR = 7.1; 95% CI = 3.9 to 12.9).
  
  
  CONCLUSIONS
  Compared to their peers without  VI, older people with VI are more than twice as likely to need help in managing medication. In clinical practice in primary care, patients' needs for practical support in taking prescribed treatment must be recognised. Strategies for effective medication self-management should be explored.
authors.affiliation: Department of Ophthalmology, Royal Group of Hospitals Belfast and Centre for Public Health Research, Queen's University, Belfast.
authors.forename: Roseleen M
authors.initials: RM
authors.lastname: McCann
authors.forename: A Jonathan
authors.initials: AJ
authors.lastname: Jackson
authors.forename: Michael
authors.initials: M
authors.lastname: Stevenson
authors.forename: Martin
authors.initials: M
authors.lastname: Dempster
authors.forename: James C
authors.initials: JC
authors.lastname: McElnay
authors.forename: Margaret E
authors.initials: ME
authors.lastname: Cupples
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D016022:Case-Control Studies; D005194:Family Practice / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D055553:Prescription Drugs / Q000627:therapeutic use; D011788:Quality of Life; D012646:Self Administration; D012648:Self Care; D012944:Social Support; D014786:Vision Disorders / Q000150:complications*; D016903:Drug Monitoring
chemical_list: D055553:Prescription Drugs