Identification of the drug-use behaviors of the elderly living in nursing homes
Clinical Interventions in Aging
Identification of the drug-use behaviors of the elderly living in nursing homes
Ayse Ferdane Oguzoncul 2
emel ercan 1
Evrim Celebi 0
0 Faculty of Health Sciences, Firat University , Elazig , Turkey
1 Department of Public Health, Faculty of Medicine, Firat University Hospital , Elazig , Turkey
2 Department of Public Health, Faculty of Medicine, Fırat University , Elazig , Turkey
PowerdbyTCPDF(ww.tcpdf.org) Objective: As our society ages, the incidence of acute and chronic diseases increases, and so does chronic drug use and polypharmacy. This study was intended to examine the medication behaviors of the elderly who lived in the nursing homes in the Elazig and Malatya provinces, located in eastern Turkey, and in the Kayseri province located in Central Anatolia. Materials and methods: The population of this cross-sectional study included people over the age of 60 years (n=310) who lived in the nursing homes in the Elazig, Malatya, and Kayseri provinces. The entire population was included in the research without sampling, of which 255 (82.2%) people participated. Data were collected using a survey form, and the survey was conducted through face-to-face interviews. The data were reported in numbers, percentages, and averages. Results: Of the studied population, 87.8% were treated through polypharmacy, using various drugs. The most commonly used drugs were antihypertensives (52.2%). Females over 60 years used more polypharmacy than men (p,0.05). Of the elderly studied, 97.3% used drugs as recommended, 95.3% did not know about the side effects of the drugs they used, and 93.7% did not read the prospectuses of the drugs. Also, 82.7% stated that their drugs did not have any side effects and 70.2% said that the health care personnel did not educate them about their drugs. Of the elderly who were informed about their drugs, 55.3% obtained the information from the nurse and 44.7% from the physician. Of the elderly, 51.3% received education on the duration they would need to take the drug, 30.3% were educated on the intended use of the drugs, 7.9% received education on their drug dose, and 6.6% were educated on the side effects of the drugs. Conclusion: The results of this study showed that the majority of the elderly studied used more than one drug (polypharmacy) and the most used drug group was antihypertensives.
approaches play an important role in managing the chronic
diseases in the elderly.6 Within the general population, elderly
people make up a significant segment of those taking drugs.
The higher the prevalence of chronic diseases, the more drugs
the old individual has to use. Also, the cost of drugs increases
with the age of the individual. However, sociodemographic
factors, such as age, gender, and education, play an important
role in drug requirement and use.7–10
Polypharmacy, as addressed in most studies, could be
defined as the use of more medicines than the clinically
required ones or the use of five or more medications at the
same time during treatment. It is a health problem that is more
common and significant during old age and especially harmful
when the patient uses multiple drugs or high dosage of drugs
for a long time. Because of the illnesses that require more and
long-term medications for old people, polypharmacy increases
with age.11 Previous research shows that almost 50% of the old
adults use one or more drugs, even when this is not medically
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/sw laon able to procure them, 3) good communication between the
h ep patient and the doctor/nurse, 4) the frequency of receiving
from roF medical consultation, 5) patients’ levels of knowledge about
de their drugs, and 6) their adherence to the recommended dose.6
laod The fact that there is no adequate information about the
agenow associated pharmacodynamic and pharmacokinetic effects
idgn caused by drugs, polypharmacy, side effects of drugs, and high
gA cost of drugs, as well as the fact that health care personnel do
isnn not receive adequate education about geriatric treatment and
itno care, raises the importance of drug use in the elderly.12,13
trvee This research was intended to identify the medication
lIna behaviors of the elderly who lived in the nursing homes in
iilcn the Elazig and Malatya provinces located in eastern Turkey
C and the Kayseri province located in Central Anatolia.
Materials and methods
The population of this cross-sectional research included
people over the age of 60 (n=310) who lived in the nursing
homes in the Elazig, Malatya, and Kayseri provinces. The
study, which was conducted without sampling, included
255 people (82.2%) who agreed to participate in the research.
Of the population, 55 people were excluded from the research
due to declining the interview, failure to cooperate, and visual
and auditory dysfunction that would hinder
communication. Data were collected using a survey form which was
prepared through a literature review. The participants had
been informed about the survey and the research beforehand,
and the survey was completed by the researcher through
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face-to-face interviews. Written informed consent was
obtained from the participants.
The relevant drugs were classified based on Nobili et al’s
“Anatomical Therapeutic Chemical Classification System”.14
The symptoms and side effects of the relevant drugs were
questioned based on the patients’ expressions.
