POLYPHARMACY IN THE ELDERLY: EXPLORING THE PATIENTS’ PERSPECTIVEA. Driesen 1, S. De Coster 2, V. Foulon 2

1Test Gezondheid, Brussels, 2Research Centre for Pharmaceutical Care and Pharmaco-economics, K.U.Leuven, Belgium

 BACKGROUND AND OBJECTIVE

DISCUSSION AND CONCLUSION

KNOWLEDGE AND INFORMATION

Polypharmacy is very common among older people. About 25% of people aged 65-74 and 40% of people over 70 are taking five or more drugs. Research has shown that the use of multiple drugs increases the risk of drug related problems, including reduced adherence to the treatment regimen (1). The aim of this study was to explore patients' views on polypharmacy as to understand their medication taking behavior.

The majority of patients had moderate to good knowledge of the indication for each of the prescribed drugs.

The most important source of information for patients seemed the treating physician. Pharmacists were considered a usefull and reliable source of information concerning the practical use of medication. Generally, patients were quite satisfied with the information they received from their general practitioner and pharmacist. Some patients read patient information leaflets; others had no further information desire.

PATIENTS’ ROLE IN MEDICATION MANAGEMENT

Although patients don't discuss the choice of the medication ('the doctor knows what he is doing'), the majority of patients admitted to have stopped a drug once or alternated the dose or moment of intake by own initiative.Patients used various tools (e.g. daily pill boxes, medication lists,…) as to manage their medications. Often, they were very creative in finding solutions for practical problems.

PATIENTS BELIEFS ABOUT MEDICATION

Most patients saw their medication as ‘essential’ or ‘life-saving’. Patients considered the number of medication they had to take ‘a lot’, but didn’t perceive this as problematic.

Elderly patients trust their physician blindly when it comes to treatment choices. However, a detailed analysis of the medication profiles shows that a regular review of the medication used by elderly patients would be appropriate.

REFERENCES(1) Anthierens S, Tansens A, Petrovic M, Christiaens T. Qualitative insights into general

practitioners’ views on polypharmacy. BMC Family Practice 2010, 11:65(2) Beers MH. Explicit criteria for determining potentially inappropriate medication used by the

elderly. An Update. Arch In Med 1997; 157; 1531-6(3) Ruths S et al. Multidisciplinary medication review in nursing home residents: what are the

most significant drugrelated problems? The Bergen District Nursing Home (BEDNURS) study. Qual Saf Health Care 2003;12:176-80

METHODS

1 •Recruitment of patients aged > 65 and taking five or more drugs through an organization of home care nurses and community pharmacies

2 •Semi-structured interviews with patients. Interviews were recorded, transcribed verbatim, and analyzed using a thematic framework approach

3 •Analysis of medication profiles of participating patients according to the Beers (2) and Bednurs criteria (3) and check for the presence of drug-drug interactions

Some people had notes (written by the treating physician or by themselves) as to remember why each of the medications had been prescribed.

When asked to sort their medication according to the perceived importance, patients relied often on what the GP had said on the importance of the drug. Patients also thought that medication that had to be taken every day, was more important than medication that had to be taken less frequently.

RESULTSANALYSIS OF MEDICATION PROFILES

On a total of 186 drugs used in the study population, 54 drug related problems were identified:

• 13 drugs were inappropriate according to the Beers criteria; 7 of those were benzodiazepines

• 17 problems were identified using the Bednurs criteria; 9 problems were related to the chronic and combined use of psychopharmacological drugs

• using Delphi care, drug-drug interactions were identified in 15 / 22 patients; in total, 31 combinations that required follow-up or change of the medication regimen were found