A study by community nurses found that many older people take the
wrong dose, forget or do not take their medications at all.
Older people are more likely to
not follow their prescriptions.
They either take the wrong
dose, forget or do not take
their medicine altogether.
In a Singapore General
Hospital (SGH) study, it was found that
60 per cent of older people surveyed did
not take their medications as prescribed
by their doctors. This figure is higher
than the average 50 per cent in
international studies.
“Considering Singapore’s
rapidly ageing population
and increasing prevalence
of chronic diseases, it is
of utmost priority for
our community nurses
to address this issue,”
said Dr Rachel Marie
Towle, Advanced Practice
Nurse, Regional Health
System (Population Health
and Integrated Care Office), SGH.
“Medication adherence is crucial for the
optimal control of patient’s chronic diseases
and health outcomes,” added Dr Towle,
who co-led the Prevalence and predictors
of medication non-adherence among older
community-dwelling people with chronic disease
in Singapore study with Research Nurse
Chew Suet Mei.
The study, published in the Journal of
Advanced Nursing in May 2021, recruited
400 participants who were at least 60
years of age and suffered from at least one
chronic disease between May 2019 and
December 2019. They were either under
SGH’s Hospital-to-Home programme for
discharged patients who were followed up
by community nurses for six months at
home, or the hospital’s Community Nursing
Programme for residents in the southeast
of Singapore.
Understanding the reasons behind
medication non-adherence can help
guide healthcare workers in improving
compliance. In this respect, community
nurses play an important role. In the course
of their duties, they identify those at risk
of not taking their medication correctly
and help them manage their conditions
by ensuring they take their medication
according to the instructions given,
providing health coaching and coordinating
their care.
For instance, the study found an
association between smokers and
non-adherence, with people who smoke 2.9
times more likely than non-smokers to not
follow their doctors’ medication instructions.
“Older people who smoke perceived
their medication regime as being
complicated. They felt dissatisfied with
their regime, did not know the purpose of
their medications, and experienced side
effects,” said Dr Towle.
The study also found that older
people were more unlikely to take their
medications correctly if they felt that their
medication regime was complicated;
if they were taking many different drugs;
if they had to cut their tablets; if they did not
understand the purpose of their medications;
or if they suffered side effects from taking
the medications.
The cost of medications was not a
significant reason for medication
non-adherence among participants of
this study. This could be due to the various
financial assistance schemes available to
the elderly in Singapore.
Medication education is important, as
the elderly patient would be more likely
to continue to take a medication when he
understands the reason for taking it.
“Such knowledge has enabled
our team to strategise targeted
interventions to improve medication
adherence among our older patients
with non-adherence issues, such as
medication packing using a pill box, pill
reminders and education leaflets. Future
improvement plans include incorporating an
assessment tool or a care pathway into the
nurse’s daily workflow,” said Dr Towle.
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