The aging process is associated with disease states that may be painful, disabling and life-threatening. Elderly patients frequently have more than one disorder and appropriate pharmacotherapy may result in polypharmacy (treatment with multiple drugs). This situation, combined with age-related alterations in the handling of and sensitivity to drugs, predisposes older patients to adverse drug reactions (ADR's). This study was undertaken to assess the actual risks and potential benefits of long-term polypharmacy in the management of elderly hospital out-patients. A particular aim was to get some indication of whether or not polypharmacy was justifiable in the study population. Accordingly, the medical records of 132 ambulatory patients, 70 years of age and over, who had been attending the general out-patient department of a large teaching hospital for a period of twelve months or longer, were retrospectively examined. The patient's age, diagnoses, prescribed medication, ADR's and clinical therapeutic benefit were assessed, recorded and analyzed. The average patient age in the sample studied was 77,6 years. 71% of the sample were females. 419 disorders were identified, giving an average of 3,17 per patient. 603 drugs were prescribed in total, giving an average of 4, 57 per patient. There was no statistically significant association between increasing age and the number of diagnoses per patient or the number of drugs prescribed. Medication was felt to be therapeutically effective in 63% of the patients, whilst an ADR was noted in 14% of the sample. There was no statistically significant difference in the age, number of diseases or number of drugs prescribed between the total group, the ADR group and the non-ADR group. These parameters were therefore not useful in identifying those patients more likely to experience an ADR. The apparent effectiveness of the medication prescribed and the relatively low incidence of ADR' s in the group studied suggests that appropriate and judicious multiple drug therapy can benefit many elderly ambulatory patients and therefore polypharmacy could be regarded as permissible in this context. Apart from these observations, this dissertation also includes recommendations on ways to minimize the incidence of ADRs in the elderly, and areas for ongoing research in this field are identified.

This study examined the behaviors relating to the utilization of prescription and over-the-counter medications in a small group of elderly subjects in the 65 years and over age range. This group was attending an Elderhostel at Western Oregon State College during the summer of 1991, when the information was obtained. The objectives of this study were to ascertain specific medication taking behaviors, and whether or not directions were adhered to as prescribed by physicians for this highly educated group, or if their behaviors were similar to those referred to in the literature for all elderly. A sample of 38 elderly was obtained during an Elderhostel Wellness Vacation at Western Oregon State College in Monmouth, Oregon during July, 1991. Subjects completed questionnaires regarding medication-taking behaviors as part of a wellness class session regarding the safe use of medications. Questionnaires were filled out prior to the class discussion. Data were assembled using one survey instrument with questions relating to medication usage. Descriptive statistics using histograms showing frequency distributions were used for data analysis. Sixty-five percent of this group were taking prescription medications and sixty-eight percent of this group were taking over-the-counter medications. Medications were being obtained from more than one physician and more than one pharmacy. The subjects took fewer doses of medications per day and less medication per dose than prescribed. Medications were discontinued prematurely if feeling better or worse. Leftover medications from previous prescriptions were being taken. Outdated or expired medications were being taken. Alcoholic beverages were being used in conjunction with the use of prescription medications. In some cases, prescriptions were not filled because they were considered to be unnecessary. Recommendations for education and future research in the problematic area of drug use in the elderly include: 1) More time spent by health care professionals to educate the elderly in the correct and safe use of medications; 2) Community health promotion programs targeted at the well elderly; 3) Personalized "brown bag" medication counselling sessions; 4) Medication education programs at Elderhostels throughout the country; 5) Education programs through the American Association of Retired Persons; and 6) Further studies of larger groups of well-educated, healthy and active elderly. / Graduation date: 1993

Thesis (Ph. D.)--University of Adelaide, Depts. of Psychology and Community Medicine, 1992. / Includes bibliographical references (leaves 217-238).

Thesis (Ph.D.)--University of Adelaide, Dept. of Dentistry, 1999. / Bibliography: leaves 249-260.

