Non-compliance with drug therapy, either
under or over-dosing, is said to occur in one-third to one-half of elderly
patients. In Canada, the
Department of Health and Welfare reported in 1989, that seniors received 25%
of all prescription medications even though they accounted for only 11% of
the population. Similarly, 12% of Americans
take 23% of prescription medications. By
the year 2030, 21% of the population will take 40% of prescription medications.A medication management study conducted
in theUnited States found
that between 10 to 25% of the elderly population take NONE of their prescribed
medications and many elderly patients do not even have their prescriptions
filled. (Canadian Journal of Aging)
The rate of adverse medication reactions
is estimated to be 2-3 times higher in patients over 65 years than in younger
patients. (JAGS). Poor patient compliance is one of the factors
cited to account for this higher rate (Report from Royal College of Physicians).
Improper medication use among the elderly
population has numerous negative consequences. When the number of different medications
that these patients are prescribed is considered, these estimates are not
surprising, given the vagaries of aging, sight and memory. Indeed, it is difficult to imagine, when one
considers drug regimens involving upwards of 10 different medications, how
anyone could comply fully.
Non-compliance does not simply mean
failing to take the prescribed medication, but can also mean: taking more
than is prescribed, failing to attend follow up appointments, not collecting
prescriptions, not refilling prescriptions, discontinuing medications earlier
than recommended or not making the recommended changes in daily routine. In essence, non-compliance can be defined as
inappropriate medication use.
Non-compliance is not a new problem.
Doctors as early as Hypocrites learned those patients often make mistakes
in reporting their medication taking.
As a pharmacist in the Day hospital,
assessing and improving medication compliance in the elderly population is
one of my roles.
FACT: Less than 10% of all the patients I have met
in Day Hospital since
March 1993, carry an up-to-date medication list with
them. This is a dangerously low number.
FACT: Less than 10% of all the patients I have seen
so far have EVER had a thorough review of their medications performed with
them by a health professional.
How can we expect good compliance from
the elderly when the groundwork has never been done with/for them? We cannot lay all the blame on the elderly for
their lack of compliance. They are the most vulnerable population in the community
and as such, require our proper and more thorough attention.
TEN TECHNIQUES
TO IMPROVE COMPLIANCE (FOR THE PATIENT)
C Call your pharmacist or physician if you
have any concerns about any of your medications.
O Order your
medication renewals/refills well in advance -- don’t wait until the weekend
or until you have just swallowed your last tablet.
M Make your
medication regimen fit into your lifestyle, not the other way around. Associate taking your medication with something
you regularly do every day, e.g. brushing your teeth, sitting down to meals.
P Plan you medication times by using a daily
planner, e.g. a pill organizer (dosette).
L Learn to
never leave home without an up-to-date medication list. After all, you wouldn’t
consider going to the bank without your bank passbook.
I Inform your pharmacist or physician of any issues or concerns
you may have regarding side effects, etc.
A Ask, Ask,
Ask! Before you crush or stop or change
a medication.
N Never, never stop a medication abruptly -- always
consult with your pharmacist or physician first.
C Clarify
with your pharmacist what over-the-counter (non-prescription) or herbal medications
are safe to mix with your prescription medications.
E Enquire from your physician on a regular
basis about the ongoing need for each medication.
TEN TECHNIQUES
TO IMPROVE COMPLIANCE (FOR THE HEALTH-CARE PROFESSIONAL
C Communicate
effectively -- in language that the patient will understand. Avoid using medical jargon.
O Open-ended questions are more helpful in
determining the actual level of compliance.
M Make time for the patient’s questions. Patients are less inclined to open-up if they
feel that you are rushing.
P Provide each patient with an up-to-date
medication list.
L Listen
for clues to non-compliance, i.e. patient reports an unpleasant after-taste
or experiences nausea with a specific medication.
I Inform the
patient of the risks of non-compliance.
A Assess if the patient is being prescribed
the medication formulation that has been designed to enhance compliance
N Never assume
that compliance is good -- wait until you get to know the patient. Initially, patients like to tell us what they
feel we want to hear!
C Counsel
the patient on all available aids to compliance, i.e. dosettes, calendars,
programmable timers, etc.
E Evaluate
the effectiveness of each counselling session by asking the patient to summarize.
Evaluate the ongoing need for each medication on a regular basis.
The trends of an aging, multi-medicated
population and early hospital discharge, have created an urgent need to provide
elderly patients with proper instruction in the use of their medications.
Never before has educating patients about their medications been more important.