Student: Lauren Cumberpatch
Supervisors:Dee Mangin & Kim Burgess [Dept Public Health & General Practice and Pegasus Health]
Sponsor: The Canterbury Health Care of the Elderly Education Trust
New Zealand has an ageing population, and the health of older people is becoming an increasingly important aspect of medicine. Prescribing medicines for older people can be difficult. Most medical guidelines are based on a 'one size fits all' approach that assumes patients have only a single disease. Older people most often have multiple diseases. If GPs use these guidelines to prescribe medicines for older patients with several health conditions, the risk of drug interactions and side effects is increased. Patients make choices that vary depending on their ideas and preferences. Research suggests that adults have preferences about the medicines they take, preferred cause of death, and end of life care. However, there is almost no information from groups of adults over age 75 on how they view and use prescription medicines, and their priorities and preferences for use. This is particularly important in the area of preventive medicine where a patient has no current symptoms.
This study aimed to explore the views of older adults on the role of medicines in their healthcare.
A group of 300 patients aged 75 and over from 14 randomly selected Pegasus Health general practices were mailed a questionnaire. The questionnaire included questions about age, sex, ethnicity, current health and medications, and a variety of questions on medicine use, and views on death and dying.
1/3 of the questionnaires were returned (97/300). Most patients were NZ European, and almost half (45%) were between 75 and 80 years old. Most patients (88%) reported having at least 1 ongoing health condition, with 37% of conditions occurring without symptoms. Most patients were on prescription medicines, with an average of 5 medications (range 1-12). 1 in 6 patients reported experiencing side effects from their medicines. 1 in 6 patients reported having stopped taking their medicines at some time, half because of side effects. All patients agreed that they take their medicines according to instructions, although 1 in 6 said they adjust how much medicine they take according to how well they feel. Most (98%) were happy to take their medicines, but 1 in 4 patients agreed that having to take medicines worries them, and 1 in 4 also worried about the long term effects of medicines. 5 in 6 patients agreed that their health in the future will depend on their medicines. 7 in 8 said that medicines do not disrupt their lives. Medicines for symptom control, disease prevention and treatment, and long life were all regarded as very important or somewhat important by the majority of patients for their current and future health. Most patients indicated that they would want to die suddenly, peacefully and without pain. Several patients would prefer to have a heart attack or 'die in my sleep' as their cause of death. The most important qualities of a 'good' death were pain relief, dignity and privacy, and support of loved ones. The main issues patients wished to avoid around the time of their death were prolonged dying, burden on friends and family, reduced brain function and physical disability. Patients wished to have control of their decisions about the level and nature of intervention with medical care at the end of life and have their wishes in that area respected.
Conclusions and Recommendations
Older adults believe that prescription medicines for symptom relief, disease prevention and treatment and long life are important for their current and future health. They also have preferences about their end of life care, including cause or nature of death, the role of medicines and medical care, and qualities that contribute to a 'good' or 'bad' death. These personal preferences should be sought, discussed and considered by health care practitioners when prescribing medicines for a range of conditions. The risks of multiple medicine use are a concern, as many patients in the survey reported taking multiple medications, and 1 in 5 reported side effects.