Aim: to assess the extent to which intentional non-adherence to medical regimes is present in elderly patients.
Method: Self report
Sample: Random Sample, 161 patients, aged 65+, All taking 3 or more drugs prescribed from a general practice. Mean age :76 Range- 65 to 96. 53 were male (33%) and the rest were female. 71% lived alone. Mean number of medicines prescribed was 4.
Procedure: All participants were visited at bom, They were all interviews using a structured questionnaire, they were asked a) which medicines they took b) the dose taken c) how often). Responses were compared with their medical records. Patients were then questioned about any discrepancy between their responses and their records.
Results: There was a discrepancy in 86 cases (53% of sample). In 28 cases the discrepancy was due to an administrative error e.g. wrong prescription recorded. In 3 of these cases it was due to patient confusion. The remaining 55 patients made a rational decision to alter their medication . Overall 92 different medicines were involved. 51 medicinews were no longer being taken by the patients. in 19 cases dosage was adjusted. In 22 cases frequency was adjusted.
Reasons for non adherence:
- Side effects: 17
- Drugs not working: 12 (explain these)
- drug not needed:10
- adjustment to symptoms:17
Discussion: according to this student, the stereotypical image of elderly peoples non adherence to prescribed medication is not due to confusion. They argued that the elderly patients weigh up the cost and benefit of their adherence or non-adherence and showed intentional non-adherence. They believed they were making rational decision about the medication. They concluded, that it was concerning that patients didnt communicate their concerns with there doctors.
Evaluation
Sample:
Advantage(A): fairly represent both genders, large sample, ethnocentric
Disadvantage (D): demand characteristics-self report therefore they may over/underestimate there adherence, Mean age-76 which represent the elderly so its representative.
Validity:
(A): no order effects, good face validity and good temporal validity
(D): Self report so there will be demand characteristics and social desirability, also participant variables will be a issue seen as there is other problems with them and subjective answers.
Reliability:
(A): structured questionnaires so it is standardised
(D): out of date records
Ethics:
(A) protection enhanced and they had consent
Useful:
(A): collect both quantitative and qualitative data so they had patterns and why it happened- went back to find out why. also they proved elderly do make choices.
(D) Not much about the demographic details and you cant generalize them to other groups
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