“It’s just routine.” A qualitative study of medicine-taking amongst older people in New Zealand
- 394 Downloads
Aim To explore how New Zealanders aged 65 years and older manage their medicines in their own homes, and determine the problems and concerns they might have with taking them. Setting Urban setting, Dunedin (population 120,000), New Zealand. Methods Twenty in-depth semi-structured interviews were undertaken of community-dwelling people 65 years and older. Sixty people, from a random sample of 80 from the electoral roll, met the recruitment criteria and were invited to participate. The first ten men and ten women agreeing to participate were interviewed. Interviews were taped and transcribed verbatim. Transcriptions were thematically coded and analysed using grounded theory and constant comparison. Main Outcome Measures Emerging themes were explored under the topics: accessing medicines, remembering to take medicines, following instructions, practical problems, adverse effects, concerns about medicines, and beliefs about medicines. Results Ten of thirteen men and 10/20 women contacted (61%) agreed to participate. The men were aged 71, 67–82 years (median, range) and women 77, 69–87 years. They were using 140 prescription medicines (median 7, range 3–16) and 34 non-prescription medicines (1, 0–6); mainly for the nervous system (28%), or the cardiovascular system (22%). Participants felt that they had good access to medicines, could afford them, managed them well, and had systems and routines to help them remember to take them. Occasional doses were missed following a change in routine. Practical problems were found such as difficulty swallowing or halving tablets. Three-quarters of participants had experienced adverse effects during their lives. These were managed by dose or drug changes or by taking practical measures. People were worried about adverse effects occurring whether or not they had experienced them previously. Beliefs about medicines were mainly positive, although some people disliked taking them. Conclusion The people 65 years and over in this study felt that they could access, afford and manage their medicines well. Although many participants had experienced adverse effects, their beliefs about medicines were mainly positive. Practical problems and concerns should be routinely enquired about and addressed, and prescribing and monitoring optimised to minimise adverse effects, in order to assist older people take their medicines.
KeywordsAdverse reactions Behaviour Compliance Concerns Cost Elderly Medication adherence Medicines Patient beliefs Qualitative research
We thank the people who participated in the study and Vicky Luscombe for administration and transcribing.
The study was funded by the Health Research Council of New Zealand (grant number FS 06-558).
Conflicts of interest statement
None to declare.
- 1.Royal College of Physicians. Medication for older people. Second edition. A report of a working party of the Royal College of Physicians. London: Royal College of Physicians; 1997. 48p. ISBN 1860160557.Google Scholar
- 10.Fincke BG, Miller DR, Spiro A III. The interaction of patient perception of overmedication with drug compliance. J Gen Intern Med. 1998;13(3):182–5.Google Scholar
- 15.Dormuth CR, Maclure M, Glynn RJ, Neumann P, Brookhart AM, Schneeweiss S. Emergency hospital admissions after income-based deductibles and prescription copayments in older users of inhaled medications. Clin Ther. 2008;30(Spec No):1038–50.Google Scholar
- 18.Thompson ST, Stewart K. Prescription medication use practices among non-institutionalised older persons. Int J Pharm Pract. 2001;9(3):141–51.Google Scholar
- 24.WHO Collaborating Centre for Drug Statistics Methodology. ATC Index, 2009 [cited 25/11/09]. Available at http://www.whocc.no/atcddd/.
- 25.Pharmaceutical Management Agency. New Zealand Pharmaceutical Schedule August 2009. Wellington: PHARMAC; 2009. 212p. ISSN 1172-9376.Google Scholar
- 28.Bernsten C, Björkman I, Caramona M, Crealey G, Frøkjaer B, Grundberger E, et al. Pharmaceutical care of the Elderly in Europe Research (PEER) Group. Improving the well-being of elderly patients via community pharmacy-based provision of pharmaceutical care: a multicentre study in seven European countries. Drugs Aging. 2001;18(1):63–77.CrossRefPubMedGoogle Scholar
- 31.Lincoln YS, Guba EG. But is it rigorous? Trustworthiness and authenticity in naturalistic evaluation. In: Williams DD, editor. New directions for program evaluation, vol. 30. San Francisco: Jossey-Bass; 1986. p. 73–84.Google Scholar