The study was approved by the Research Ethics
Committee of Fırat University Faculty of Medicine Non-interventional
Clinical Researches Ethics Board and the Turkish Social
Service and Children Protection Institution (Sosyal Hizmetler
ve Çocuk Esirgeme Kurumu, SHÇEK).
After the necessary permissions had been obtained, the
fieldwork of the research was completed in three months
between April and June of 2010.
The obtained data were evaluated using a statistical
software package and expressed in numbers and percentages,
and p,0.05 was regarded to be significant.
The mean age of the elderly (N=255) included in this study
was 72.70±8.26 years (min: 60, max: 100), and it was
determined to be 72.99±9.31 years (min: 60, max: 100) for males
and 72.55±7.65 years (min: 60, max: 95) for females.
Of the old people studied, 64.7% were males, 38.5% had
graduated from an educational institution, and 36.5% did not
have any social security.
The most widely used drugs by the elderly who
participated in the study were as follows: antihypertensive drugs
(52.2%), analgesic and anti-inflammatory drugs (43.1%),
gastrointestinal tract drugs (20.8%), and cardiovascular
system drugs (14.9%) (Table 1).
Of the elderly who participated in the study, 87.8% (n=224)
were treated through polypharmacy and 98.4% reported that
the drug classes used by the elderly (Table 1). Previous
studies also suggested that antihypertensive drugs ranked
first among the drug classes used by the elderly, and they
were followed by analgesic drugs and endocrine system
drugs.12,15 These results are in accord with the findings of
the present study. Since hypertension is widely observed
among the elderly, it is expected that antihypertensive drugs
rank first. Also, the fact that the occurrence of diseases such
as osteoarthritis increases with age explains why analgesic
and anti-inflammatory drugs rank second. A study on the
old population conducted in a different country suggested
that the most widely used drugs included antihypertensive,
antiarrhythmic, hypnotic, and sedative drug classes.10
The present study found that the rate of polypharmacy
was higher among the female elderly (43.3%) than that of the
male elderly (p,0.05). Similar results were achieved in the
studies conducted by Arslan et al7 and Seçkin et al.16 There
was no significant difference in the average age between the
genders. The difference between the findings related to
genders was the result of the responsibilities of females regarding
status in social life, childbearing, and maternity.
Of the elderly who participated in the study, 87.8%
were treated through polypharmacy. According to a study
conducted by Arslan et al in the nursing homes located in
23 provinces, 71.8% of the elderly were treated through
polypharmacy.7 The studies conducted by Seçkin et al,16
Bayik et al,17 and Disçigil et al18 found that polypharmacy
was widely observed. de Oliveira and Novaes10 determined
that each elderly person used five drugs, on average. These
findings were compatible with the present study. The
epidemiological studies found that polypharmacy among
their drugs had been recommended by the physician. Of the
elderly, 97.3% used their drugs as recommended.
A higher proportion of females were used through
polypharmacy than males (p,0.05).
Table 2 indicates the distribution of drug-use behaviors
of the elderly who participated in the research by gender.
Of the elderly, 95.3% reported that they did not know
about the side effects of their drugs (Table 3).
Of the elderly who participated in the study, 93.7%
(n=239) did not read the prospectuses of the drugs. Table 4
indicates the reasons for the elderly people not reading the
prospectuses. Of the elderly, 41.2% considered reading
prospectuses to be unnecessary.
Of the elderly, 82.7% reported that their drugs did not
have any side effects (Table 5).
Of the elderly, 70.2% reported that the health care personnel
had not informed them about the drugs they used (Table 6).
Of the elderly who were informed about the drugs they
used, 55.3% obtained the information from the nurse and
44.7% from the physician (Table 7).
Of the elderly, 51.3% (n=39) received education on the
duration of drug use, 30.3% (n=23) were educated on the
intended use of the drugs, 7.9% (n=6) received education
on their drug dose, and 6.6% (n=5) were educated on the
side effects of the drugs.
