Effective self management of pharmacological therapies for chronic illness is essential to maintaining the pharmacological therapies for chronic illness is essential to maintaining the independence of elder adults living in the community. Very little data exists that describes the patterns of self management related to medication adherence in inner city community-dwelling elders can lead to increased incidence of falls, hip fractures and mental impairment resulting in increased hospitalizations and the potential for nursing home placement. Therefore methods to increase and improve the effective self management of medications in inner city community- dwelling elders much be tested since the elderly continue to be the fastest growing population in the US. The long term goal of this program of research is to test the effectiveness of a practical, theory-based nursing intervention to increase mediation adherence and thus improve clinical outcomes among at-risk inner city community-dwelling elders. However, since little is known about inner city community-dwelling elders and their self management of medications we aim to: 1) describe and understand the pattern of medication adherence among inner city, community- dwelling elders, and 2) employ 2 cooperative inquiry groups to adapt a Freirian based home nursing intervention originally developed to improve medication adherence in an HIV/AIDS inner city population to inner city community-dwelling elders. To accomplish the aims of this pilot study, a prospective descriptive design will be used to follow for 12 weeks 20 randomly selected inner city, community-dwelling elders with chronic medical conditions for which three or more medications are prescribed. Data will be collected from face-to-face interviews, microcomputer monitoring technology. Physical examinations and medial record review, including confirmation of medication prescriptions, beginning at baseline through 3 months. Moreover, a subset (n=5) of the 20 randomly selected subjects will be recruited and participate in a focus group to discuss the challenges and/or barriers to self-management of medication for inner city community-dwelling elders. This qualitative data will be correlated with our quantitative data to increase understanding of the patterns of self-management of medication adherence in this at-risk elder population. Finally, a diverse group of health and educational professionals and community members will be sought to develop a cooperative inquiry group. Because the members of the community inquiry groups will either have formal education in geriatrics/gerontology or be elderly, this group will start working immediately on modifying the Freirian home-based nursing intervention to the elderly population.
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