Nienke Bleijenberg, Alexander K. Smith, Sei J. Lee, Irena Stijacic Cenzer, John W. Boscardin, Kenneth E. Covinsky

Difficulty managing medicines and finances becomes increasingly common with advanced age, and compromises the ability to live safely and independently. Remarkably little is known how often this occurs. To provide population-based estimates of the risk of developing incident difficulty managing medications and finances in older adults. A prospective cohort study. The Health and Retirement Study (HRS), a nationally representative study of older adults. 9,434 participants aged 65 and older who did not need help in managing medications or managing finances in 2002. Follow-up assessments occurred every 2 years until 2012. The primary outcomes were time to difficulty managing medications and time to difficulty managing finances. Risk factors such as demographics, comorbidities, functional status, and cognitive status were assessed at baseline. Hazard models that considered the competing risk of death were used to estimate both the cumulative incidence of developing difficulty managing medications and finances and to identify potential risk factors. Analyses were adjusted for age, gender, race, marital status, wealth and education. The 10 years incidence of difficulty increased markedly with age, ranging from 10.3% (95% CI 9.3-11.6) for managing medications and 23.1% (95% CI 21.6-24.7) for managing finances in those aged 65-69, to 38.2% (95% CI 33.4-43.5) for medicines and 69% (95% CI 63.7-74.3) for finances in those over age 85. Women had a higher probability of developing difficulty managing medications and managing finances than men. This study highlights the importance of preparing older adults for the likelihood they will need assistance with managing their medicines and finances as the risk for having difficulty with these activities over time is substantial.