Abstract
Background/Aims Many Medicare beneficiaries have conditions or disabilities that affect their functional status and self-care capabilities. There is limited information on the potential associations between functional limitations, home support, and self-care activities such as managing and taking medications.
Methods We conducted telephone interviews in a stratified random sample of community-dwelling Medicare Advantage beneficiaries in an integrated delivery system, age 65+ years (N = 1,201; response rate = 70.0%). Participants reported their functional status as measured by activities of daily living (ADLs; e.g., bathing) and instrumental activities of daily living (IADLs; e.g., preparing meals), and whether they received any support from family members or caretakers in obtaining, paying for, or taking medications. We also examined drug cost-related changes in medication use: cost-reducing behaviors (e.g., switching to generics), cost-related non-adherence (e.g., not refilling), and financial stress (e.g., cutting back on necessities). We used multivariate logistic regression to assess associations between functional status, support with medications, and drug cost responses, adjusting for patient characteristics.
Results Nearly half of respondents (42%) reported having a functional limitation: 26.7% reported 1–2; and 15.6% reported 3+. Among beneficiaries with functional limitations, 15.8% received help with their medications versus 4.8% among those without limitations (P <0.001). Overall, 17% reported a cost-reducing behavior, 3% non-adherence, and 8% financial stress due to drug costs; these behaviors were more common among beneficiaries with functional limitations. In multivariate analyses, beneficiaries with 3+ functional limitations who did not receive help with their medications had higher rates of cost-related non-adherence (OR = 6.06, 95% CI: 1.71–21.51) and financial stress (OR = 4.06, 95% CI: 1.73–9.51) than those without limitations and without help with their medications. Beneficiaries with 3+ functional limitations who received help with their medications were also more likely to experience financial stress (OR = 2.81, 95% CI: 1.13–6.98). However, there were no significant differences in the odds of general non-adherence compared with beneficiaries who did not receive help.
Conclusions Beneficiaries with functional limitations frequently report receiving informal support with their medication regimens and cost-related drug use behavior changes. Among beneficiaries with multiple limitations, those receiving assistance were less likely to reduce adherence. Support with self-care activities for beneficiaries with limited functional status could improve adherence and outcomes.
