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Managing multiple medicines gets
Background
easier with age?
› Previous literature: focused on multiple medicine use in older populations,
(co-morbidities and multiple medicines use) (Moen et al 2009)
However:
FACULTY OF PHARMACY
Jacqueline Tudball1,2 & Lorraine Smith2
University, 2University of Sydney
1Latrobe
2
Background
Background
› Previous literature: focused on multiple medicine use in older populations,
(co-morbidities and multiple medicines use) (Moen et al 2009)
› Previous literature: focused on multiple medicine use in older populations,
(co-morbidities and multiple medicines use) (Moen et al 2009)
However:
› However:
- No independent association between increased age and reduced adherence
- No independent association between increased age and reduced adherence
(Vik
- Clinically complex treatments - reality for increasing number of people aged < 65
- Clinically complex treatments - reality for increasing number of people aged < 65
(Auduluv & Asplund 2012)
(Auduluv & Asplund 2012)
- Australians are retiring later
(Vik
et al 2004)
et al 2004)
- Australians are retiring later
(Delpachitra & Beal 2002)
(Delpachitra & Beal 2002)
The ‘Living with Multiple Medicines’ study:
› conducted by NPS MedicineWise in 2012 employing ‘DIPEx methods’
› participants recruited via NPS connections, Advisory Panel and
snowballing
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Participants
Data analysis
› 37 consumers recruited to theoretical saturation
› Males n = 13, females n = 24
› Ages 22 – 88 yrs. Aged 65 and over = 15 (1 still employed); retired = 18
› Very eastern seaboard (NSW, Vic, Qld, SA); rural n = 12
Thematic
Analysis (Bazeley
2007)
Constant
comparative
analysis (Schreier
2012; Pope 2003)
NVivo 9 for
coding & analysis
<65 compared
with ≥65+
› 92+ conditions represented; prescription, OTC & complementary
medicines – into the hundreds & includes tablets, liquids, creams, enemas,
injections, pumps, implants, home haemodialysis
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Older people experienced less time-pressure
Stories of day-to-day events that were irreconcilable with medication
regimens did not arise for older participants…
Results
“To be honest Jacqueline, it’s really not a
problem. I have them out where I can see
them. They fit with me and my day, I don’t
have to fit with them. And [wife] reminds me
before I can forget.” (Male, 82, retired)
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Older people experienced less time-pressure
Older people have more control over hours in the day
Older people had somewhat more flexibility to ‘work around’ medicines regimens
…like these stories did for younger people
“I've discovered that pain relief, like Panadol
Osteo, doesn't work for me until at least one hour
50 minutes to two hours after I've taken the
tablets. So if I'm going to be able to go to work
on public transport without pain, I have to take
those medications at least two hours before I leave
for work. Going home, I’ve started always carrying
a fold-up walking stick, so I always get a seat.
(Female, 50, employed full-time)
One of the bigger disruptions [was]
around when my daughter was born
and in the first few months of her life,
when everything just gets thrown up in
the air anyway…I was still awake at 6
[o'clock]the next morning, so it was
just, when did I actually get breakfast
that day? (Male, 44, employed fulltime)
“If I’m having one of those days when it’s
all just too much, then I just don’t go
out.” (Female, 82, retired)
“Most of my medicines are taken in the
morning and I’m not a morning person. So I
do the afternoon shifts at the Op Shop,
so I don’t have to get up early just to
take my medicines” (Female, 74, retired)
“I just take it with breakfast, whenever that
happens to be, the whole smash. So it’s
not a problem.” (Male, 79, retired)
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Forgetting to take medicines
Older people only forget ‘occasionally’
“If I'm out and maybe having lunch
with friends and chatting, about two
hours later, I'll say, "Oooh, I forgot to
take my medication." (Laughs.)
That's about the only time that I
forget.” (Female, 76, retired)
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Older people experience less stigma
The younger the person, the more stigmatised about their medicines
“I don't forget the morning one.
