- Email: [email protected]
Knowledge of prescription medications among elderly emergency department patients
BRIEF REPORT
Knowledge of Prescription Medications Among Elderly Emergency Department Patients
From the Department of Emergency Medicine, Albany Medical College, Albany, NY.
Michael K. Chung, MD Joel M. Bartfield, MD
Author contributions are provided at the end of this article. Received for publication July 5, 2001. Revision received December 3, 2001. Accepted for publication January 10, 2002. Address for reprints: Joel M. Bartfield, MD, Department of Emergency Medicine, MC-139, Albany Medical College, 43 New Scotland Avenue, Albany, NY 12208; E-mail [email protected]. Copyright © 2002 by the American College of Emergency Physicians. 0196-0644/2002/$35.00 + 0 47/1/122853 doi:10.1067/mem.2002.122853
Study objective: We determine how knowledgeable elderly (>65 years old) patients seen in the emergency department are of their prescription medications. Methods: Patients older than 65 years who presented to the ED of an urban teaching hospital were interviewed concerning their prescription medications and the indications for their use. Medications and dosages were verified through the patients’ pharmacies. Medication indications were assessed for accuracy by referencing the Physicians’ Desk Reference. Results: Data on 88 patients were collected over a period of 2 months. Eleven patients were excluded from the study because of logistics (9) and rescinding of consent (2). Patients averaged 5.9 prescription medications on presentation to the ED. Patients correctly identified 78.4% (359/458) of these medications. Thirty-three (42.8%) patients were able to correctly identify all of their prescription medications. Furthermore, patients correctly identified 65.5% (236/359) of dosages (25 [32.5%] patients named all dosages correctly), 91.4% (328/359) of dosing intervals (44 [57.1%] patients named all intervals correctly), and 83.3% (299/359) of indications (49 [63.3%] patients named all indications correctly). Conclusion: Elderly patients presenting to the ED have only a fair knowledge of their prescription medications. [Chung MK, Bartfield JM. Knowledge of prescription medications among elderly emergency department patients. Ann Emerg Med. June 2002;39:605-608.] INTRODUCTION
Currently, there are nearly 35 million people in the United States who are older than 65 years, comprising 12.6% of the total population. The US Census Bureau estimates that this number will increase to 54 million (16.5%) by the year 2020, making this the fastest-growing age group.1 As the aging of the United States continues,
JUNE 2002
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MEDICATION KNOWLEDGE OF THE ELDERLY Chung & Bartfield
issues of medication usage among the elderly will increasingly come to the forefront. Elderly patients consume a disproportionate share of prescription medications. They take a range of 2.2 to 8.1 prescription medications per person,2-4 which represents up to 3 times as many medications as other age groups.5 Although pharmacotherapy has no doubt led to substantial improvements in the quality of life of the elderly patient, it is certainly not without its inherent dangers. It is estimated that as many as 17% of hospital admissions of elderly patients are caused by adverse drug reactions and allergies, inappropriate medications prescribed by physicians, inadvertent overdoses, and medication interactions.6 Furthermore, the likelihood of adverse outcomes related to medications is increased in the elderly by comorbid conditions, decreased renal clearance, and declining cognitive functioning. Proper understanding and compliance regarding medication usage should be the goal of the physician and patient to avoid medication-related problems. However, several studies of patients seen in medical and surgical clinics suggest that the elderly have relatively poor knowledge of their medication dosage (70% incorrect recall)7 and indication for use (25% inadequate understanding)8 and an even poorer ability in remaining compliant (75% noncompliance).9 Certainly, the potential for catastrophe resulting from polypharmacy and elderly patients’ misunderstanding and misuse of medications is most evident in US emergency departments. The chance of introducing a drug–drug interaction in ED patients is nearly 30% if the patient is taking more than 3 prescription medications, whereas this number decreases 10fold if the patient is taking less than 3 medications.10 Furthermore, the addition of medications to a patient’s regimen leads to increased complexity and decreased medication knowledge.11 The purpose of this study was to assess how knowledgeable elderly patients seen in the ED are of their prescription medications. We were unable to find a study that specifically addresses this issue in ED patients. We aimed to assess, by direct interview of elderly patients, the extent to which they understand their prescription medications, including doses, frequency of use, and indication for use.
