***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND We tested the hypothesis that impairment in the ability to take medication independently predicts early functional decline . METHODS A 12-month , prospect i ve cohort study was performed at two continuing-care retirement facilities using the Drug Regimen Unassisted Grading Scale ( DRUGS ) . This geriatric screening tool utilizes a stepwise progression of four tasks : ( i ) identification , ( ii ) access . ( iii ) dosage , and ( iv ) timing . RESULTS Forty-seven ( 86 % ) of the eligible participants completed the 12-month follow-up assessment ; three were transferred to skilled nursing facilities . The mean age at study entry was 84.2+/-5.1 years ; 72 % of the participants were women , and 68 % were college educated . At 12 months there was a decline in the Mini-Mental State Examination ( MMSE ) score ( p = .029 ) , an increase in the timed " Up and Go " test ( p = .023 ) , and a decline in the DRUGS score ( p .029 ) . Nine ( 18 % ) of the participants resided in assisted- versus independent-living situations compared with three participants ( 5 % ) at study entry ( p = .031 ) . Both 12-month DRUGS score and 12-month self-reported medication management capacity were associated with 12-month MMSE ( p = .0001 and p = .019 , respectively ) . Baseline DRUGS score was associated with 12-month MMSE and Geriatric Depression Scale scores ( p = .0002 and p = .002 , respectively ) . Both baseline DRUGS score and self-reported medication management capacity were also associated with residence in assisted-living communities at 6 months ( p = .029 and p = .040 , respectively ) . MMSE was not associated with any of the clinical outcomes Abstract BACKGROUND : Patients ’ ability to manage medications is critical to chronic disease control . Also known as medication management capacity ( MMC ) , it includes the ability to correctly identify medications and describe how they should be taken . OBJECTIVE : To evaluate the effects of low literacy , medication regimen complexity , and sociodemographic characteristics on MMC . DESIGN : Cross-sectional analysis of enrollment data from participants in a r and omized trial . PARTICIPANTS : Patients with coronary heart disease in an inner-city clinic . MEASUREMENTS : Medication management capacity was measured with the  Drug Regimen Unassisted Grading Scale ( DRUGS )  , which scores subjects ’ ability to identify , open , describe the dose , and describe the timing of their medications . DRUGS overall and component scores were compared by literacy .  Mini Mental State Exam score , regimen complexity ( number of prescription medications )  , and sociodemographic characteristics . RESULTS : Most of the 152 participants were elderly ( mean age 65.4 years ) , women ( 54.6 % ) , and African American ( 94.1 % ) . Approximately half ( 50.7 % ) had inadequate literacy skills , and 28.9 % had marginal skills . In univariate analysis , MMC was significantly associated with literacy ( P<.001 ) , and this effect was driven by the ability to identify medications . In multivariable models , patients with inadequate literacy skills had 10 to 18 times the odds of being unable to identify all of their medications , compared with those with adequate literacy skills ( P<.05 ) . CONCLUSIONS : Adults with inadequate literacy skills have less ability to identify their medications . Techniques are needed to better educate low-literacy patients about their medications , as a potential strategy to enhance adherence OBJECTIVE To examine whether reduced ability to self-administer medication can accurately classify living placement ( independent or assisted living ) in a continuing care retirement community ( CCRC ) . DESIGN Convenience sample of consecutive patients seen in a medical clinic . SETTING An outpatient medical clinic at a CCRC . PARTICIPANTS A group of 78 consecutive patients ( aged 68 - 98 years ) scheduled for a geriatric medical evaluation between May 1 , 2001 , and August 31 , 2001 , residing in an independent ( IL ) or assisted living ( AL ) apartment . MEASUREMENTS Ability to self-administer medication  was assessed by asking residents to respond to a medication administration question based on a 5-point Likert scale . Residents were also given  measures  of  cognitive status ( MMSE ) , activities of daily living ( ADL ) , and depression ( GDS ) .  