Medicines in the context of older people's lives

Abstract

Background: Older people often take a relatively high number of prescription medicines and experience a range of issues linked with these medicines. Older people admitted to hospital for an acute condition often experience changes to their medicines and as a result they may experience problems such as adverse medicine events. The number of older people is increasing in New Zealand and worldwide. It is important, therefore, to understand older people’s attitudes towards their medicines.

Aim: The aim of this thesis is to look at medicines in the context of older people’s (≥75 years) lives. It consists of two investigations. The aim of Investigation One is to explore older people’s experiences of medicines over their lifetime. The aim of Investigation Two is to explore how older people, who had recently been discharged from hospital to their own home, managed medicine changes which were made during their stay in hospital. Methods: For Investigation One twenty people ≥75 were selected and interviewed using open-ended questions with an oral history approach. Participants with a range of different characteristics (e.g. age, sex, occupation, and ethnicity) were chosen. For Investigation Two, forty people aged ≥75 were recruited from two internal medicine wards in Dunedin Hospital. Participants were included in the study if they were taking four or more prescription medicines at admission, experienced a change to these medicines in hospital and were discharged to their own home. Semi-structured qualitative interviews were undertaken with participants after their discharge. Interviews were digitally recorded, transcribed verbatim, coded using NVivo and analysed for themes. Results: Participants in Investigation One took a wide range of medicines (over the counter products and home remedies) in their youth but do not perceive these to be the same as their modern prescription medicines. Most participants did not begin taking regular prescription medicines until later in life and some struggled initially with this transition. Participants believe that younger people are too quick to “run to the doctor” and access prescription medicines in comparison to their youth. Participants in Investigation Two experienced a median of four medicine changes per person. Sixteen (40%) participants were not fully aware of all of the changes to their medicines and others had concerns about changes. The majority of participants trusted the hospital doctors and had a positive view of their stay in hospital. Many said they did not want to trouble the staff with questions about their medicines and did not necessarily think it was their place to ask questions. Participants in both investigations would rather not take medicines and at times are dismayed at the number that they do take. They trust their doctors, believe that the medicines are good for their health and, therefore, are willing to accept medicines as part of their normal lives. Conclusion: Investigation One shows the importance of understanding older people’s past experiences of medicines in seeking to better understand their current attitudes to medicines. Investigation Two highlights the need to improve communication regarding medicine changes with older people at discharge from hospital. Participants from both investigations would rather not take any medicines but were willing to accept them as part of their everyday routine because they believed they were necessary and trusted their doctors.