annual census of 66,000 visits. Exclusion criteria included patients who were: (1) medically unstable; (2) residents of nursing home or extended care facilities; (3) disoriented to person, place, or time; (4) not currently taking any prescription medications; or (5) unable to recall their pharmacy name. Patients were enrolled as a convenience sample when either the lead author or one other individual (BS, see Acknowledgment) was available. Interviews were conducted from January 2, 2001, through March 1, 2001. Patients were asked the following questions about their prescription medications (including prescription as needed medications): (1) names, (2) doses, (3) dose frequency, (4) indication, and (5) “Has your doctor made any changes in dosage or frequency since the prescription was last filled.” If the patient stated that there had been a change, the dosage that the patient provided was considered correct. Patients were allowed to consult medication lists, prescription bottles, or any companions with them at the time of the interview. Patients were not asked to describe the method(s) that they used to organize their medications. In determining how knowledgeable patients were of medication indications, patients were simply queried, “For what reason do you take this medication?” Indications were referenced in the Physicians’ Desk Reference12 for accuracy. Additionally, patients were required to identify the location of the pharmacy or pharmacies where they obtained their medication. All pharmacies identified by each patient were then contacted by telephone and consent forms were transmitted by fax for release of patient prescription medication lists. These lists were then verified for accuracy against patients’ selfreported medications. If a patient reported that they were taking a medication that could not be corroborated, this was also considered an error. Analyses were largely descriptive. In addition, 2 other analyses were performed: the influence of number of medications taken and age on not being able to name at least one medication. For the age analysis, age was grouped into 5-year increments. Both analyses were performed using χ2 analysis with significance defined as P less than .05.
M AT E R I A L S A N D M E T H O D S
A total of 189 patients were screened for participation. Sixty-one declined, and 40 were excluded for the following reasons: 15 nursing home residents, 15 medically unstable and/or disoriented, 7 unable to recall pharmacy name, 3 not taking any prescription medication. This left 88 patients, with an average age of 76.7 years (SD 0.84
Our institutional review board approved this study. After obtaining informed consent, interviews were conducted on a convenience sample of elderly (>65 years) patients seen in the ED of a tertiary care, urban hospital with an
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MEDICATION KNOWLEDGE OF THE ELDERLY Chung & Bartfield
years), available for interview. Eleven patients were excluded from the study because of the following reasons: unable to contact mail order or online pharmacy (5), pharmacy out of business (2), refusal by the pharmacy to release information (2), and rescinding of consent (2). The 77 patients included in the study had an average age of 76.6 years (SD 6.9 years) and median age of 76.0 years. Twenty-nine (38%) were men. The study group took 458 prescription medications (including 26 as needed medications), for a per patient average of 5.9 medications (median 6). A total of 359 medications were correctly identified by the study group, for an accuracy of 78.4% (359/458). Thus, each patient omitted an average of 1.3 medications. Twenty-two (84.6%) of 26 as needed medications were correctly identified. Thirty-three (42.8%) patients were able to correctly identify all of their prescription medications. The total number of medications taken influenced this result. Patients taking 1 to 3 medications correctly identified all medications 78% (14/18) of the time, compared with 45% (15/33) of patients taking 4 to 6 medications and 15% (4/26) of patients taking more than 6 medications (P<.01). Age was not found to influence the ability of patients to correctly name all of their medications. Patients between the ages of 65 and 70 years correctly identified all of their medications 63% (12/19) of the time, compared with 56% (9/16) of the patients between the ages of 71 and 75 years, 58% (11/19) of the patients between the ages of 76 and 80 years, and 52% (12/23) of the patients older than 80 years (P value not significant). Patients correctly identified 65.5% (236/359) of dosages (25 [32.5%] patients named all dosages correctly), 91.4% (328/359) of dosing intervals (44 [57.1%] patients named all intervals correctly), and 83.3% (299/359) of indications (49 [63.3%] patients named all indications correctly). Eleven patients erroneously reported that they were taking a medication that could not be corroborated (1 patient reported 2 “extra” medications). Only 12 (15.5%) patients correctly identified all of their prescription medications, dosages, frequency of dosing, and indications. Twenty-three (30%) patients reported that further information concerning their medications would be helpful. DISCUSSION
