Managing Medications Together: A Qualitative Study of Collaboration Between Primary and Secondary Caregivers of Older Adults

Background Medication management is a crucial and complex task that demands both physical and cognitive effort from older adults, often leading them to depend on caregivers for support. Although previous research has examined the roles of primary caregivers (PCGs) and secondary caregivers (SCGs) in caring for older adults, limited attention has been given to how they collaborate in medication management. This study aimed to explore PCGs’ experiences of collaborating with SCGs in managing medications for older adults, as well as the contextual factors influencing SCG involvement. Methods Using a qualitative descriptive design, this study conducted a secondary analysis of semistructured interviews with 28 PCGs. Both deductive and inductive content analyses were applied to understand how medication management activities were allocated between caregivers and to identify the factors shaping these allocations. The findings were then used to categorize and characterize styles of collaborative strategies for medication management. Results PCGs were primarily adult children or children-in-law, who reported collaborating with SCGs that included family members, paid home care aides, or both. Across different medication management activities, PCGs primarily handled tasks requiring higher cognitive effort, whereas SCGs often assisted with tasks involving physical effort and copresence with care recipients. Two main categories emerged as influencing caregiver collaboration: (1) conferring decision-making authority and (2) positioning the SCG as active or passive. Collaboration was shaped by contextual and relational factors, such as kinship ties, familiarity with and knowledge of the care recipient’s medication regimen, geographic proximity, marital status, and employment. Four distinct styles of collaboration between PCGs and SCGs were identified and categorized as Partnering, Operating, Bench-Playing, and Intervening. Conclusions This study offers valuable insights into how caregivers collaborate to manage medications for older adults, emphasizing distinctions in responsibility and varying degrees of collaboration. Future research should systematically examine the social and demographic factors influencing these collaborative strategies and contribute to the development of tailored interventions that better support caregivers.