Introduction: Although drug-related problems (DRPs) are known to be prevalent in elderly patients, there are not many studies that have been performed in geriatric outpatients at public health facilities in South Africa. Thus, the prevalence of DRPs in elderly outpatients attending Addington Hospital was investigated and suitable preventive intervention strategies to overcome or minimise these DRPs were developed. Research Methodology: The study was conducted in two phases. Phase 1 was conducted in March and April 1998, during which 281 elderly patients on chronic medical treatment were chosen for the study by systematic random sampling, according to specific inclusion criteria. Data collection was via a retrospective review of the elderly patient's medical notes and by personally interviewing the patient. Two research instruments were used in this phase. The customised Patient Profile (PF) form helped to delineate DRPs in the elderly patients. A Prescription Intervention Form (PIF) was used to inform the prescriber of the DRP and to make recommendations to change the drug therapy in order to overcome the DRP. In phase 2 of the study, intervention strategies were devised to address some of the major DRPs identified in phase 1 of the study. A patient counselling leaflet, prescribing guidelines for geriatric patients and a protocol for counselling of in-patients were developed. In addition, two DRP reporting systems were developed for surveillance of adverse drug reactions and medication errors during dispensing. Results and Discussions: Most geriatric subjects suffered from multiple, chronic conditions, these being hypertension (64.8%) followed by ischaemic heart disease (43.8%), musculoskeletal disorders (arthritis or gout) (42.7%), diabetes (29.2%), chronic obstructive airways disease (13.2%), hypercholesteremia (11.7%) and arrythmias (atrial fibrillation) (11.0%). The 281 patients were taking 1730 prescribed drugs, with a mean of 6.2 (range 3 to 15) prescribed drugs per patient. An astounding 45.6% of the total geriatric patients were taking or using between 7 to 9 medicines and 10.3% were taking or using between 10 to 15 medicines. The antihypertensives (15.9%) were the most widely prescribed drugs followed by medicines acting on CNS (10.9%), coronary vasodilators (9.1%), diuretics (9.1%) and medicines acting on the musculoskeletal system (8.7%). A total of 856 actual DRPs experienced by 262 geriatric patients (93.2%) ranged from 1 to 11 DRPs. The greater the number of prescribed drugs the greater the actual DRPs experienced by geriatric patients (p = 0.000). The most common DRPs were those involved in drug safety (56.6%); effectiveness of the drug therapy (20.8%); compliance (7.8%) and indication of drug therapy (7.6%). 159 elderly patients (56.6%) experienced 223 adverse effects either with their current or past prescribed medicines. The most common ADRs were as follows: gastro-intestinal ulceration (11.0%), cough (9.3%), diuretic side effects (dehydration, fatigue, hypotension, etc) (7.1%), constipation (6.8%), equilibrium problems (6.4%) and headaches (6.4%). For those DRPs warranting interventions, the mean number of prescription interventions in the entire sample population of 281 elderly patients was 0.65 ± 1.16. 87 elderly patients (30.1 %) had from 1 to 4 interventions on their current prescription. The most common prescription interventions were on problems involving drug therapy monitoring (26.9%), safety of drug therapy (26.5%), indication of drug therapy (17.5%), prescribing errors (15.3%) and prescription information omission (11.1 %). The three intervention strategies and DRPs surveillance reporting systems were successfully devised and developed. Conclusions: A profile related to the elderly patient's medical history and pharmacotherapy was completed for each of the 281 patients. General trends of prescribing pattern prevalence of DRPs and the prescribed inappropriate medication was established. The interventions of problem prescriptions were based on a newly developed PIF. The development and implementation of suitable intervention strategies to minimise DRPs were as follows: a compliance information leaflet, prescribing guidelines and the protocol for counselling in-patients. A medication error form as well as an adverse drug reaction reporting forms was developed for surveillance of DRPs. The recommendations for clinical practice and directions for future research that are presented should help to make drug therapy in the elderly safer and more effective. / Thesis (M.Pharm.)-University of Durban-Westville, 2000.

Bibliography: leaves 249-260. / xvii, 260, [35] leaves ; 30 cm. / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Systematically explores the relationship between medications, dry mouth and dental caries in a longitudinal study of older people. / Thesis (Ph.D.)--University of Adelaide, Dept. of Dentistry, 1999

Elderly people, or those over 65 years of age, are known to comprise 10% of the United States population today and are projected to reach nearly 12% by the year 2000. Further, 5% of this population is reported to be institutionalized resulting in approximately 1.1 million chronic care patients or 0.5% of the population. The use of drugs in this population comprises approximately 25% of the prescription drug market in the United States which is directly related to the greater occurrence of pathological problems associated with the aging process. While it is evident that the beneficial outcome of drug therapies is partially related to the increased longevity observed in these elderly people, this population is also well-known to be the most prone to adverse drug reactions. Factors complicating drug use in the elderly include high usage, chronic therapy, long-term hospitalization, inappropriate and multiple prescribing of drugs, inadequate monitoring of adverse drug effects, susceptibility to physical deterioration and senility. Therefore, the objective of this project is to test the hypothesis that the quality and cost of drug therapy in SNF patients can be significantly improved by implementing measures to improve the utilization of drugs.

The purpose of this study was to assess the effectiveness of communication with elderly mental health clients regarding medication concordance.

Bibliography: leaves 217-238 / xix, 238, [82] leaves : ill ; 31 cm. / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Thesis (Ph.D.)--University of Adelaide, Depts. of Psychology and Community Medicine, 1992