Maintaining compliance at home : Helping the elderly with their medications

The elderly population consumes more drugs for their chronic conditions compared to any age group. In this study it was indicated that the average elderly takes two to four drugs per day. The high quantity and wide range of drugs used by the elderly can lead to significant risks. Adding to the risks is the problem of compliance. Areas of concern regard­ ing safety in administering medications to the elderly are the need for increased awareness of the effects o f drugs in their systems.


Introduction
There is an increased likelihood with ageing that anyone can develop a chronic disabling condition.Physiological ageing make the body to be more susceptible to infection and reduce their ability to heal.M any o f these conditions can be treated with drugs, allowing the elderly years o f comfortable and in dependent ageing.Age-related changes influence patterns of m edication consum ption and actions of m edications in the bod> (Nelson & M ayfield, 1994:120).This is the reason that the elderly are prone to adverse effects to normal doses.O b taining information on use o f m edication by the elderly can assist in educating them on use and prevent side and toxic effects.

Research problem
The elderly people take several m edications for their chronic conditions.There are problem s related to use o f medication, these emanates from self-medication with over the counter (OTC) drugs.These medications are not considered by the elderly as "medi cation", because their perception o f medication is a prescrip tion by their physician.M any elderly do not understand why they are taking a medication, which may lead to non-com pli ance and misuse (Ringsven & Bond, 1991:140).The elderly also has a tendency o f obtaining m edications from friends their spouses, neighbours and anybody who they think suf fers the same condition as them.Obtaining medication from other sources not prescribed by either the physician or phar macist can lead to side effects and medication abuse.During a research done in M angaung am ongst the elderly people 83,9% o f them had not been adm itted to a hospital for the past two years.This means that the elderly had to take care of their health needs at home.One hundred and ninety six (51.6%) o f the respondents were on medication.This is in line with the literature which states that most old people take several m edicines for th eir chronic diseases (N elson & M ayfield, 1994:120).The respondents obtained their medi cations from different sources mentioned on Table 1.There is a critical need to assess the use o f medication and to educate the elderly on how to use medication to promote independent and healthy ageing.

Purpose of the study
The purpose of this study is to determine where the elderly person obtains their medication and whether the elderly take their medication as prescribed.

Methodology
A survey was chosen to explore the needs o f the elderly and the use o f medication was one o f the areas assessed .A nonexperimental method was done where there was no manipu lation o f the environment.It was conducted in a natural, un controlled real life situation (Bums & Grove, 1995:25;Wilson, 1989:145).

Sampling
A cluster random sample was done.A sample o f 340 elderly people living in M angaung w ere in terv iew ed o f w hich 196(51.6%)were on medication.All respondents were black elderly who were sixty-five (65) years and above.The females 72.1 % outnumbered males 27.9%

Measuring instrument
Data was collected through a structured interview.A ques tionnaire which was completed by nine trained fieldworkers all registered nurses trained by the researcher on com m uni cation skills and on how to complete the questionnaire.the content o f the instrument.Face va lidity means the researcher looks at the instrument and decides visually that the respondents will agree it m easures the domain o f interest and it therefore repre sents an opinion.

Validity of the instrument
To asses face validity the questionnaire was presented to two lay persons, who were both retired persons from the same ethnic and cultural background as the population o f the study assessed.

Reliability of the instrument
A test-re te st reliability was done.The researcher adm inis tered the instrum ent to ten ( 1 0 ) respondents as part o f pilot study.After two weeks the instrum ent was adm inistered to the same individuals.The results o f the first administration did not differ from those o f the second except on a few subjec tive aspects such as pain which was no longer experienced in the second administration.Conducting a pilot study contrib uted to the reliability o f the instrument.

Findings
As indicated on Table 1, m ajority 51% obtained their medi cation from private hospitals, whereas 9.7% from the shops and 0.5% from family members and neighbours.The latter respondents are those who are at risk o f drug intoxication and non-compliance.This is because these drugs are not pre scribed by the doctor and their use cannot be ascertained.Old people can also be at risk of non-com pliance because o f poor understanding, poor eyesight and difficulties in handling bot tles due to arthritis (M acGuire, Preston & Pinches, 1987:32-37).Such people need help to comply with their prescription.
Majority o f the respondents (91.8% ) understood the reasons for using their m edication see Figure 1.H ow ever sixteen (8 .2%) o f the respondents d on't understand the reasons for their use o f medication .The respondents were directly asked if they understood the reason for the use o f the medication they were using during the research. tion.
As indicated in Table 2, 137 (69,4%) of the respondents took their m edications without supervision.It is important to im prove their understanding o f m edication and nurses should ascertain that they indeed comply in taking their medication.
Thirty five (18,4%) had their children supervising their medi cation.Reasons for being supervised may be due to poor vi sion, inability to read or write as 53,1% of the respondents in this study were illiterate.The clinic sister visited three in their homes and helped with their m edications.Only tw o ( 1 ,0 %) were supervised by neighbours and ,this support the fact that friends and neighbours do not usually provide personal care (Sampson, 1992:156-158).

