Date of Award

5-2022

Document Type

Dissertation

Degree Name

Master of Medicine (MMed)

First Supervisor/Advisor

Dr. Gulnaz Mohamoud

Second Supervisor/Advisor

Dr. Adelaide Lusambili

Third Supervisor/Advisor

Dr. Njeri Nyanja

Department

Family Medicine (East Africa)

Abstract

Introduction: Life expectancy has increased over the last century amongst older individuals, and in particular, those 60 years and over. The World Health Organization estimates that the world's population of persons over 60 years will rise to 22 per cent by the year 2050. Ageing is associated with increasing disability, multiple chronic conditions, and an increase in the use of health services. Multiple chronic conditions associated with ageing are managed with different medications (polypharmacy) amongst the older population. Polypharmacy has numerous adverse effects including non-adherence, an increased risk of drug interactions with the various medications, reduced appetite, and risk of falls. Studies on polypharmacy and ageing overall are few and poorly understood, especially in low and middle-income countries. Thus, this study aimed to explore the knowledge, attitudes and beliefs of older people towards polypharmacy attending the Family Medicine Clinic at the Aga Khan University Hospital, Nairobi, Kenya.

Methodology: A qualitative study of 15 patients aged 60 years and above, taking more than five medications per day was conducted at the Aga Khan University using Semi-structured in-depth interviews. Three interviews were pilot interviews, and data analysis was performed on 12 interviews. Data were analyzed using NVIVO 12 software. A thematic qualitative analysis was carried out guided by Braun and Clarke's (2006) framework.

Results: The following themes were identified from this study; - knowledge of their co-morbidities and of the medication that older persons take, sources of information about medicines, and storage of the medication, experiences and attitudes of older patients towards polypharmacy both positive and negative, older peoples’ beliefs and their coping mechanisms with polypharmacy. The study participants had good knowledge of their multiple co-morbidities, and the medication they took. Multiple sources of information about the medication were identified, with healthcare professionals, family and friends and the internet being prominent. The patients had positive attitudes towards medication as it enhanced their health and well-being and enabled them to perform their activities of daily living. There was a strong belief among older patients that the medications were necessary for their health. All these factors enhanced compliance with the multiple medications. However, some older patients had negative attitudes due to the pill burden, side effects of the medication, and stigma associated with being ill. Cost of healthcare was a major concern identified. However, most of the patients interviewed relied on insurance to cover the cost of their medication.

Conclusion:In conclusion, older patients deduced that polypharmacy was essential for good health and completion of activities of daily life. However, polypharmacy was associated with increased side effects, that could be mitigated by patient education on their medication. However, some concerns about the side effects of the medication arose among the older patients, which brought about the need for patient education that would ensure that the patients are aware of the medications they take, and their potential side effects. The relationship between the primary care physician and the older patient is an important one, especially in LMICs such as Kenya. This is because many the older patients trust the doctors wholeheartedly to make the best decision about their health and about the medication that they took. This study recommends the use of a Patient centered approach when dealing with polypharmacy in older patients. This will ensure that patients understand their co-morbidities and the side effects of the medication they take. In addition, a recommendation to perform a prescription review at each clinical encounter is important to avoid the use of potentially inappropriate medication. Subsidized healthcare should be offered to older patients to enable them to access quality healthcare.

Download

Share

COinS