Further , age of residents as well as number of falls within the previous 6 months were recorded . RESULTS A discriminant function analysis accurately classified living placement ( IL or AL ) in 89.7 % of the cases based on the ability of residents to self-administer medication . The additions of MMSE score , ADL performance , GDS score , number of falls , and age of the residents to the analyses did not improve the number of cases that were correctly classified . CONCLUSION Ability to self-administer medication emerged as the main predictor of current living environment within the CCRC in the present study . These results underscore the importance of considering a resident 's ability to independently manage his or her medications when placement decisions are being made within CCRCs Background : Consumer participation in planning and implementing health care is actively encouraged as a means of improving patient outcomes . In assessing the ability of patients to self-medicate , health professionals can identify areas in which patients need assistance , education , and intervention to optimize their health outcomes after discharge . Objective : To develop and vali date a tool to quantify the ability of patients to administer their regularly scheduled medications while they are hospitalized . Methods : Past research enabled us to develop the Self-Administration of Medication ( SAM ) tool . Using a Delphi technique of 3 rounds , a panel of expert health professionals established the content validity of the tool . For determining level of agreement in using the SAM tool , 56 patients were selected ; for each patient , 2 r and omly selected nurses completed an assessment . Construct validity and internal consistency were examined by testing the tool in 50 patients and comparing with other vali date d scales . Results : The 29-item SAM tool had high content validity scores for clarity , representation , and comprehensiveness , with content validity index values ranging from 0.95–1.0 . In testing the level of agreement between 2 nurses , out of 43 valid cases , 95.3 % of nurses overwhelmingly agreed about the patients ’ competence to self-administer their drugs . The intraclass correlation coefficient was 0.819 ( 95 % Cl 0.666 to 0.902 ) . Internal consistency for the SAM tool was high , with a Cronbach 's alpha of 0.899 . A moderate to strong correlation was obtained when comparing the SAM tool with other vali date d measures . Conclusions : The SAM tool is valid and reliable for quantifying patients ’ ability to manage their regularly scheduled medications in the hospital setting This study used performance tests to assess the cognitive , visual and physical abilities related to taking medicines in the elderly population . The study population consisted of the Swedish Panel Study of Living Conditions of the Oldest Old ( SWEOLD II ) , a nationally representative interview survey . SWEOLD II is a r and om sample of all community-based and institutionalized persons aged 77 + in Sweden . Five tests related to medication management were administered in the direct interviews ( n=492 ) : h and function ( opening bottle ) , vision ( reading label ) , and medication competence ( comprehension and calculation ) . Results showed that 9.4 % could not read instructions on a medicine container and 14.6 % had difficulty opening a plastic flip-top medicine bottle . The three cognitive tests related to taking medicine result ed in 30.7 , 47.4 and 20.1 % errors . Combining all the tests revealed that 66.3 % of the sample had at least one limitation of capacity related to taking medicine . There were no significant gender differences . Among those people who did not pass all the tests , 31.8 % lived alone with no home-help . Taking medicines is a complex task and a large proportion of the Swedish elderly population has cognitive , visual or physical limitations that may hinder their ability to take medicines accurately . Awareness of these limitations is essential to concordance OBJECTIVE To study the relationship between four cognitive screens ( Mini-Mental State Examination [ MMSE ] , Mini-Cog , Medication Transfer Screen [ MTS ] , and Medi-Cog [ Mini-Cog + MTS ] ) and pillbox concordance . DESIGN Prospect i ve cross-sectional pilot study . SETTING Primary care federal health care system . PARTICIPANTS English literate in patients not previously diagnosed or treated for dementia and without physical h and icap preventing use of a pillbox . MAIN OUTCOME MEASURE Correlation between cognitive screens and prospect i ve pill-count scores ( PPCS ) . INTERVENTIONS  Mini-Cog , MTS , and MMSE screening was followed by a 28-compartment pillbox skills assessment . A passing PPCS was defined as correctly loading 80 % of the medications in the pillbox . A PPCS of < 80 % identified patients for pillbox-organization education or supportive intervention . Variables associated with total and passing PPCS were analyzed by multivariate linear and logistic regression , respectively . RESULTS Fifty-three patients discharged on > 1 medication completed all screenings . Other than cognitive screening , only age was associated with total and passing PPCS . After adjustment for age , Medi-Cog had the highest correlation with total PPCS [ r2=0.53 ; P<0.001 ) , whereas