SCIE Research briefing 15: Helping older people to take prescribed medication in their own home: what works?
Published August 2005
Introduction - What is the issue?
The topic of this briefing is the taking of prescribed medication by older people aged 65 or over who live at home. The main responsibility for taking medication among this group belongs with the older person themselves, or an informal or formal carer, rather than a health professional. There is therefore very limited supervision of medication taking by this group. The taking of prescribed medication concerns compliance. Compliance involves "taking medicines in the right way", that is, "adhering to the prescribed drug regimen" or taking drugs in line with medical or health advice. This briefing covers all older people, including those who suffer from cognitive or other impairments. The aim of the briefing therefore is to examine the policy literature and the findings of the research into why older people living at home may intentionally or unintentionally fail to take all of their prescribed medication when they need to, and what measures may be effective in helping them to achieve compliance with the prescribed doses. The intended audience of this briefing is both the prescribers of medication and health and social care professionals who work with older people in their own homes.
- Forty-five percent of the medications prescribed in the UK are for older people aged 65 and over, and 36% of people aged 75 and over take four or more prescribed drugs. It has also been found that as many as 50% of older people on prescribed medication may not be compliant with the prescribed regimens, that is, taking their medicines as instructed.
- Older people living at home fail to comply with prescribed regimens for their medication for both unintentional and intentional reasons.
- Unintentional reasons for non-compliance include a lack of easily understandable information about how and when to take their drugs, difficulties reading labels and opening containers, and the need to take many different drugs or many doses.
- Alarm clocks, positioning medication in visible places, and taking it at routine times, such as meals, have all been found by older people to be helpful in reminding them to take their medications.
- Intentional reasons for non-compliance include concerns about the value or effectiveness of medicines, their side-effects, and the inconvenience of taking the drugs at the prescribed times and frequency.
- Concordance is seen as a way of addressing intentional non-compliance. This approach allows patients to voice their concerns about medication and reach an agreed position with their doctor about the nature and quantity of their medication.
- Other effective means of improving compliance include simplifying drug regimens, educating older patients about the importance of their medication, providing personalised instruction and written information about their medication, and making medicines available in appropriate containers.
- Reminders, compliance aids and supervision are the most effective means of improving compliance among older patients with cognitive impairments.