• Francesca M Nicosia, Malena J Spar, Marilyn Stebbins, Rebecca L Sudore, Christine S Ritchie, Kirby P Lee, Kevin Rodondi, and Michael A Steinman.
• Division of Geriatrics, University of California, San Francisco, San Francisco, USA. Francesca.Nicosia@ucsf.edu.
• J Gen Intern Med. 2020 Mar 1; 35 (3): 724-731.

BackgroundOlder adults often take multiple medications, leading to a myriad of medication-related problems. Addressing these problems requires thoughtful approaches that align with patients' perspectives and experiences.ObjectiveTo (1) identify and categorize medication-related problems from the patient perspective and (2) understand patient and clinician attitudes toward these problems and experiences with addressing these problems.DesignQualitative, semi-structured interviews with patients and focus groups with physicians and pharmacists.ParticipantsTwenty older adults recruited from an academic medical center and from a community senior center; 14 primary care physicians and 6 pharmacists affiliated with an academic medical center.ApproachHybrid deductive-inductive thematic analysis.Key ResultsOlder adults identified a variety of medication-related problems that could be classified into four broad categories: (1) obtaining medications (e.g., problems with cost and insurance coverage); (2) taking medications (e.g., organization and remembering to take pills); (3) medication effects, including side effects and concerns over lack of effectiveness; and (4) communication and care coordination, including information related to medications. Many of the problems described by older adults were framed within the person's socioemotional context, including the impact of medications on interpersonal relationships, emotional wellbeing, and activities that add meaning and quality to life. In contrast, clinicians almost exclusively focused on discrete medication issues without reference to this larger context and expressed relatively little interest in learning more about their patients' perspectives.ConclusionsOlder adults experience medication-related problems as inseparable from their broader life context. Incorporating the social and emotional context of medications and related communication into a problem-focused framework can guide clinicians in specific actions and interventions to address medication-related problems from the patient perspective.

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