Factors affecting use of medications
Level of educational M edications can be misused especially if the elderly do not understand the reasons for their use.In this study 53.1 % could not read or write and this can result in the elderly not know ing how to take their m edications which may lead to faulty adm inistration.
These are the elderly who are at risk and needed supervision.
Respondents who were on m edication m entioned that differ ent people helped or supervised them when taking medica-

None-com pliance
Factors that have been identified as contributing to none-com pliance with medication regimes include living alone, adverse m edication effect, financial consideration, com plexity o f medication regimen, cognitive and sen sory impairments (Miller, 1990:521).A com bination o f factors were found and these will be discussed below.

Living alone
Living alone can lead to forgetfulness especially when there is no one to remind the elderly to take their medication.For getting may also lead to taking double doses (Barnes, 1987:131 -132) This prob lem can be solved by giving the elderly some a aids which will help them remem-ber to take their medication.

Adverse medication effects
It is natural for people to stop taking medication if they experience adverse effects such as nausea and vomiting.
The importance of education regard to taking of m edica tions cannot be emphasized.O lder people are more likely to be taking several drugs which result from multiple symp toms.Their drug taking habits may make them more vul n erab le to ad v erse reactio n to m ed icatio n (R edfern, 1991:379).Eight (13.5%) of the respondents complained about nau sea caused by their medication.This is not uncommon be cause some medications have unpleasant side-effects espe cially w hen taken before m eals (N elson & M ayfield. 1994:120).

Financial considerations
Respondents who obtain their medications from pharmacies and private doctors may not be able to pay for their medica tions.High cost of transport may be a problem for the elderly who go to the health centers to obtain medications (Tibbit, 1992:25-26).In this study 1.8% o f the respondents had no source o f income and 85.3% were receiving a social grand which they shared with other members o f their families who were not em ployed .M ajority 95.2% of the respondents had no medical scheme.This factors indicate the financial hard ship which the elderly can face.

Cognitive and sensory impairments
Respondents who are cognitively im paired for example those suffering from A lzheim er's disease will not rem em ber to take their m edications.In assessing neurological m anifestations 45.8% o f the respondents mentioned that they suffer from memory loss including those who are on medication.Failing vision may make reading the instructions on the label diffi c u lt (K n eb l & G ra itz e r, 1 9 9 4 :1 9 6 ).O ne h u n d re d and five(28.1 %) could not read w ithout their spectacles and 13.1% could not even if they had their spectacles on.These elderly should be referred for a visual test and be helped to obtain visual aids.

Self-m edication
Over the counter medication (OTC) can be purchased w ith out a prescription.They can also be bought from a grocery store.Many elderly don't consider taking these drugs as tak ing medications.Their perception o f medication is a prescrip tion w ritten by their physician (Ringsven, 1991:140).The most common OTC m edications used by the elderly are laxa tives, analgesics, and vitamins.The respondents were not spe cifically asked about the m edications they were taking .It is possible that those obtained from neighbours and family mem bers as indicated on Table 1 include the affore mentioned.Self-medication may mean taking another persons prescrip tion medication (Ringsven, 1991:140).In a survey conducted in the Free state among black com m unities it was found that medicines recomm ended by friends and those advertised were com m only used (Van Zyl-Schalekamp, 1993;345-346).This show how easy it is for people to take any kinds of medication without consulting their doctors and registered nurses.There is a need to increase awareness of the effects o f medications on elderly body systems.

Recommendations Patien t education
• Patient education should reinforce areas of basic informa tion about the purpose o f medication.This will help in ensur ing that when a patient says '7 do not need any today, it is as a result o f knowing the purpose for which the drug is pre scribed (Bradshow, 1981:40-41).
• The elderly should be enlightened on the effects the medi cation have on their bodies.
• Specific information about taking m edication should be given to avoid side effects.This information should include specific instructions o f certain drugs such as taking meals before medications.
• Professionals must verify that the patient has received in formation about medications by explaining special directions for taking medications.

Aids used by the physically impaired
Health professionals should assist the elderly in obtaining aids to help them take medications.
R eading glasses should be obtained for the far-sighted to en able them to read the labels.
Large p rin tin g on the labels should be used to compensate for poor eye-sight.The nurses should encourage the pharm a cists to use bold or enlarged writing on prescriptions.
C onventional containers should be used to dispense drugs.Many adults have difficulty in opening child-proof drug con tainers (Redfern 1991:383).

□ Yes ■ No
8 .20% 91.80% Content validity which is im portant to all instrumentation, assess whether the instrument measures the domain o f inter est (Pierce, 1995:280-281).Five experts were called to assess Table 2 : Persons responsible for supervision of medication (