“I don’t know how many of these [medicines] are necessary..”—A focus group study among elderly users of multiple medicines

Abstract

Objective

The growing prevalence of multiple medicine use among elderly challenges health care. The aim was to conduct an exploratory study describing multiple medicine use from the elderly patient’s perspective.

Methods

Twelve focus groups of 29 men and 30 women 65 years of age or older, using five or more medicines were analysed qualitatively.

Results

Initially the participants reported no problems with using multiple medicines; they felt fortunate that medicines existed and kept them alive. However, negative attitudes were also revealed, both similar to those presented in studies on lay experience of medicine-taking and some that appear more specific to users of multiple medicines. The foremost of these was that acceptance of medicines depends on not experiencing adverse effects and worrying whether multiple medicine use is ‘good’ for the body. Furthermore, participants’ perception of their medicines depended on interaction with doctors, i.e. trusting ‘good’ doctors.

Conclusion

The participants revealed co-existing accounts of both immediate gratitude and problems with using multiple medicines. Furthermore, the patient–doctor relationship coloured their attitudes towards their medicines.

Practice implications

Importance of the patient–doctor relationship for treatment success is highlighted. Moreover, to be able to capture both accounts of the elderly in this study an appropriate consultation length is needed.

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.