Medical Education“I don’t know how many of these [medicines] are necessary..”—A focus group study among elderly users of multiple medicines
Introduction
There are widespread concerns about both extent and quality of medicine use by older people [1]. The average rate of non-adherence to chronic medication has been estimated at about 50% [2]. Multiple diseases and complex medicine regimes in elderly patients may compromise adherence even further [3], [4]. Studies of regimen simplification, like reduced dose frequency, often focus on patient adherence only and fail to include measures of satisfaction or acceptability by patients or show that simplification leads to clinical improvements [5], [6], [7], [8], [9].
The literature contains many studies on patients’ experiences of medicine-taking in general, among different patient groups [10], but few focus on elderly and/or users of multiple medicines [6], [11]. We know that medicines occupy a central place in the way people with high levels of chronic morbidity manage their diseases [6], [11]. Patients see medicines as unwelcome but necessary and having a routine is recognised as the key to coping with multiple medicine regimes. Results from a synthesis of qualitative studies of medicine-taking indicate considerable general reluctance to medicine use and a preference for using as little as possible [10]. The majority of studies focus on reasons for not taking medicines as prescribed based on the view that the norm is taking medicines as prescribed. Patients try out medicines and weigh risks and benefits; the occurrences of adverse effects are key criteria in their evaluations [12]. Furthermore, as medicine use is equated with having an illness, people who do not accept their illnesses are unlikely to accept their treatment, e.g. asthma patients [13].
Quality of medical care for elderly people is a national priority in Sweden and elsewhere [14], [15]. Limiting the number of unnecessary medicines has current priority, although attention to under-prescribing of beneficial medicines should not be neglected [16]. Important initiatives for improving treatment quality include the Beers criteria (1997), a list of 48 individual/classes of medicines to avoid and 20 conditions and medicines to be avoided in older people with these conditions [17], [18]. Other initiatives focus on adherence to Standard Treatment Guidelines [19] incorporating available evidence regarding a given disease and provide recommendations, including the use of multiple medicine regimens, for the treatment of patients with that disease. No one doubts their benefits, though what is less clear are the long-term net benefits and potential harm associated with multiple medicine use due to adherence to all different disease-specific guidelines relevant for patients with co-morbidity [20].
Patients are increasingly encouraged to take active roles in managing their health, expressing their concerns and preferences, and in participating in medical decision-making [21], [22]. There is little empirical research examining elderly patients’ perceptions of multiple medicine use. Increased knowledge of everyday experience with a multiple medicine regime is of great importance in improving quality of care and health outcomes for elderly patients.
The aim of this study was to conduct an exploratory study describing multiple medicine use from the elderly patient’s perspective.
Section snippets
Methods
The study was approved by the Regional Ethical Review Board at Uppsala University (Dnr. 2006:159).
Results
Because the same categories and subcategories emerged in separate analyses of men’s and women’s focus groups, we decided to merge the results. However, it is stated clearly when statements were made by only one of the genders under each subcategory. Three main categories with subcategories were generated by the focus group data (Table 1): Belief about medicines (A): ‘Attitude to medicines (A1)’, ‘Definition of multiple medicine use (A2)’, ‘Benefit from medicines (A3)’, and ‘Adverse effects and
Discussion
This study explored use of multiple medicines from the elderly patient’s perspective. The results reveal co-existing accounts of positive and negative attitudes to and experiences of being users of multiple medicines. The positive accounts found deviate from the existing literature on lay experience of medicine-taking, while the negative accounts confirm previous results [10]. Furthermore, the elderly participants’ experiences of being users of multiple medicines and their perceptions about
Acknowledgements
We would like to thank the elderly persons who volunteered to participate in this study for their time and contributions. This study was undertaken as part of a doctoral thesis supported by a grant from the Swedish Association for Senior Citizens (SPF), which we gratefully acknowledge. The funding source had no involvement in the research process. The authors have no competing interests to declare.
References (44)
- et al.
Electronic pill-boxes in the evaluation of antihypertensive treatment compliance: comparison of once daily versus twice daily regimen
Am J Hypertens
(2000) - et al.
Resisting medicines: a synthesis of qualitative studies of medicine taking
Soc Sci Med
(2005) - et al.
Reasons for adherence with antihypertensive medicine
Int J Cardiol
(2000) - et al.
Medicine, chronic illness and identity: the perspective of people with asthma
Soc Sci Med
(1997) - et al.
Optimal matches of patient preferences for information, decision-making and interpersonal behaviour: evidence, models and interventions
Patient Educ Couns
(2006) - et al.
Patients’ preference for involvement in medical decision making: a narrative review
Patient Educ Couns
(2006) - et al.
Focus group research and “the patient’s view”
Soc Sci Med
(2006) - et al.
Older people’s preferences for involvement in their own care: a qualitative study in primary health care in 11 European countries
Patient Educ Couns
(2007) - et al.
Lay perceptions of type 2 diabetes in Scotland: bringing health services back in
Soc Sci Med
(2005) - et al.
Doctor–patient communication: a review of the literature
Soc Sci Med
(1995)
Suboptimal prescribing in older inpatients and outpatients
J Am Geriatr Soc
Drug therapy in the elderly: what doctors believe and patients actually do
Br J Clin Pharmacol
Improper intake of medication by elders—insights on contributing factors: a review of the literature
Res Theory Nurs Pract
A comparison of enalapril 20 mg once daily versus 10 mg twice daily in terms of blood pressure lowering and patient compliance
J Hypertens
Patient perspectives on multiple medications versus combined pills: a qualitative study
Quart J Med
How can we improve adherence to blood pressure-lowering medication in ambulatory care? Systematic review of randomized controlled trials
Arch Intern Med
Patient compliance and therapeutic coverage: comparison of amlopidine and slow release nifedipine in the treatment of hypertension
Eur J Clin Pharmacol
Managing multiple morbidity in mid-life: a qualitative study of attitudes to drug use
Brit Med J
National service framework for older people
Prescribing for seniors. Neither too much nor too little
J Am Med Assoc
Cited by (101)
Barriers and facilitators to reducing paracetamol use in low back pain: A qualitative study
2023, Musculoskeletal Science and PracticeTranslation, cross-cultural adaptation, and validation of the Danish version of the revised Patients’ Attitudes Towards Deprescribing (rPATD) questionnaire: Version for older people with limited life expectancy
2021, Research in Social and Administrative PharmacyCitation Excerpt :The proposed model (model 3) showed acceptable construct validity. We failed to prove hypothesis 1 (that a higher ‘burden’ score would correlate positively with a higher Abbreviated Wake Forest Trust in Physician score) as well as hypothesis 5 and 8 (that a lower ‘concerns about stopping’ factor would correlate negatively with a higher BMQ Specific-Concerns score and a larger number of regular medications, respectively) (Appendix A); however, as mentioned above, a possible explanation for this may be the conflicting attitudes of older people.49–53 The principal strength of our study is the application of established guidelines and quality criteria for translation and cross-cultural adaptation as well as validation of the study,28,40 respectively.
Antidepressant use and its relationship with current symptoms in a population-based sample of older Australians
2019, Journal of Affective DisordersDistrict nurses' use of a decision support and assessment tool to improve the quality and safety of medication use in older adults: A feasibility study
2020, Primary Health Care Research and DevelopmentPolypharmacy, deprescribing, and trust in the clinician–patient relationship
2024, Journal of the American Geriatrics Society