Previous studies that have examined medication use in the elderly have reflected widespread misunderstanding among this group. Opdycke et al8 determined that there was an average of 5.6 medication-related problems per
JUNE 2002
39:6
ANNALS OF EMERGENCY MEDICINE
elderly patient. These problems included inadequate drug knowledge (25.5%) and inappropriate drug use (17.4%). Blenkiron13 interviewed patients aged 75 years and older in office visits for surgery consultation or at home for routine checkup. This study found that the elderly incorrectly stated the purpose of their medication in 28% of cases and the dosages of 25% of medications. Another study, which evaluated patients in the clinic setting, showed that the elderly had poor knowledge of their medication doses (70% incorrect recall) and indication of use (36% incorrect recall).7 To our knowledge, our study is the first to specifically determine medication knowledge of patients seen in the ED. Consistent with prior studies, our group had a relatively poor understanding of their medications. Furthermore, polypharmacy was prevalent among our patients, with each patient taking an average of just less than 6 medications. Not surprisingly, as the number of medications per patient increased, the likelihood of missing the name of at least one medication also increased. We did not find a similar relationship with increasing patient age; however, it is possible that this is because of insufficient power. Patients reported general satisfaction with information given by their physicians and pharmacists concerning these medications. Our study is not without several limitations. Perhaps most evident is our small sample size. Our convenience sample of 77 patients might not have been representative of our general elderly population. In addition, our results may not be generalizable to other EDs in other settings. Future, larger-scale studies are warranted to more accurately gauge elderly knowledge of their medications. Because the study was limited to elderly patients, it is not possible to draw the conclusion that this population is less knowledgeable than a younger cohort. Furthermore, we did not attempt to correlate medication errors with the type of system that patients used to keep track of their medications. We are therefore unable to comment on the effectiveness of these various systems. In addition, the inclusion and exclusion criteria of the study introduce much potential for selection bias. It is possible that patients who agreed to participate were more knowledgeable about their prescription medications. Patients were excluded if they did not know the name of their pharmacy, were disoriented, or were medically unstable. It is likely that patients excluded for any of these reasons would have had a poorer knowledge of their prescription medications. Furthermore, those patients deemed medically unstable were more likely to have comorbid conditions and thus be taking more prescrip-
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MEDICATION KNOWLEDGE OF THE ELDERLY Chung & Bartfield
tion medications. Conversely, those patients with mild to moderate cognitive impairment, despite being oriented, were included in the study. Additionally, interviewees were given much latitude in answering the question: “For what reason do you take this medication?” Although we referenced the Physicians’ Desk Reference12 indications, indications were deemed correct if they were generally relating to the correct organ system. For example, “bad lungs” would be a correct indication for the use of prednisone. Therefore, it is also likely that we overestimated our patients’ knowledge of indications for their medication. The results of our study initially appeared to be very encouraging. One could surmise from our data that the elderly have good knowledge of their medications because they correctly identified 91% of dosing frequencies and 83% of indications. However, on closer scrutiny, this does not provide an accurate picture. On average, patients omitted 1.3 medications, and only 15% could correctly name all of their medications, dosages, frequencies, and indications. This is in agreement with earlier studies of elderly patients seen in surgical and medical clinics, which revealed a widespread misunderstanding of prescription medications. Our study should be considered a reflection of poor communication between patients and their health care providers, the complexity of modern medication regimens, and the passive role elderly patients are taking in their health care. Indeed, only 30% of patients interviewed reported that they would want more information concerning their medications. Educational efforts on the part of physicians, pharmacists, and other health care providers should be encouraged to increase elderly patients’ knowledge of their medication and to help avoid the pitfalls of polypharmacy in the elderly.
