Beliefs about Polypharmacy among Home-Dwelling Older Adults Living with Multiple Chronic Conditions, Informal Caregivers and Healthcare Professionals: A Qualitative Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Participants
2.3. Data Collection
2.4. Data Analysis
3. Results
3.1. Stance Vis-à-Vis the Information Transmitted by Healthcare Professionals—A Continuum between Accepting and Distancing Oneself from Physicians’ Prescriptions
- Interviewer:
- (…) It’s coming back to me now, but I remember that Mrs [IC15] was telling me that she wanted to remove the drugs [from their packaging].
- HP15:
- Yes, so that’s what we do at her place; we leave them in their blister packs and then she takes them out like that, and that allows her to monitor them too, and there you go.
3.2. Day-to-Day Polypharmacy Management—The Effects of Beliefs and Lived Experiences
- IC07:
- As to pain, she waits too long.
- Interviewer:
- She waits too long?
- OA07:
- Yes… listen. If I take it all, in the end, it doesn’t work anymore when it really does hurt.
- Interviewer:
- Right. So, you feel more relief like that, yes?
- OA07:
- But when I’m not in pain, I don’t take it. (…) You shouldn’t take drugs when you don’t need them.
- HP28:
- (…) So, we always try to remove what isn’t absolutely necessary, that’s for sure. The less he takes, the better he is, in general.
- Interviewer:
- So that’s something you discuss with your patients?
- HP28:
- Yes, yes, yes, yes. Then there are those who really cling on to their regular medication, you know? They’re the opposite. I try to remove a drug, and they absolutely don’t want to—for their stomach or things like that. There are some like that. Each person is different. But when it comes down to it, we try to shorten the length of medication prescriptions.
3.3. Turning the Obligation to Manage Medication into an Automatism: Everyday Resourcefulness
- Interviewer:
- What’s your trick for not forgetting them?
- OA02:
- Nothing, it’s just habit.
- Interviewer:
- It’s a habit.
- IC02:
- (Laughs) You’re just so used to it, I think. I don’t know.
- OA11:
- Bah! I take it because I’m obliged to, otherwise you think I’m taking…
- Interviewer:
- Because you have to do it.
- IC11:
- But you are satisfied [with your treatment] at the moment. If you don’t take them, you…
- OA11:
- But if I want to feel as good as I do now, I’m obliged to take that rubbish.
- HP20:
- So, that’s to say it’s to avoid, err, errors or the temptation of taking more. For example, because of his dependence on benzodiazepines—Xanax, for example—it would be annoying if he… (…) went to get something more, some sleeping pills or…
- Interviewer:
- Yeah, yeah, of course. It’s actually a safety measure.
- HP20:
- Yes, although I’ve never felt very comfortable setting up this type of thing. (…) I find that it’s a little bit of a heavy-handed method, but there you go.
- OA25:
- Absolutely nothing at all. You could make me take 50; I’d take them and that would be fine, but I don’t worry about knowing whether it’s going to do me any good or not.
- Interviewer:
- Okay. So, it’s something that you observe from afar, and…
- IC25:
- Do you know what I called my husband when he was young? I still call him that—my carefree beau. He doesn’t care about anything. He’s lucky.
- OA25:
- I am totally indifferent about it.
4. Discussion
5. Study Strengths and Limitations
6. Recommendations for Practice and Research
7. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Participants | Inclusion Criteria | Exclusion Criteria |
---|---|---|
Older adult |
| Unable to speak and understand French |
Informal caregiver |
| Unable to speak and understand French |
Healthcare professional | Designated by the older adult as having a key role in medication management |
|
Socio-Demographic and Professional Characteristics | Older Adults (n = 28) | Informal Caregivers (n = 17) | Healthcare Professionals (n = 13) |
---|---|---|---|
Sex | |||
Female | 11 | 15 | 10 |
Male | 17 | 2 | 3 |
Age | |||
Mean [range] | 81.1 [66–94] | 67.6 [48–86] | 43.8 [28–58] |
Relationship with the older adult | |||
Spouse/partner (%) | 10 (58.8%) | ||
Children (%) | 6 (35.3%) | ||
Daughter-in-law (%) | 1 (5.9%) | ||
Work status or profession | |||
Retired (%) | 28 (100%) | 9 (52.9%) | |
Employed (%) | 0 | 7 (41.2%) | |
Unemployed (%) | 0 | 1 (5.9%) | |
Nurse (%) | 5 (38.5%) | ||
Pharmacist/assistant pharmacist | 4 (30.8%) | ||
General practitioner/specialist (%) | 4 (30.8%) | ||
Number of medicines | |||
Mean [range] | 9.0 [5–21] |
Themes | Description |
---|---|
Stance vis-à-vis the information transmitted by healthcare professionals—a continuum between accepting and distancing oneself from physicians’ prescriptions |
|
Day-to-day polypharmacy management—the effects of beliefs and lived experiences | The way older adults and informal caregivers adhered to the medication prescription depended on their beliefs, based on their individual, personal daily lived experiences about:
|
Turning the obligation to manage medication into an automatism: everyday resourcefulness | Taking polypharmacy was experienced as:
|
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Bieri, M.; del Río Carral, M.; Santiago-Delefosse, M.; Miano, G.; Rosset, F.; Verloo, H.; Pereira, F. Beliefs about Polypharmacy among Home-Dwelling Older Adults Living with Multiple Chronic Conditions, Informal Caregivers and Healthcare Professionals: A Qualitative Study. Healthcare 2021, 9, 1204. https://doi.org/10.3390/healthcare9091204
Bieri M, del Río Carral M, Santiago-Delefosse M, Miano G, Rosset F, Verloo H, Pereira F. Beliefs about Polypharmacy among Home-Dwelling Older Adults Living with Multiple Chronic Conditions, Informal Caregivers and Healthcare Professionals: A Qualitative Study. Healthcare. 2021; 9(9):1204. https://doi.org/10.3390/healthcare9091204
Chicago/Turabian StyleBieri, Marion, María del Río Carral, Marie Santiago-Delefosse, Giorgia Miano, Fanny Rosset, Henk Verloo, and Filipa Pereira. 2021. "Beliefs about Polypharmacy among Home-Dwelling Older Adults Living with Multiple Chronic Conditions, Informal Caregivers and Healthcare Professionals: A Qualitative Study" Healthcare 9, no. 9: 1204. https://doi.org/10.3390/healthcare9091204