Find out why elderly patients find it hard to stick to their medicine regime, from Ms Lim Zhiying, Senior Medical Social Worker from Singapore General Hospital.
In her line of work, Ms Lim Zhiying, Senior Medical Social Worker at
Singapore General Hospital, sees elderly people with multiple chronic illnesses such as diabetes, high blood pressure, high cholesterol as well as kidney disease, other cardiac conditions and cancer. The elderly patients often have difficulties adhering to their complex treatment regimens, which involve taking multiple daily medicines for each illness.
“In some cases, elderly people with multiple chronic illnesses unintentionally do not adhere to their treatment regimens because of carelessness, forgetfulness or poor health literacy. In other cases, they choose not to adhere to the treatment regimens after evaluating the effects of medication on their daily lives,” says Ms Lim.
Physical and emotional side-effects of taking multiple medicines
Elderly people can experience various side-effects from the treatment regimens of their multiple medical conditions. Some side-effects from the medications include constipation, nausea and tiredness. Sometimes, elderly patients feel emotionally tired from taking the medicine because they end up taking more medicine to address the side-effects.
Some elderly patients do not adhere to their treatment regimen because they either find it disruptive to their daily routines or they do not experience any immediate or visible physical improvements such as reduced pain or lethargy.
In addition, the elderly patients were constantly in an emotional tussle. On one hand, their negative emotions were often triggered by reminders that they have multiple chronic illnesses. On the other hand, they saw that they had to adhere to their treatment regimens in order to be physically independent, so that they could take care of their loved ones or to avoid being a burden to their loved ones.
Physical independence a strong motivator for adhering to multiple treatment regimens
According to her previous study which was concluded in 2016, Ms Lim found that the desire for independent living seems to play a role in shaping how elderly people see their multiple chronic illnesses (co-morbidities) and treatment regimens.
The study revealed that elderly people with multiple chronic illnesses evaluated and prioritised illnesses that might affect their physical independence. They were more concerned about symptoms such as pain and breathlessness or illnesses such as stroke, which can affect their mobility.
Understanding Singapore’s elderly’s perspectives of having multiple chronic illnesses
Numerous overseas studies have attempted to understand the experience of elderly people with multiple chronic illnesses when it comes to adhering to their treatment regimens. For example, Bower et al. (2012)1 posited that the overall experience of having multiple chronic illnesses may affect how patients view their conditions and treatment regimens. Patients also experience and attach different perceptions and emotions to the experience of having multiple chronic illnesses as compared to those with a single or specific chronic condition.
However, there were only a few Singapore-based studies that have attempted to understand the experience of elderly people with multiple chronic illnesses with regards to adhering to their treatment regimens.
Ms Lim, who has recently received the 2017 Mitsui Sumitomo Insurance Welfare Foundation Research Grant, aims to find out the experience of elderly people, with varying levels of physical dependency, in adhering to treatment regimens. She eventually hopes to implement targeted interventions to better help elderly people manage their multiple chronic illnesses.
“It is important to understand the experience of having multiple chronic illnesses as a whole and the impact it has on a senior patient’s ability to adhere to his treatment regimens,” says Ms Lim.
“We must also identify the factors in our system of care that encourage or hinder their adherence so as to better support them through their complex treatment regimens.”
See next page for tips on
how to help the elderly keep to their multiple medication regimens.