In the present study, antihypertensive drugs ranked first and
analgesic and anti-inflammatory drugs ranked second among
Knowing about side
the elderly was three or four times more common than
it was among the young population. This frequency of
polypharmacy increased drug interaction risks as well as
According to the present study, 98.4% of the elderly
took drugs on the advice of the physician. The study
conducted by Bayik et al17 found that 84.2% of the elderly
continued to consistently use a drug on the advice of the
physician. This is because the elderly in nursing homes
are always under the supervision of a physician. They can
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frohm roepF the appropriate dose and during the period recommended
de by the physician, unless the medicines are taken without
lado consulting the medicines of the patients in our country or
onw storing medicines at home. Storing medicines at home or
dg similar complaints were found to be common non-rational
ignA drug use problems.19
isn In the present study, almost all (97.3%) of the elderly
itonn living in the nursing homes took the recommended dose of
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associated with the fact that they are provided with adequate
professional support for regular drug use. Erturk20 found that
74.0% of the elderly did not take their drugs as recommended.
Age-associated physical defects and various
accompanying chronic diseases affected the drug-use behaviors of the
elderly in this study.
Of the elderly, 95.3% did not know about the side effects
of drugs they used. Similarly, another study reported a high
rate as well regarding this relevant issue.13 Eski and Pinar21
found that a high proportion (94.2%) of the elderly did not
know about the side effects of the drugs. This finding is in
accord with our study. Thus, the elderly did not have adequate
information about the side effects of the drugs they used.
Of the elderly included in the research, 93.7% did not
read prospectuses. Solmaz and Akin15 found that 80.8%
did not read prospectuses, and Arslan and Eser22 found that
81.7% did not read prospectuses. These findings support the
present study. Of the elderly who did not read prospectuses,
41.2% did not consider this activity to be necessary, 29.8%
did not understand the words, 16.5% were illiterate, and 6.3%
had visual impairment. Solmaz and Akin15 and Arslan et al7
reported similar results. Based on these findings, the text of
the prospectuses, except for their terminological meanings,
should be expressed in a plain language. The research
findings also showed that a great majority of the elderly did not
consider reading prospectuses to be necessary.
The present study found that the drugs used by the elderly
did not cause any side effects (82.7%). Similarly, in the study
conducted by Arslan et al,7 73.3% of the elderly reported that
their drugs did not cause any side effects. On the other hand,
in the study conducted by Solmaz and Akin,15 90.8% of the
elderly reported that their drugs did cause side effects. This
finding is not in accord with the present study. The
differences among the research findings may be the result of the
individual characteristics of the elderly, their diagnoses, the
number of drugs they used, and the drug types.
In the present study, 70.2% of the elderly did not obtain
information about the drugs they used from the health care
personnel. Similar to the present study, the study conducted
by Eski and Pinar21 found that 62.5% of the elderly were not
informed about the drugs they used. On the contrary, high
rates of obtaining information about the drugs used by the
elderly were observed in the studies conducted by Solmaz
and Akin15 and Dolu.23
In the present study, of the elderly who received
information about the drugs they used, 55.3% obtained the
information from the nurse and 44.7% from the physician.
Hacıhasanoğlu et al24 reported that 65.0% of the elderly
obtained this information from the nurse and the physician.
The results of the previous studies were unlike that of the
present study. This information was found to be provided
mostly by the physicians.22,23
The prevalence of disability and chronic disease is higher
among the individuals living in nursing homes than the
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individuals living in other segments of society. Therefore,
this study may not represent the drug use among the elderly
living outside of nursing homes. Since the occupancy rate
in the nursing homes located in the study region is low, the
number of subjects also comprises a limitation of the study.
In addition, the fact that we cannot know if nursing home
residents remember or not the medication they have and we
cannot evaluate their knowledge level about the side effects
of the medication is among the other limitations.
Conclusion and suggestions
The results of this study showed that the majority of the
elderly studied used more than one drug (polypharmacy) and
the most used drug group was antihypertensives.
The study concluded that the elderly should be under the
supervision of the nurses in order to be compliant with taking
drugs, and for understanding why the drugs are given. This
is important because the majority of the elderly are treated
through polypharmacy. They should be informed by the
physician and the nurse about the importance of drug use in the
treatment of their diseases. Also, the text of the prospectuses
and that on drug containers should be printed in large fonts so
that they can be read by the elderly. Drug companies should use
words that the elderly can understand. Also, the elderly should
be educated on the importance of reading the prospectus.
Dr Ayse Ferdane Oguzoncul provided her experience on
data analysis and advised throughout the study. She did data
crunching and evaluation, and commented on the results.
Ms. Emel Ercan did surveying on the field and data
analysis, and wrote the manuscript together with Dr Oguzoncul.
Dr Evrim Celebi participated in writing both the manuscript
and the proposal. All authors contributed toward data
analysis, drafting, and critically revising the paper, and agree to
be accountable for all aspects of the work.
The authors report no conflicts of interest in this work.
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