Drug treatment of elderly : The need for changing behaviour among providers and patients

Sammanfattning: Medication-related illness is a great problem, particularly among the elderly. Elderly people use many different drugs, they have many diseases and symptoms, and also experience natural signs of aging. Altogether, the treatment of an elderly patient is complex and assessment of the appropriateness of a drug therapy is difficult. In order to make a treatment as effective as possible and to achieve the best possible health it is important that the care personnel can identify problems associated with drug treatment. Such problems, e.g. polypharmacy, may lead to non-compliance. The overall aim of this thesis was to explore the drug utilization among elderly people in order to develop methods for rational drug audits and to get a knowledge of the patient’s view on the use of drugs. In the first study, we studied drug treatment of nursing home patients who had cardiovascular diseases (heart failure, post-myocardial infarction, angina pectoris, hypertonia, or cardiac valvular disease), and assessed the effect of medication advice given. We found that intervention did not affect the cardiovascular symptoms, i.e. medication could be decreased or even disrupted with no (harmful) effect on the health of the patients. Revisions of drug treatment should therefore be practiced on a regular basis in order to decrease the risk for polypharmacy and also decrease unnecessary costs. Revisions should involve more than one class of drugs in order to be cost-effective. In the second study, we investigated the effects of withdrawing SSRI drugs for nursing home patients who had no documented diagnosis or symptoms of depression. We found that treatment with SSRI drugs in patients without a clinically major depression or anxiety disorder often was unjustified and seemed to have had no essential effect. The medication with SSRI drugs should discontinued in those patients. In the third study, the relationship among elderly people between adherence to prescribed drugs and the patient’s perception of the care and information given was explored. We found that better perceived health was related to higher adherence. Patients in the non-adherent group reported a higher consumption of drugs. Moreover, patients who felt they did not get an opportunity to ask the physicians questions were over-represented in the non-adherent group. Care-providers should therefore increase their efforts to communicate with the patients. The fourth study was designed to analyse the relationship between the attitude to drugs, general health, psychological well-being, stress coping ability, and adherence to prescribed drugs in an elderly population. We found that of the mentioned factors the number of drugs prescribed and consumed is the most important factor for adherence to a drug treatment. The higher the number of prescribed drugs, the lower the proportion of adherent patients will be. The study also showed that non-adherent patients who took too many or too few drugs possibly may be approached in a different way in order to improve their adherence to the drug treatment. Drugs are essential for a successful management of diseases. Although the prescription of a drug is well intended, its use can bring about serious consequences. It is important to reconsider medication after some period of time as the indication no longer may be valid. When a patient chooses to take a drug or not to take it, the responsibility lies with the patient, and the patient should therefore be given tools to make a rational decision. It is the care-providers who can supply the patient with these tools. The patient should be given adequate information on the possible adverse effects of drugs and be encouraged to report adverse reactions. The patient’s participation and involvement in decisions concerning his/her care and treatment is an important principle in nursing.