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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