Identifying Compliance Issues with Prescription Medicines among Older People

Background: Older people are at greater risk from polypharmacy and adverse effects due to interactions and altered pharmacokinetics. They may also have greater difficulty managing their medicines and complying with dosage regimens for various reasons.

Objective: To identify the types of medicine compliance issues that occur among older people.

Method: The study was undertaken in suburbs of the city of Auckland, New Zealand. A sample of 31 older people (≥65 years of age) living in the community consented to participate in the study. Semi-structured interviews and observation were used to determine how older people were managing their medicines. Observation of the interaction between the pharmacist and older person was performed to gather baseline information and semi-structured interviews were undertaken within 1 month to determine how older people were using their medicines and to identify compliance issues surrounding their use of medicines. Observation of the pharmacist-older person interaction was undertaken in the pharmacy where the older people usually collected their medicines, and participants were subsequently interviewed in their homes. The main outcome measure was compliance issues associated with the use of medicines.

Results: The main issues identified were alteration of labelled medicine instructions; transferring medicine into other containers and the associated labelling and safety issues; and patients not taking medicines for various reasons, including swallowing difficulties, expense, difficulty in opening packaging, confusion about the regimen and adverse effects experienced and personal reasons. There was an average of five compliance issues per participant.

Conclusion: This study identified intentional and non-intentional compliance issues that could hinder the optimal use of medicines by older people who are at greater risk of medicine-related adverse effects. Large quantities of medicines, confusion, and lack of knowledge as to why a medicine had been prescribed contributed to non-compliance. Appropriate communication between the pharmacist and patient, patient education and aids such as medication cards and referral for medication review could improve compliance in this age group.