Authors & InstrumentsSample SettingResearch design FindingsStrengths/weaknesses

Albert et al., 1999. MMTn = 118, HIV positive with cognitive impairment. Mean age 43.7, mix gender.Outpatient HIV clinics, New York Cohort

Poor scores on executive function and psychomotor skills associated with poorer pill dispensing performancePoor memory scores associated with poorer understanding about drugThe recall method suggested that subjects with poorer memory and lower MMT scores were more likely to be non-adherent

Medium sample size for its purpose

Carlson, et al., 2005. HMSn = 360 older adult women (70 80 years old)

Community dwelling, Eastern Baltimore, Maryland.Survey Only < 2% reported difficulties with taking medication but 22% had difficulties in dose timing and/or filling the pillbox.Difficulties in IADL were marginally associated with speed-based measures of HMSRegression analysis showed that score: time ratio most strongly associated with schedule test.

Adequate sample size

Windham, Griswold, Fried, Rubin, Xue, and Carlson, 2005. HMS

n = 235 women aged 70-80 years drawn from the same sample of Carlson et al., 2005Community, Baltimore MarylandCross-sectional analysis, prospective cohort studyMMSE score and patients vision has little or no association with completion time and with pillbox ratio score (visual acuity, contrast sensitivity, stereopsis)Preliminary findingsResults are presented in plane graphics, make it hard to be understood.

Edelberg, et al., 2000. DRUGSn= 58 with 47 respondent completed 12 month follow-up assessmentOlder adult ( 70 years)

Community, Boston12-month prospective cohort DRUGS can measure medication management capacityOver one year, MMSE and DRUGS score were decline but timed Up and Go was increaseDRUGS score has significant association with self-reported ADL capacity: Change in DRUGS score between baseline and 6 month in line with increased emergency department visits.Change in DRUGS score between baseline and 12 month in line with assisted livingDRUGS score has no correlation with institutionalisation

Paper explains patient recruitment and follows up very clearly.Relatively small sample size

Fitten, et al., 1995. RACT. N = 55 ( 65 years old) divided into:Standard healthy group ( n = 20)Medical outpatient group (n = 15)Medical inpatient ready for discharge (n = 20)

A department of veteran affairs in CaliforniaSurvey No differences across 3 groups in reading labels or manual dexterityMMSE score for Scenario 1: r =0.7; MMSE score for Scenario 2: r = 0.69Overall score on Scenario 1differed by study groupOutpatients missed out most memory, judgment, and consequences questions; cueing helped scores in all groupsMMSE: sensitivity 73% and specificity 80% in identifying scenario-impaired subjects

Relatively small sample size.

Fulmer & Gurland, 1997. MM Testn = 125 pairs (participants and caregivers), age > 70 years divided into normal group (n=74) and borderzone Alzheimers disease and related dementia (n=51)Participants houses or out-patient clinic, North ManhattanSurvey

Normal group were reported as more independent in self-medicating and had higher MM Test scores compared to dementia group (72% vs 29%) and (61% vs 23%) respectively. Among normal group and dementia group who self medicate, 91% and 42% had good MM Test scores respectivelyAmong those who have poor MM test scores, one person in each group was required to self-medicateThe correlation between MM Test scores and caregivers report of self-medicate was 0.49 (p 0.001) for combined sample

Small sample size. Correlation of caregiver report and MM Test score for the dementia group was not statistically significant.

Gurland, et al., 1994. MM Testn = 259 older adult ( 65 years old). Community, North Manhattan Survey

MM test associated with CARE cognitive screening (r = 0.47) and diagnosed of dementia (r = 0.45)Regression: CARE cognitive scale and education related to MM Test (r =0.44)MM test was directed to diagnose early dementia, not medication management capability itself

Hutchison, Jones, West, & Wei, 2006MMAA and DRUGSn = 52 older adult, mean age 75.8 years

Community , The University of Arkansas for Medical sciencesSurveyMMSE scores have strong association with MMAA and DRUGS scores, both MMAA and DRUS were recommended as Instruments to assess patients capacity in managing their medicationThe study did not find a correlation between the ineffectiveness and ability to manage medication with self-reported drug related problems