6. Colley CA, Lucas LM. Polypharmacy: the cure becomes the disease. J Gen Intern Med. 1993;8:278-283. 7. O’Connell MB, Johnson JF. Evaluation of medication knowledge in elderly patients. Ann Pharmacother. 1992;26:919-921. 8. Opdycke RA, Ascione FJ, Shimp LA, et al. A systematic approach to educating elderly patients about their medications. Patient Educ Couns. 1992;19:43-60. 9. Anonymous. Medication for the elderly. A report of the Royal College of Physicians. J R Coll Physicians Lond. 1984;18:7-17. 10. Beers MH, Storrie M, Lee G. Potential adverse drug interactions in the emergency room. An issue of quality of care. Ann Intern Med. 1990;112:61-64. 11. Hayes KS. Adding medications in the emergency department: effect on knowledge of medication in older adults. J Emerg Nurs. 1999;25:178-182. 12. Physicians’ Desk Reference. 55th ed. Montvale, NJ: Medical Economics Company; 2001. 13. Blenkiron P. The elderly and their medication: understanding and compliance in a family practice. Postgrad Med J. 1996;72:671-676.
Author contributions: MKC and JMB were involved in planning, data analysis, and manuscript preparation. MKC collected the data. JMB performed the χ2 analyses. MKC takes overall responsibility for the paper as a whole. We thank Brett Scudder, BA, for his help with data collection.
REFERENCES 1.
US Census Bureau. Population estimates. Washington, DC: US Census Bureau; 2000
2. Broderick E. Prescribing patterns for nursing home residents in the US. The reality and the vision. Drugs Aging. 1997;11:255-260. 3. Nobili A, Tettamanti M, Frattura L, et al. Drug use by the elderly in Italy. Ann Pharmacother. 1997;31:416-422. 4. Zanocchi M, Ponzetto M, Spada S, et al. Polypharmacy in the ambulatory care of aged patients. Recenti Prog Med. 1999;90:455-461. 5. Kasper J. Prescribed medicines: use, expenditures, and sources of payment. National Health Care Expenditures Study Data Preview 9. DHHS Pub. No. (PHS) 82-3320. Public Health Service. Hyattsville, MD: National Center for Health Services Research; 1982.
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ANNALS OF EMERGENCY MEDICINE
39:6 JUNE 2002
Knowledge of Prescription Medications Among Elderly Emergency Department Patients
From the Department of Emergency Medicine, Albany Medical College, Albany, NY.
Michael K. Chung, MD Joel M. Bartfield, MD
Author contributions are provided at the end of this article. Received for publication July 5, 2001. Revision received December 3, 2001. Accepted for publication January 10, 2002. Address for reprints: Joel M. Bartfield, MD, Department of Emergency Medicine, MC-139, Albany Medical College, 43 New Scotland Avenue, Albany, NY 12208; E-mail [email protected]. Copyright © 2002 by the American College of Emergency Physicians. 0196-0644/2002/$35.00 + 0 47/1/122853 doi:10.1067/mem.2002.122853
Study objective: We determine how knowledgeable elderly (>65 years old) patients seen in the emergency department are of their prescription medications. Methods: Patients older than 65 years who presented to the ED of an urban teaching hospital were interviewed concerning their prescription medications and the indications for their use. Medications and dosages were verified through the patients’ pharmacies. Medication indications were assessed for accuracy by referencing the Physicians’ Desk Reference. Results: Data on 88 patients were collected over a period of 2 months. Eleven patients were excluded from the study because of logistics (9) and rescinding of consent (2). Patients averaged 5.9 prescription medications on presentation to the ED. Patients correctly identified 78.4% (359/458) of these medications. Thirty-three (42.8%) patients were able to correctly identify all of their prescription medications. Furthermore, patients correctly identified 65.5% (236/359) of dosages (25 [32.5%] patients named all dosages correctly), 91.4% (328/359) of dosing intervals (44 [57.1%] patients named all intervals correctly), and 83.3% (299/359) of indications (49 [63.3%] patients named all indications correctly). Conclusion: Elderly patients presenting to the ED have only a fair knowledge of their prescription medications. [Chung MK, Bartfield JM. Knowledge of prescription medications among elderly emergency department patients. Ann Emerg Med. June 2002;39:605-608.] INTRODUCTION
Currently, there are nearly 35 million people in the United States who are older than 65 years, comprising 12.6% of the total population. The US Census Bureau estimates that this number will increase to 54 million (16.5%) by the year 2020, making this the fastest-growing age group.1 As the aging of the United States continues,
