Preserving Self: Medication-Taking Practices and Preferences of Older Adults With Multiple Chronic Medical Conditions.
To examine the experiences of older adults with multiple chronic medical conditions when a new medication was added to their existing multiple medication regimen.



A multimethod qualitative design was used. Thirty adults 60 years of age with (a) at least three chronic medical diagnoses, (b) at least five medications at baseline, and (c) a new medication prescription were enrolled in a prospective study of 30 days duration, participating from their homes.



In-depth hermeneutic interviews (2 per 15 participants) and self-assessment diaries recorded on electronic tablets (daily per 30 participants) were completed. Transcribed interviews and self-recorded survey data were analyzed using hermeneutical analysis and ecological momentary assessment and content analysis, respectively.



Common reasons participants did not take medications as prescribed included tolerability, transportation, access to medications, and forgetting. The overarching pattern, "preserving self," was supported by two patterns that subsumed several themes: (a) engaging the powerful hold of my illness, and (b) engaging providers in visioning health.



A deeper understanding of the impact of receiving a new prescription and of managing medication reveals the challenges patients experience in preserving a sense of self. Healthcare providers of all disciplines should understand the meaning of medication prescribing and medication taking to ameliorate medication-taking difficulties.



The provider-patient relationship is often cited as an area that needs to be addressed in healthcare practice. Our study emphasized the patients' voices and their profound needs around medication management. The emphasis on preservation of self is an important finding that focalizes the concern.
Donald L. Ross Endowed Chair for Advancing Nursing Practice, University of Missouri-St. Louis, College of Nursing, St. Louis, MO, USA. vandermauserk@umsl.edu.
Roxanne
R
Vandermause
Associate Professor, Washington State University, College of Pharmacy, Spokane, WA, USA.
Joshua J
JJ
Neumiller
Clinical Professor, Washington State University, College of Pharmacy, Spokane, WA, USA.
Brian J
BJ
Gates
Dean, Michigan State University, College of Communication Arts and Sciences, East Lansing, Michigan, USA.
Prabu
P
David
Research Assistant, Washington State University, College of Nursing, Spokane, WA, USA.
Molly
M
Altman
Research Assistant, Washington State University, College of Pharmacy, Spokane, WA, USA.
Daniel J
DJ
Healey
Patient-Stakeholder Investigator, Spokane, WA, USA.
Patricia
P
Benson
Patient-Stakeholder Investigator, Spokane, WA, USA.
Duane
D
Sunwold
Staff Nurse, Providence Medical Center, Providence Health Care, Spokane, WA, USA.
Gail
G
Burton
Executive Director for Research, Providence Medical Research Center, Providence Health Care, Spokane, WA, USA.|Clinical Professor of Medicine, University of Washington School of Medicine, Division of Nephrology, Spokane, WA, USA.
Katherine R
KR
Tuttle
Professor, Washington State University, College of Nursing, Spokane, WA, USA.
Cynthia F
CF
Corbett
D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D000071069:Multiple Chronic Conditions / Q000188:drug therapy* / Q000523:psychology; D057240:Patient Preference; D010817:Physician-Patient Relations; D055553:Prescription Drugs / Q000627:therapeutic use*; D011446:Prospective Studies; D036301:Qualitative Research; D012649:Self Concept
D055553:Prescription Drugs
Hermeneutics; medication safety; medications; patient-centered outcomes