Small sample size for the purpose of comparing two instruments.The only paper that compare two instruments

Isaac, Tamblyn, & Mc-Gill-Calgary drug research team, 1993n = 20, older adult ( 65 yo) convenience imple

Community dwelling, California

Cross sectionalPoor cognitive function was associated with low scores on SM task performance (read the prescription label, interpret instruction, open bottle, cut pills, and plan dose and timing of medication)Visual and motor skills were strongly correlated with compliance

Convenience sample, prone to bias and chance

Kurtz, et al., 2007. VRAMMAn = 43 encompasses 2 samples: schizophrenic patients (n = 25) and community dwelling healthy volunteer (n = 18). Community. Yale school of MedicinesPilot study Schizophrenic patients made more quantitative errors than healthy volunteers (4.0 3.7 vs. 0.67 1.6) and have lower score in clock checking (2.7 3.4 vs. 9.26.2) with p = 0.001.72% agreements in classification of adherence with the MMAA score.HVLT scores associated with quantitative errors in VRAMMA and MMAA

Small sample sizeLimited applicability in real setting

Manias, et al., 2006. SAM-toolOlder adult (n=106) median age 73 years old

3 general medical ward of a private, non-profit hospital in middle-class suburb, Australia.

Survey

Content validity: SAM-tool has high score in clarity, representation, and comprehensiveness (95%-100%)The SAM-tool has significant correlations with compliance, MMSE, and FIM.Reliability by two nurses each patients was shown to have internal consistency of 0.89A rigorous method to obtain validity of instrument and reliability of data.Adequate sample size, computer generated random sampling.High profile sample characteristics may result in false positive of the effectiveness of the SAM-tool)

Orwig, et al., 2006. MedMaIDEConvenience sample, n = 50 older adult ( 65 yo) who live independently in community Community: high-rise apartment and local retirement community, Baltimore

Cohort Test re-test 0.93, inter-rater 0.74MedMaIDE more specific and predictive of patients compliance as compare to pill count Mix socioeconomic and educational background of sampleConvenience and relatively small sample

Patterson, et al., 2001. MMAA.N = 137 divided into schizophrenic group (n=104, mean age 56 years, outpatient) and normal older adult comparison group (n=33, mean age 63 years, community dwelling). Three health care services in San DiegoSurveyOne week test-test ICC 0.96. Correlation 0.53 with MMSE, 0.22 with Quality well being scale, and 0.27 for scale for assessing negative symptom.67% agreement with pill record refill.Adequate sample sizeComparison group

Raehl, et al., 2002, MedTaken = 57 older adult, mean age 79.49Three retirement communities (homes) and adult day care centre in TexasCross-sectional80% participants self-medicate, 20% received help.Average composite MedTake score = 88.5% 21.3%.Score for correct dose: 94%; correct indication:95%; correct food & water cpingestion: 97%; correct regiment: 89%Education and MMSE associate with MedTake score with p=0.034 and p = 0.001 respectivelySome assessment were conducted at participants homes, hard to replicate

Romonko & Pereleles, 1992Pharmacy assessmentn = 51age 62-94 yearsGeriatric rehabilitation setting in CalgaryProspective cohort.

Pharmacist was made a better assessments and prediction of patients capacity to self medicate compared to nurses and doctors Patients ability was relied heavily on health care personnel judgement based on check list, possibly result in variable results

Ruscin & Semla, 1996A structured assessment instrument

n = 59, older adult (62-102 years)

Outpatient of a geriatric clinicIllinois, ChicagoCross sectional

Low MMSE scores and Katz scores were associated with the inability to self medicate, odds ratio 7.24 (CI 95%), and poorer outcome (odds ratio 9.39Data validated with caregiver report

Schmidt & Lieto, 2003. MATn = 62, mean age 85.56 years old. Divided into 2 samples: subjects lived in independent living (IL) apartment (n = 28) and subjects living in assisted living (AL) apartment (34)

Continuing retirement community care in New JerseySurvey

Average score of subjects in IL was 88.92 and in AL was 54.71Correlated 0.59 with MMSE, 0.46 with naturalistic action test, 0.46 with IADL (all p