JUNE 2002
39:6
ANNALS OF EMERGENCY MEDICINE
6 0 5
MEDICATION KNOWLEDGE OF THE ELDERLY Chung & Bartfield
issues of medication usage among the elderly will increasingly come to the forefront. Elderly patients consume a disproportionate share of prescription medications. They take a range of 2.2 to 8.1 prescription medications per person,2-4 which represents up to 3 times as many medications as other age groups.5 Although pharmacotherapy has no doubt led to substantial improvements in the quality of life of the elderly patient, it is certainly not without its inherent dangers. It is estimated that as many as 17% of hospital admissions of elderly patients are caused by adverse drug reactions and allergies, inappropriate medications prescribed by physicians, inadvertent overdoses, and medication interactions.6 Furthermore, the likelihood of adverse outcomes related to medications is increased in the elderly by comorbid conditions, decreased renal clearance, and declining cognitive functioning. Proper understanding and compliance regarding medication usage should be the goal of the physician and patient to avoid medication-related problems. However, several studies of patients seen in medical and surgical clinics suggest that the elderly have relatively poor knowledge of their medication dosage (70% incorrect recall)7 and indication for use (25% inadequate understanding)8 and an even poorer ability in remaining compliant (75% noncompliance).9 Certainly, the potential for catastrophe resulting from polypharmacy and elderly patients’ misunderstanding and misuse of medications is most evident in US emergency departments. The chance of introducing a drug–drug interaction in ED patients is nearly 30% if the patient is taking more than 3 prescription medications, whereas this number decreases 10fold if the patient is taking less than 3 medications.10 Furthermore, the addition of medications to a patient’s regimen leads to increased complexity and decreased medication knowledge.11 The purpose of this study was to assess how knowledgeable elderly patients seen in the ED are of their prescription medications. We were unable to find a study that specifically addresses this issue in ED patients. We aimed to assess, by direct interview of elderly patients, the extent to which they understand their prescription medications, including doses, frequency of use, and indication for use.
annual census of 66,000 visits. Exclusion criteria included patients who were: (1) medically unstable; (2) residents of nursing home or extended care facilities; (3) disoriented to person, place, or time; (4) not currently taking any prescription medications; or (5) unable to recall their pharmacy name. Patients were enrolled as a convenience sample when either the lead author or one other individual (BS, see Acknowledgment) was available. Interviews were conducted from January 2, 2001, through March 1, 2001. Patients were asked the following questions about their prescription medications (including prescription as needed medications): (1) names, (2) doses, (3) dose frequency, (4) indication, and (5) “Has your doctor made any changes in dosage or frequency since the prescription was last filled.” If the patient stated that there had been a change, the dosage that the patient provided was considered correct. Patients were allowed to consult medication lists, prescription bottles, or any companions with them at the time of the interview. Patients were not asked to describe the method(s) that they used to organize their medications. In determining how knowledgeable patients were of medication indications, patients were simply queried, “For what reason do you take this medication?” Indications were referenced in the Physicians’ Desk Reference12 for accuracy. Additionally, patients were required to identify the location of the pharmacy or pharmacies where they obtained their medication. All pharmacies identified by each patient were then contacted by telephone and consent forms were transmitted by fax for release of patient prescription medication lists. These lists were then verified for accuracy against patients’ selfreported medications. If a patient reported that they were taking a medication that could not be corroborated, this was also considered an error. Analyses were largely descriptive. In addition, 2 other analyses were performed: the influence of number of medications taken and age on not being able to name at least one medication. For the age analysis, age was grouped into 5-year increments. Both analyses were performed using χ2 analysis with significance defined as P less than .05.