Mini-Cog was the single cognitive assessment that remained significantly associated with a passing PPCS ( r2=0.23 ; P=0.023 ) . Age-adjusted models , including MMSE , had relatively poor association with total PPCS ( r2=0.23 ; P=0.046 ) and no association with passing PPCS ( r2=0.15 ; P=0.46 ) . The Medi-Cog exhibited modest highest overall sensitivity ( 72 % ) and specificity ( 61 % ) to detect a passing PPCS . CONCLUSION MMSE is a relatively poor measure of the ability of patients to fill a pillbox . The Medi-Cog and Mini-Cog may have value for assessing pillbox concordance for patients who load their own pillboxes OBJECTIVES To assess relationships between vision ( contrast sensitivity , stereopsis , visual acuity ) and a performance-based measure of ability to implement new medications . DESIGN Cross-sectional analysis ; prospect i ve cohort study . SETTING Community-based . PARTICIPANTS Three hundred thirty-five participants aged 73 to 82 in Year 3 of the Women 's Health and Aging Study II , a representative sample of the two-thirds least-disabled community-dwelling women . MEASUREMENTS Hopkins Medication Schedule Pillbox Ratio , a joint measure of accuracy and time , and a performance-based measure of ability to implement a prescription . Participants received written and verbal instructions for taking two medications and were directed to place pills in a pillbox accordingly .  Vision assessment s : contrast sensitivity ( Pelli-Robson letter sensitivity chart ) , stereopsis ( R and ot Circles ) , and visual acuity ( Early Treatment Diabetic Retinopathy Study eye chart ) . RESULTS Forty-four percent ( 148/335 ) of women incorrectly placed one or both medications . Each vision measure was positively associated with Pillbox Ratio scores and varied with cognition and time to completion . Better visual acuity , contrast sensitivity , and stereopsis were each associated with better performance in women with poor cognition who filled the pillbox quickly . Additionally , better visual acuity was associated with better performance in participants with good cognition who filled the pillbox slowly ; better stereopsis was associated with better performance in participants with poor cognition who filled the pillbox slowly and whose stereoacuity was below normal . CONCLUSION Visual acuity , contrast sensitivity , and stereopsis should be considered potential risk factors for impaired ability to implement a medication regimen in older adults . Future research should investigate the role of vision , including contrast sensitivity and stereopsis , on performance of other instrumental activities of daily living OBJECTIVES To clarify the association between unmet medication management need and 3-year mortality and hospitalization for community-dwelling older people with various levels of disabilities . DESIGN Prospect i ve cohort study ( the Nagoya Longitudinal Study for Frail Elderly ) . SETTING Community-based . PARTICIPANTS One thous and seven hundred seventy-two community-dwelling elderly subjects ( 611 men , 1,161 women ) . MEASUREMENTS Data included the clients ' demographic characteristics , a rating for basic and instrumental activities of daily living ( ADLs ) , number of prescribed medications and physician-diagnosed chronic diseases , medication adherence , ability to manage medication  , and  presence or absence of medication assistance .  Cox proportional hazard models and the Kaplan-Meier method were used to assess the association between the medication management at baseline and mortality or hospitalization during a 3-year period . RESULTS Of 1,772 participants , 681 reported no difficulty with self-medication management , and 1,091 experienced difficulty with self-medication . Of participants with difficulty with self-medication management , 929 had  medication assistance  , and 162 did not . During a 3-year follow up , 424 participants died , and 758 were admitted to hospitals . The baseline data demonstrated that participants not receiving medication assistance were younger and had better ADL status and fewer comorbidities . Multivariate Cox regression models adjusting for potential confounders showed that the lack of assistance in those who needed medication assistance was associated with hospitalization but not mortality during the study period . CONCLUSION In community-dwelling disabled elderly people , lack of medication assistance in those needing medication support was associated with higher risk of hospital 
    Output:
    
Most instruments had some evidence of construct validity , through associations with tests of cognitive function , health literacy , activities of daily living or measures of medication management or adherence .
Conclusion A number of performance-based instruments exist to assess patients ' capacity to manage their own medications .