Authors &

Instruments
Albert et al., 1999.
MMT

Sample

Setting

n = 118, HIV positive with

cognitive impairment.
Mean age 43.7, mix
gender.

Outpatient
HIV clinics,
New York

Carlson, et al., 2005.

HMS

n = 360 older adult women

(70 80 years old)

Community
dwelling,
Eastern
Baltimore,
Maryland.

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

n = 235 women aged 70- Community,

80 years drawn from the
Baltimore
same sample of Carlson et
Maryland
al., 2005

Edelberg, et al.,
2000. DRUGS

n= 58 with 47 respondent
completed 12 month
follow-up assessment
Older adult ( 70 years)

Fitten, et al., 1995.

RACT.

N = 55 ( 65 years old)
A department of Survey
divided into:
veteran
Standard healthy group ( n
affairs in
= 20)
California
Medical outpatient group
(n = 15)

Community,
Boston

Research
design
Cohort

Findings

Strengths/weaknesses

Poor scores on executive function and psychomotor skills associated

with poorer pill dispensing performance
Poor memory scores associated with poorer understanding about drug
The 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

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 HMS
Regression analysis showed that score: time ratio most strongly
associated with schedule test.

Adequate sample size

Cross-sectional
analysis,
prospective
cohort study

MMSE score and patients vision has little or no association with

completion time and with pillbox ratio score (visual acuity, contrast
sensitivity, stereopsis)

12-month
prospective
cohort

DRUGS can measure medication management capacity

Over one year, MMSE and DRUGS score were decline but timed Up
and Go was increase
DRUGS 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 living
DRUGS score has no correlation with institutionalisation

Preliminary findings
Results are presented in
plane graphics, make
it hard to be
understood.
Paper explains patient
recruitment and
follows up very
clearly.
Relatively small sample
size

No differences across 3 groups in reading labels or manual dexterity

MMSE score for Scenario 1: r =0.7; MMSE score for Scenario 2: r =
0.69
Overall score on Scenario 1differed by study group
Outpatients missed out most memory, judgment, and consequences
questions; cueing helped scores in all groups

Relatively small sample

size.

Medical inpatient ready for

discharge (n = 20)

MMSE: sensitivity 73% and specificity 80% in identifying scenarioimpaired subjects

Fulmer & Gurland,

1997. MM Test

n = 125 pairs (participants Participants

and caregivers), age > 70
houses or
years divided into normal
out-patient
group (n=74) and
clinic, North
borderzone Alzheimers
Manhattan
disease and related
dementia (n=51)

Survey

Gurland, et al.,
1994. MM Test

n = 259 older adult ( 65

years old).

Survey

Hutchison, Jones,
West, & Wei, 2006
MMAA and
DRUGS

n = 52 older adult, mean

age 75.8 years

Community ,
The University
of Arkansas
for Medical
sciences

Isaac, Tamblyn, &

Mc-Gill-Calgary
drug research team,
1993

n = 20, older adult ( 65

yo) convenience Oimple

Community
dwelling,
California

Kurtz, et al., 2007.

VRAMMA

n = 43 encompasses 2
Community.
Pilot study
samples: schizophrenic
Yale school
patients (n = 25) and
of Medicines
community dwelling
healthy volunteer (n = 18).

Community,
North
Manhattan

Normal group were reported as more independent in self-medicating

Small sample size.
and had higher MM Test scores compared to dementia group (72%
Correlation of
vs 29%) and (61% vs 23%) respectively.
caregiver report and
Among normal group and dementia group who self medicate, 91% and
MM Test score for
42% had good MM Test scores respectively
the dementia group
Among those who have poor MM test scores, one person in each group
was not statistically
was required to self-medicate
significant.
The correlation between MM Test scores and caregivers report of selfmedicate was 0.49 (p 0.001) for combined sample

MM test associated with CARE cognitive screening (r = 0.47) and

MM test was directed to
diagnosed of dementia (r = 0.45)
diagnose early
Regression: CARE cognitive scale and education related to MM Test (r
dementia, not
=0.44)
medication
management
capability itself
Survey
MMSE scores have strong association with MMAA and DRUGS
Small sample size for
scores, both MMAA and DRUS were recommended as Instruments to
the purpose of
assess patients capacity in managing their medication
comparing two
The study did not find a correlation between the ineffectiveness and
instruments.
ability to manage medication with self-reported drug related problems The only paper that
compare two
instruments
Cross sectional Poor cognitive function was associated with low scores on SM task
Convenience sample,
performance (read the prescription label, interpret instruction, open
prone to bias and
bottle, cut pills, and plan dose and timing of medication)
chance
Visual and motor skills were strongly correlated with compliance
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 size

Limited applicability in
real setting

Manias, et al., 2006.

SAM-tool

Older adult (n=106)

median age 73 years old

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

Orwig, et al., 2006.

MedMaIDE

Convenience sample, n =
50 older adult ( 65 yo)
who live independently in
community

Community:
high-rise
apartment and
local
retirement
community,
Baltimore

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).
n = 57 older adult, mean
age 79.49

Raehl, et al., 2002,

MedTake

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 0.89

A 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)

Test re-test 0.93, inter-rater 0.74

MedMaIDE more specific and predictive of patients compliance as
compare to pill count

Mix socioeconomic and

educational
background of
sample
Convenience and
relatively small
sample

Three health
Survey
care services
in San Diego

One 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 size

Comparison group

Three
Cross-sectional
retirement
communities
(homes) and
adult day
care centre in
Texas

80% participants self-medicate, 20% received help.

Some assessment were
Average composite MedTake score = 88.5% 21.3%.
conducted at
Score for correct dose: 94%; correct indication:95%; correct food &
participants homes,
water cpingestion: 97%; correct regiment: 89%
hard to replicate
Education and MMSE associate with MedTake score with p=0.034 and
p = 0.001 respectively

Cohort

Romonko &
Pereleles, 1992
Pharmacy
assessment

n = 51age 62-94 years

Geriatric
rehabilitation
setting in
Calgary

Prospective
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,

1996
A structured
assessment
instrument

n = 59, older adult (62-102

years)

Outpatient of a
geriatric clinic
Illinois,
Chicago

Cross sectional

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

Schmidt & Lieto,

2003. MAT

n = 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
Jersey

Survey

Average score of subjects in IL was 88.92 and in AL was 54.71

Correlated 0.59 with MMSE, 0.46 with naturalistic action test, 0.46
with IADL (all p<0.001)
Discrimination function analysis accurately classified 79.03 % at their
appropriate level of care

Small sample size.

High profile sample
Only preliminary
findings

Wilbur and Wong,

2007
Medication
administration task

n= 60, mean age 82.9

years, two third women

Acute elderly
centre in a
major tertiary
care centre in
Canada

Prospective
non
randomised
single arm
observational
study.

28% participants demonstrated inability to functionally self-medicate.

Functional task score does not correlate with medication complexity
index, self-reported difficulty to self-medicate at home, and clockdrawing tasks scores

Consecutive sampling
Reliability data not
gathered
Follow up by phone
only