Reasons differ on a caseto- case basis. According to Ms Joey Tan, Manager, Pharmacy Services, Sengkang Community Hospital (SKCH) under SingHealth Community Hospitals, this may be due to forgetfulness, fear of side effects, or actual side effects that patients may not share with healthcare professionals. Some patients may simply be not used to taking so many pills, or they may fear developing a dependence on medication.

Health literacy also plays a big part in patient compliance. Some seniors may be confused by the instructions or may not understand the purpose of the medication.

“Some conditions like high blood pressure have few or no symptoms. Patients may think that although they take the medication every day, they have not noticed any difference and so the medication does not really matter; or they may think that they are fine and therefore do not require medication. However, if they do not take it on a regular basis and their blood pressure gets too high, it may lead to other problems, such as heart disease,” said Ms Tan.

It is important for elderly patients to take medication as prescribed, at the right time, and at the right dose. If patients overdose, they may suffer from side effects; and if they underdose, the disease condition may not be treated as intended.

“For example, certain diabetes medication must be taken with food to avoid low blood sugar levels and its accompanying symptoms, such as perspiring, dizziness, trembling or cold clammy skin. If the patient skips taking medication, the diabetes may not be well controlled and may progress to cause heart-, eye-, nerve- and kidney-related problems,” she explained.

Even as health literacy among elderly patients has improved over the years, seniors, especially those with poor memory or who are living alone without a caregiver, can still benefit from closer attention.

“It is important to check in on seniors periodically, especially if they are staying alone. Observe if they are going for appointments, and whether they are replenishing their medication and taking them on time. If they have problems taking their medication, find out if they are intentionally or unintentionally omitting the medication and why,” said Ms Tan.

With patience, caregivers and loved ones can better understand the difficulties elderly patients face, and help them manage their medication with simple steps that suit their lifestyles, and address their needs and concerns.

Tips to help elderly patients take medication correctly and safely

Overcoming forgetfulness

· Prepare a pillbox with the right medication in advance, and leave it in places that the patient usually goes to at particular times, such as at the breakfast table in the morning, at the kitchen top in the afternoon, and at the bedside at night.

· Set regular alarm reminders or install a medication reminder app on the patient’s mobile phone.

Understanding instructions

· Accompany the patient for medical appointments to understand his or her medication needs, and explain instructions patiently.

· Create a medication list with photos of the pills or icons to signify the condition that the medication can treat, instead of complex medicine names. Use pictorial representations, such as the sun to depict morning consumption, and the moon to represent night consumption.

Making it easier to swallow

· Check with the doctor or pharmacist if the medication can be cut or crushed into smaller pieces or dissolved in water, and if the medication comes in syrup or mixture formulation.

Addressing concerns

· Talk to the patient to find out what side effects he or she is experiencing, and discuss these with the doctor or pharmacist.

Duplicated or expired medication

· Help the patient remove discontinued, expired or duplicated medication. If unsure, bring the medications to healthcare professionals for help in sorting them out.