MANAGING DRUG USE IN THE ELDERLY. General practitioners’ adherence to guidelines and patients’ conceptions of medication

Sammanfattning: Introduction: Older patients’ knowledge about their medicines is generally poor. Patients are entitled to be informed on an individual and adequate level. Evidence-based guidelines should, in most cases, be followed also in the treatment of elderly to avoid suboptimal treatment, for example for cardiovascular conditions, or risky prescriptions in the case of renal impairment. Objectives: 1. To describe frail elderly patients’ knowledge about and attitudes towards their medicines and to explore their experiences of receiving information about their medications. 2. To describe how well general practitioners (GPs) adhere to guidelines when using renal risk drugs in frail elderly patients and when treating elderly with cardio¬¬vascular disease and to evaluate local education of GPs as a tool for improvement. Methods: (Paper I, IV) For each prescribed medicine, the patient was asked about the indication and possible adverse effects. Attitudes were investigated with the Beliefs about Medicines Questionnaire. Semi-structured interviews covering questions on information about medication were analysed qualitatively. (Paper II) Medications for elderly patients in nursing homes were registered and the use of renal risk drugs was compared to renal function, estimated from s-creatinine and s-cystatin C. (Paper III) Data about GPs adherence to guidelines was collected from the medical records of patients aged ≥ 65 with a cardiovascular diagnosis. Local education was organized, followed by repeated measurements. Results: The knowledge about indication was satisfying but the knowledge about possible adverse effects was poor. The patients believed strongly in the benefits of their medication. The elderly felt comfortable with information when they trusted their physician or their medication, when they received enough information from the prescriber or when they knew how to find out sufficient information by themselves. They felt insecure if they were anxious, if the availability of medical care was poor or if they did not receive enough information. Reduced renal function was common (53%) in nursing home patients but s-creatinine was often normal. Renal risk drugs were rarely prescribed. The adherence to guidelines about cardiovascular diseases was low among GPs, but educational efforts appeared to increase the adherence. Conclusions: To receive an adequate drug therapy in the elderly, GPs should pay attention to patients’ need for suitable information on their medication and follow evidence-based guidelines about when to initiate and when to avoid certain drugs.