M AT E R I A L S A N D M E T H O D S
A total of 189 patients were screened for participation. Sixty-one declined, and 40 were excluded for the following reasons: 15 nursing home residents, 15 medically unstable and/or disoriented, 7 unable to recall pharmacy name, 3 not taking any prescription medication. This left 88 patients, with an average age of 76.7 years (SD 0.84
Our institutional review board approved this study. After obtaining informed consent, interviews were conducted on a convenience sample of elderly (>65 years) patients seen in the ED of a tertiary care, urban hospital with an
6 0 6
R E S U LT S
ANNALS OF EMERGENCY MEDICINE
39:6 JUNE 2002
MEDICATION KNOWLEDGE OF THE ELDERLY Chung & Bartfield
years), available for interview. Eleven patients were excluded from the study because of the following reasons: unable to contact mail order or online pharmacy (5), pharmacy out of business (2), refusal by the pharmacy to release information (2), and rescinding of consent (2). The 77 patients included in the study had an average age of 76.6 years (SD 6.9 years) and median age of 76.0 years. Twenty-nine (38%) were men. The study group took 458 prescription medications (including 26 as needed medications), for a per patient average of 5.9 medications (median 6). A total of 359 medications were correctly identified by the study group, for an accuracy of 78.4% (359/458). Thus, each patient omitted an average of 1.3 medications. Twenty-two (84.6%) of 26 as needed medications were correctly identified. Thirty-three (42.8%) patients were able to correctly identify all of their prescription medications. The total number of medications taken influenced this result. Patients taking 1 to 3 medications correctly identified all medications 78% (14/18) of the time, compared with 45% (15/33) of patients taking 4 to 6 medications and 15% (4/26) of patients taking more than 6 medications (P<.01). Age was not found to influence the ability of patients to correctly name all of their medications. Patients between the ages of 65 and 70 years correctly identified all of their medications 63% (12/19) of the time, compared with 56% (9/16) of the patients between the ages of 71 and 75 years, 58% (11/19) of the patients between the ages of 76 and 80 years, and 52% (12/23) of the patients older than 80 years (P value not significant). Patients correctly identified 65.5% (236/359) of dosages (25 [32.5%] patients named all dosages correctly), 91.4% (328/359) of dosing intervals (44 [57.1%] patients named all intervals correctly), and 83.3% (299/359) of indications (49 [63.3%] patients named all indications correctly). Eleven patients erroneously reported that they were taking a medication that could not be corroborated (1 patient reported 2 “extra” medications). Only 12 (15.5%) patients correctly identified all of their prescription medications, dosages, frequency of dosing, and indications. Twenty-three (30%) patients reported that further information concerning their medications would be helpful. DISCUSSION
Previous studies that have examined medication use in the elderly have reflected widespread misunderstanding among this group. Opdycke et al8 determined that there was an average of 5.6 medication-related problems per
JUNE 2002
39:6
ANNALS OF EMERGENCY MEDICINE
elderly patient. These problems included inadequate drug knowledge (25.5%) and inappropriate drug use (17.4%). Blenkiron13 interviewed patients aged 75 years and older in office visits for surgery consultation or at home for routine checkup. This study found that the elderly incorrectly stated the purpose of their medication in 28% of cases and the dosages of 25% of medications. Another study, which evaluated patients in the clinic setting, showed that the elderly had poor knowledge of their medication doses (70% incorrect recall) and indication of use (36% incorrect recall).7 To our knowledge, our study is the first to specifically determine medication knowledge of patients seen in the ED. Consistent with prior studies, our group had a relatively poor understanding of their medications. Furthermore, polypharmacy was prevalent among our patients, with each patient taking an average of just less than 6 medications. Not surprisingly, as the number of medications per patient increased, the likelihood of missing the name of at least one medication also increased. We did not find a similar relationship with increasing patient age; however, it is possible that this is because of insufficient power. Patients reported general satisfaction with information given by their physicians and pharmacists concerning these medications. Our study is not without several limitations. Perhaps most evident is our small sample size. Our convenience sample of 77 patients might not have been representative of our general elderly population. In addition, our results may not be generalizable to other EDs in other settings. Future, larger-scale studies are warranted to more accurately gauge elderly knowledge