There is considerable interest in the problems of the elderly taking drugs correctly and appropriately. A recent survey (Parkin et al. 1976) showed that these problems that have long been known in geriatric practice have now been noted by general physicians. This review was undertaken when an occupational therapist in a geriatric unit team noted that, although patients and their relatives were taught methods of dressing, toileting, shaving, bathing, eating, walking, transferring to a chair, wheelchair mobility and communication by the occupational therapist, physiotherapist and speech therapist, no advice or teaching was given concerning the accurate taking of the drugs prescribed. The results of a detailed investigation are reported elsewhere (Atkinson, Gibson & Andrews 1978). Repeatedly, patients ready for discharge were handed a batch of drugs by a nurse at the last possible moment, even while sitting by their luggage awaiting the ambulance. Following this, special attention was paid to problems such as intellectual impairment, loss of memory and confusion, poor sight, inability to handle containers, failure to take drugs and lack of patient-education. During ward rounds, particularly when a geriatric health visitor was present, attention was drawn to special topics such as the number of patients who inadvertently kill themselves and the numbers needing readmission due to failure to take drugs, overdosage or underdosage or mixing of drugs (Wade 1972). Ferguson Anderson’s comment (1974) that 7.15% of hospital admissions are due to drug reactions was also noted.
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Seventy-eight elderly patients in hospital were studied for up to four weeks to assess drug compliance. Forty patients received medication from individualized calendar packs (‘C-Pak’) and 38 received medication from standard bottles. There was no difference in compliance between the two groups, the percentage error for each group being 26%. This result suggests that C-Pak is unlikely to improve drug compliance in unselected elderly patients.
Fifty-six elderly patients (age range 65–98 years) discharged from a geriatric unit were visited at home on or after the 5th post-discharge day (median day 8) and their medication assessed.
By the day of the visit, 15 of the 56 had not had a new prescription issued (27%) and 27 patients (48%) had old prescribed medication at home. Forty-one new scripts, issued by general practitioners, should have contained 128 medications if the general practitioners wished to continue unchanged the medication given on hospital discharge. Fourteen drugs (11%) had been added and 17 drugs (13%) omitted. The number of prescriptions issued unchanged was 26/41 (63%). Inaccurately labelled containers and/or changed drug names were found in 28%. Contrary to hospital advice, 47% of medications were issued in childproof containers.
Poor communication between hospital and general practitioners is only part of the problem. Methods to expedite the delivery of new presciptions should be developed.
This study measured the prevalence of difficulty experienced by elderly inpatients in opening and removing tablets from a range of common commercial medication packagings and in breaking a bar-scored tablet in half. One hundred and twenty elderly patients admitted to a teaching hospital acute geriatric service were tested for their ability to open the container and remove a tablet from it. They were rated as ‘able’ or ‘unable’ to do so. In all, 94 patients (78.3%) were unable to break a tablet or open one or more of the containers. Of the 111 patients taking medication at the time of their admission, 46 (41.4%) were unable to perform one or more tasks necessary to gain access to medications in their own treatment regimen. The factors that were significantly and independently associated with inability to open containers were poor vision, impaired general cognitive function, and female sex. Many of the drug packagings in common use significantly impede access by elderly patients to their medications.
Background: multi-compartment medication devices (MMDs) are widely used, primarily by older people, to aid correct-medication taking. Several MMD types are available yet little is known about the ease with which patients with varying functional ability use these devices and whether some types are easier than others. Such knowledge would assist healthcare practitioners in advising patients on a suitable choice of device.
Objective: this study investigates the ease with which patients with differing functional ability use three types of MMD.
Method: participants were recruited from an older person’s medical ward. Demographic and medication information, cognitive function, visual acuity and manual dexterity were recorded. The Venalink®, Nomad Clear® and Dosett®MMDs were tested. Participants rated each MMD according to text readability, ease of opening, ease of medication removal, transportability and overall rating. These ratings were compared between MMDs for all patients and for subgroups with differing functional abilities.
Results: the MMDs were trialled by 50 patients; the majority rated text readability well but rated MMDs poorly according to the other criteria. Cognitively impaired participants may encounter difficulties in opening and removing medication from Venalink® and Nomad®. The Dosett® consistently rated better across all criteria. Transportability was the most influential criterion for overall MMD usability.
Conclusion: the poor patient rating of MMDs which are widely used in practice is of concern. Some MMDs may be difficult to open and access, especially for patients with cognitive impairment. This offers some guidance to health professionals in advising patients on MMD choice however, overall MMD rating appears dominated by transportability.