That's a ritual when you get up and
have them with your breakfast. But
the evening ones, the occasional
forget. I'm doing things and I
forget.” (Male, 74, retired)
“I still remember very vividly being told at
work that someone else in my section had
cancer and his attendance wasn't as
sporadic as mine, as if in some way that
invalidated my experience; ‘your illness is
not serious, because you don't have
cancer.’” (female, 38, employed part-time)
“When I'm at work, my physical health and wellbeing - my
illnesses, my conditions - they're not uppermost on my
mind. I'm there to get my job done. I will open the drawer
and I might see them there, but I'm not opening my drawer
all throughout the day.” (Female, 50, employed fulltime)”
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Older people experience less stigma
Services open during business hours - easier for retirees
The younger the person, the more stigmatised about their medicines
“I still remember very vividly being told at
work that someone else in my section had
cancer and his attendance wasn't as
sporadic as mine, as if in some way that
invalidated my experience; ‘your illness
is not serious, because you don't have
cancer.’” (female, 38, employed part-time)
Enhanced access to services for older people
“I just trundle down on me scooter sometime after breakfast to get me
scripts” (male, 74, retired)
“Some [pharmacies] open till 5.00. Fortunately the one I've got now is open till
eight o'clock at night, which is great, because you can't always get things done
between the hours of 9.00 and 5.00, particularly if you're working” (male, 50,
looking for work)
“It’s almost normal at this
age; just about everyone is
on a lot of medicines and
more of them the older they
get” (female, 82, retired)
Services available only to older people
“There's a [pharmacy] who delivered to the Village anyway. Every Friday you would put
it in a box up there, which says "Chemist" and they'd deliver it that night. It's a
marvellous service.” (female, 88, retired)
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Medicines are often more affordable for older people
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What do we take from all this?
Pensioners were acutely aware of PBS benefits and grateful
› Complex medication regimens + complex work life = enormous challenge
It was harder to afford when we were still working
fulltime. All of my medicines we get on the PBS.
That has made an enormous difference to us.
(Female, 54, retired)
Affordability was a significant issue for the youngest participants
I’m tired of spending nearly half my salary on
medicines. Other people my age get to spend their
money on going out and the things they want.
(Female, 22, employed fulltime)
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What do we take from all this?
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What do we take from all this?
› Complex medication regimens + complex work life = enormous challenge
› Complex medication regimens + complex work life = enormous challenge
› Medication regimens are often at odds with the demands of young people,
such as working fulltime and raising young children. These demands do
not feature as strongly, or at all, in older years
› Medication regimens are often at odds with the demands experienced
younger people, such as working fulltime and raising young children.
These demands do not feature as strongly, or at all, in older years
› Retirement provides access to PBS reductions in price and services that
greatly assist medication adherence
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What do we take from all this?
References & Acknowledgements
› Bazeley, P (2007). Qualitative Data Analysis with NVivo, Thousand Oaks: Sage
› Complex medication regimens + complex work life = enormous challenge
› Delpachitra, S & Beal, D (2002). Factors influencing planning for retirement. Economic
Papers: A journal of applied economics and policy, 21: 1–13
› Medication regimens are often at odds with the demands of young people,
such as working fulltime and raising young children. These demands do
not feature as strongly, or at all, in older years
› Moen et al (2008). “I don’t know how many of these [medicines] are necessary..”—A focus
group study among elderly users of multiple medicines. Patient Education & Counseling.
74 (2): 135–141
› Retirement provides access to PBS reductions in price and services that
greatly assist medication adherence
› Schreier M (2012). Qualitative Content Analysis in Practice. Thousand Oaks: Sage
› Pope, C & Mays, N (2006). Qualitative Research in Health Care. Massachussetts:
Blackwell Publishing
› Sokolowski, R (2000). Introduction to phenomenology. Cambridge, UK: Cambridge
University Press
› Multiple medicines have a very different, more normalised, meaning for
older people than younger people
› Vik S, Maxwell C, Hogan D (2004). Measurement, correlates and health outcomes of
medication adherence among seniors. Annals of Pharmacotherapy, 38:303–12.
The authors would like to acknowledge:
› the Commonwealth Department of Health & Ageing, who funded this study
› A/Prof Kath Ryan, Latrobe University, for commenting on this presentation
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