of their medications. Because the study was limited to elderly patients, it is not possible to draw the conclusion that this population is less knowledgeable than a younger cohort. Furthermore, we did not attempt to correlate medication errors with the type of system that patients used to keep track of their medications. We are therefore unable to comment on the effectiveness of these various systems. In addition, the inclusion and exclusion criteria of the study introduce much potential for selection bias. It is possible that patients who agreed to participate were more knowledgeable about their prescription medications. Patients were excluded if they did not know the name of their pharmacy, were disoriented, or were medically unstable. It is likely that patients excluded for any of these reasons would have had a poorer knowledge of their prescription medications. Furthermore, those patients deemed medically unstable were more likely to have comorbid conditions and thus be taking more prescrip-
6 0 7
MEDICATION KNOWLEDGE OF THE ELDERLY Chung & Bartfield
tion medications. Conversely, those patients with mild to moderate cognitive impairment, despite being oriented, were included in the study. Additionally, interviewees were given much latitude in answering the question: “For what reason do you take this medication?” Although we referenced the Physicians’ Desk Reference12 indications, indications were deemed correct if they were generally relating to the correct organ system. For example, “bad lungs” would be a correct indication for the use of prednisone. Therefore, it is also likely that we overestimated our patients’ knowledge of indications for their medication. The results of our study initially appeared to be very encouraging. One could surmise from our data that the elderly have good knowledge of their medications because they correctly identified 91% of dosing frequencies and 83% of indications. However, on closer scrutiny, this does not provide an accurate picture. On average, patients omitted 1.3 medications, and only 15% could correctly name all of their medications, dosages, frequencies, and indications. This is in agreement with earlier studies of elderly patients seen in surgical and medical clinics, which revealed a widespread misunderstanding of prescription medications. Our study should be considered a reflection of poor communication between patients and their health care providers, the complexity of modern medication regimens, and the passive role elderly patients are taking in their health care. Indeed, only 30% of patients interviewed reported that they would want more information concerning their medications. Educational efforts on the part of physicians, pharmacists, and other health care providers should be encouraged to increase elderly patients’ knowledge of their medication and to help avoid the pitfalls of polypharmacy in the elderly.
6. Colley CA, Lucas LM. Polypharmacy: the cure becomes the disease. J Gen Intern Med. 1993;8:278-283. 7. O’Connell MB, Johnson JF. Evaluation of medication knowledge in elderly patients. Ann Pharmacother. 1992;26:919-921. 8. Opdycke RA, Ascione FJ, Shimp LA, et al. A systematic approach to educating elderly patients about their medications. Patient Educ Couns. 1992;19:43-60. 9. Anonymous. Medication for the elderly. A report of the Royal College of Physicians. J R Coll Physicians Lond. 1984;18:7-17. 10. Beers MH, Storrie M, Lee G. Potential adverse drug interactions in the emergency room. An issue of quality of care. Ann Intern Med. 1990;112:61-64. 11. Hayes KS. Adding medications in the emergency department: effect on knowledge of medication in older adults. J Emerg Nurs. 1999;25:178-182. 12. Physicians’ Desk Reference. 55th ed. Montvale, NJ: Medical Economics Company; 2001. 13. Blenkiron P. The elderly and their medication: understanding and compliance in a family practice. Postgrad Med J. 1996;72:671-676.
Author contributions: MKC and JMB were involved in planning, data analysis, and manuscript preparation. MKC collected the data. JMB performed the χ2 analyses. MKC takes overall responsibility for the paper as a whole. We thank Brett Scudder, BA, for his help with data collection.
REFERENCES 1.
US Census Bureau. Population estimates. Washington, DC: US Census Bureau; 2000
2. Broderick E. Prescribing patterns for nursing home residents in the US. The reality and the vision. Drugs Aging. 1997;11:255-260. 3. Nobili A, Tettamanti M, Frattura L, et al. Drug use by the elderly in Italy. Ann Pharmacother. 1997;31:416-422. 4. Zanocchi M, Ponzetto M, Spada S, et al. Polypharmacy in the ambulatory care of aged patients. Recenti Prog Med. 1999;90:455-461. 5. Kasper J. Prescribed medicines: use, expenditures, and sources of payment. National Health Care Expenditures Study Data Preview 9. DHHS Pub. No. (PHS) 82-3320. Public Health Service. Hyattsville, MD: National Center for Health Services Research; 1982.
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