Medication management and patient compliance in old age

In old age, many physiological functions decrease and many older people also suffer from multiple chronic conditions. This leads to high drug consumption, but may also impair the ability to manage these medications. The first objective of this thesis was to describe different aspects of medication management (MM) in the elderly, such as opening medicine containers, tablet swallowing and the cognitive components of MM. A second objective was to explore the relationships between MM and functions, demographics and compliance in an elderly population. Thirdly, we wanted to explore what older people do when facing difficulties with MM.

For this thesis, three different populations were used: the Kungsholmen project (paper I and III), the SWEOLD (paper II) and the Swedish National study on Aging and Care (SNAC) (paper IV). In the first and second studies we used tests of opening of containers and of MM respectively. In the third study data were collected on tablet sizes and volumes and correlated to age, gender, housing and self-reported ability to swallow medicines. For the fourth study we developed a questionnaire regarding several aspects of MM and patient compliance, also including questions of what the elderly do when facing difficulties with MM.

We found that a large proportion of older people living in the community have difficulties with MM. In the first study this was exemplified by the finding that a fairly large proportion was not able to open three different kinds of medicine containers. We also found that, among persons that did not manage to open the containers, a large proportion did not receive help with their own medications. In the second study we found that a test of MM including more cognitively demanding processes of MM, was very difficult to perform without making errors on one item or the other. In addition, the results from this test correlated poorly to the selfreported ability to manage medications.

In the third study we looked at self-reported ability to swallow tablets in relation to tablet sizes and volumes. The results show that there are older people that do experience difficulties when swallowing medicines and that they had a larger volume of tablets than others.

For the fourth study we used the theoretical framework of the International classification of functioning, disability and health (ICF). The questionnaire contained questions regarding a number of different aspects of MM, functions of importance to MM and patient compliance. We found that functions were highly correlated to activities of MM. We also found that functions and activities of MM both separately correlated to patient compliance. When asked about strategies when experiencing difficulties with their medications, the elderly in our sample reported that they find ways to manage these difficulties with or without help or aids of any kind.

List of scientific papers

I. Beckman A, Bernsten C, Parker MG, Thorslund M, Fastbom J (2005). "The difficulty of opening medicine containers in old age: a population-based study" Pharm World Sci 27(5): 393-8
https://pubmed.ncbi.nlm.nih.gov/16341746

II. Beckman AG, Parker MG, Thorslund M (2005). "Can elderly people take their medicine?" Patient Educ Couns 59(2): 186-91. Epub 2005 Jan 26
https://pubmed.ncbi.nlm.nih.gov/16257624

III. Beckman Gyllenstrand A, Bernsten C, Thorslund M, Fastbom J (2007). "Tablet size and swallowing in the elderly" (Manuscript)

IV. Beckman Gyllenstrand A, Bernsten C, Fastbom J, Johnell K (2007). "Medication management among the oldest old living in the community." (Manuscript)