Elderly Health Journal

 Introduction: Physiological changes occurring with aging increase prevalence of chronic diseases in elderly individuals. This situation brings about difficulties in medication use in elderly individuals. This study was conducted to determine knowledge, attitude and behaviours regarding medication use in elderly with chronic diseases.
 
Methods: Participants of this descriptive and cross-sectional study were 124 elderly individuals who were more than 65 years old, applied to Family Health Center in Yalova, Turkey between the dates of January- June 2018. Data were collected with data collection form including individual and disease information, medication use and knowledge, attitude and behaviours regarding medication use.
 
Results: Almost half of the elderly individuals (44.4%) expressed that they used medicine three times a day and 40.3% of them expressed that they used medicine six times and more a day. When the information about medication use of elderly individuals is evaluated, 75% of them stated that they did not receive any information on drug use and 82.3% of them did not know the side effects of drugs. When the attitudes of the individuals were evaluated, it was found that 6.5% of them liked to use medication, 67.7% of them had no dose, and 46% of them had stopped using medication without asking the physician. When the behaviors of elderly individuals were evaluated, 19.4% of them didn’t use their medicines regularly, 46% of them discontinued their medication without asking their doctors, 82.3% of them didn’t know side effect of the medicines, 81.5% of them used medicines without doctor’s advice, 79.8% of them didn’t read medicine usage instructions before using medicines, 12.9% of them kept their medicines in their bags and 55.6% of them kept them in a cabinet.
 
Conclusion: Significant problems such as lack of information about drug use in elderly individuals and self-medication use have been identified.
 

    Aging is addressed as a physiological case and it is defined as loss of physical and psychological powers irreversibly, decrease in potential of organism to balance between internal and external factors and deterioration of the individual’s physically and psychologically (1). Elderly population has been increasing in Turkey and all over the world (2). It is predicted that elderly population will be 8.7% in 2018, 16.3% in 2040 and 25.6% in 2080 in Turkey (3).
    Changes with aging such as decrease in perception and creative abilities, lack of attention, slowing in thinking pace, weakness in short term memory affect course of life (4). Besides, physiological changes occurring with the aging increase incidence of chronic diseases in elderly individuals. This situation leads to difficulties regarding medication use in elderly individuals and the number of medications used and therefore might cause undesired side effects and medication interaction (5, 6). According to 2014 data of Turkey Pharmaceuticals and Medical Devices Agency, it was stated that 23.2% of the prescriptions written in Family Health Centers belonged to individuals over 65 years elderly (7). In addition to this, averagely four to six diseases and use of three to eight different medications in elderly people were observed in the studies (8, 9). Besides, it was stated in the literature that one third of reasons of elderly individuals’ hospitalization stemmed from problems regarding medication use. (6).
    Drug compliance is important in terms of both management of chronic diseases and preventing undesired situations stemming from the medication in elderly individuals. However, it was stated in the literature that drug compliance of elderly people with chronic diseases was insufficient (10, 11). In a study conducted with elderly hypertensive patients, the compliance of the participants with the drug was found to be moderate (12). In another study, the drug use error rate of elderly individuals was found to be 57.7% (13). Factors in elderly individuals such as socio-demographic characteristics, existence of more than one chronic disease, decrease in cognitive capacity, knowledge level regarding medication, the number of medications used, attitude towards medication use, beliefs about medicines, motivation, social support might affect rational medication use behaviors (14, 15). In addition, variables such as education of health professionals, the budget allocated to health, and the culture of the society affect the practices and behaviors related to drug use (16). Healthcare professionals have a significant role in planning and assessment of medication use in elderly people, education of the individual and his family about medication use, effects and side effects. For this purpose, healthcare professionals should firstly assess knowledge and behaviours of elderly individuals about effects, way of usage, hour and dose of medications, their side effects (17).
    This research was done in order to assess knowledge, attitude and behaviours regarding medication use in elderly individuals with chronic diseases. We consider that this study will contribute to the literature with the aim of determining knowledge, attitude and behaviours of elderly individuals in order to draw attention to medication use and provide rational medication use in elderly individuals.
 
