Education And Debate

Caring for Older People: Aids to compliance with medication

BMJ 1996; 313 doi: https://doi.org/10.1136/bmj.313.7062.926 (Published 12 October 1996) Cite this as: BMJ 1996;313:926
  1. A J Corlett, senior registrar in medicine for the elderlya
  1. a St James's University Hospital, Leeds LS9 7TF

    Elderly people may need to take several forms of medication, including tablets and capsules, inhalers, insulin, and eye drops. This article describes various aids that are designed to facilitate compliance.

    Old people are more likely to suffer from chronic morbidity from multiple diseases—20-30% of older people are taking three or more medications. Several diseases may require concurrent drug treatment; polypharmacy is known to be associated with an increased risk of adverse drug reactions, drug interactions, and poor compliance.

    Compliance may be defined as the extent to which a person's behaviour coincides with medical advice. Few patients take their medication as intended by their practitioner; most are partially compliant. Up to 20% of patients do not present their prescription to a pharmacy within one month of issue. Non-compliance is multifactorial and may arise from:

    • Not knowing how to take medication (such as orally, twice daily, with food, etc)

    • Not understanding the importance of drug treatment in managing disease

    • Taking many drugs

    • Anticipation or experience of side effects

    • Forgetfulness

    • Impaired physical function.

    Even so, elderly patients with normal cognitive function are more compliant than their younger contemporaries. Simple measures can be taken to improve compliance:

    • Educating patients about disease and treatment

    • Simplifying drug regimens: minimising the number of drugs and frequency of doses

    • Using modified or controlled release preparations to decrease dosage frequency

    • Involving carers in management of medication

    • Telling patients about common early side effects to which they may develop tolerance

    • Using drug diaries, calendars, or medication charts

    • Using ordinary bottle tops instead of child resistant containers

    • Using large print or jumbo labels on containers

    • Using compliance aids, such as dose reminders for tablets and devices to help with administration of inhalers, eye drops, etc.

    Daily dose reminders and monitored dosage systems

    Several types of daily dose reminders are available (see box). Most consist of a box divided …

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