Methods
Procedure and sampling
    It was a descriptive and cross- sectional research. Target population of the research was individuals over 65 year’s elderly who applied to Family Health Center in Yalova, Turkey between the dates of 01 January- June 2018. The number of samples was calculated using the sampling method whose universe is known, with a deviation of 0.05 in the 95% confidence interval, with a probability of 50% [Nt2pq/d2 (N-1) + t2pq]. In this sense, 124 elderly individuals who were diagnosed by the doctor with a chronic disease requiring medication use for at least 6 months, were not diagnosed with dementia or Alzheimer’ disease which might affect regular medication use, not having any verbal communication disability and accepted to participate in the study were included in the study.
Data collection tools
    Research data were obtained using a questionnaire form including totally 46 questions prepared by researchers in line with literature review as 11 questions about individual information (age, marital status, educational level, with whom he lived, use of alcohol, smoking and etc.), 4 questions about disease information (disease diagnosed by the doctor, disease duration and etc.), 5 questions about medication use (medications used, duration of regular medication use, the number of medications used daily and etc.) and 26 questions about knowledge (3 questions), attitude (5 questions) and behaviours (18 questions) (liking medication use, using his medications regularly, paying attention to expiration date of the medication and etc.) regarding medication use (4, 8, 18-22).
    Before collecting data, the data collection form was evaluated for clarity by three faculty members who are experts in gerontology. After the data forms were arranged in line with expert opinions, a pilot study was conducted with 20 elderly individuals. As a result of this study, the data collection tool was clearly understandable by individuals and finalized in line with the feedback received.
    Data were collected by researchers with face to face interview method during application of the elderly individual to institution. It took nearly 20-25 minutes to fill data forms.
Ethical considerations
    Before collecting data, written permission was taken from Cumhuriyet University Non-invasive Clinical Studies Ethical Committee (Decree no: 2017-11/01). All of the participants were informed about quality and objective of the research in detail and written and oral informed consents were taken from elderly individuals after assuring confidentiality of their information.
Data Analysis
    Data were interpreted in SPSS 22.0 package program. Arithmetic average, number, percentage distribution and chi square test were used in data evaluation. If the expected value was under 5 in chi square tables, Fisher chi square test was used in tables with four cells and Yates correction chi-square was used in tables with more than four cells.
 
Results
    Age average of elderly individuals was 71.70 ± 5.28 years and 50.8% of them were male and 40.3% graduated from primary education. Economic situation of 62.1% of the participants was medium level, 7.3% of them did not have any health coverage, 18.5% of them lived alone, 14.5% of them were still smoking and 8.9% of them were still using alcohol. Approximately one-tenth of elderly individuals (9.7%) stated that they could not meet their physical needs on their own and 51.6% of them assessed their general health as good level (Table 1).
    Of the elderly, 66.1% had hypertension, 49.2% had heart disease and 33.9% had diabetes and the mean duration of disease was 16.10 ± 9.77 years. 44.4% of them stated that they used medication three times a day and 40.3% of them stated that they used six and more medications a day and 75% of them stated that they did not take any education about medication use (Table 2).
    When the information about medication use of elderly individuals is evaluated; 75% of them stated that they did not receive any training on drug use and 82.3% of them did not know the side effects of drugs.
    When the attitudes about medication use of elderly individuals were evaluated, it was found that 6.5% of them liked to use medication, 67.7% of them had no dose, and 46% of them had stopped using medication without asking the physician, 40.3% of them did not pay attention to way of taking medications on an empty stomach or on a full stomach, 89.5% of them did not pay attention to food or beverages which they need to avoid during medication use.
    When the behaviors about medication use of elderly individuals were evaluated, 19.4% of them didn’t use their medicines regularly, 33.9% of them used reminders for adaptation to medication hours, 17.7% of them did not take their medications on their own, 19.4% of them did not use their medications regularly, 67.7% of them did not take some medication doses, 46% of them discontinued their medication without asking their doctors, 3.2% of them took two medication doses when they missed their medication doses, 58.1% of them took all oral medications at the same time, 96% of them took their medications by drinking water, 82.3% of them didn’t know side effect of the medicines, 86.3% of them did not have any list consisting information about name, dose and taking time of medications, 71.8% of them have medications at home which they did not use although their doctors prescribed them, 81.5% of them used medicines without doctor’s advice, 30.6% of them used medications of other individuals such as friend/ neighbor, 29.8% of them didn’t control expiration date of the medicines, 79.8% of them didn’t read medicine usage instructions before using medicines, 12.9% of them kept their medicines in their bags and 55.6% of them kept them in a cabinet (Table 3).
    When socio-demographic characteristics and regular medication use behaviours of elderly individuals were compared in the study, statistical significance was found between educational level and regular medication use (p < 0.05) and it was confirmed that rates of regular medication use of individuals secondary school and higher education graduate were higher. Any statistical difference was not seen (p > 0.05) among gender, with whom he lived, situation of meeting personal needs on his own and general health assessment and regular medication use (Table 4).