Elderly patients' problems with medication. An in-hospital and follow-up study

To examine medication problems during a stay in hospital and after discharge and to identify risk factors that contribute to poor compliance with medication a prospective observational study was carried out in an university-affiliated geriatric hospital and a patients' home.

One hundred and nineteen patients admitted from home to the geriatric hospital underwent a comprehensive geriatric assessment. They were also tested in opening and removing tablets from various common medicine containers. Drug prescriptions before, during and after the hospital stay were recorded. Medication use at home was observed by a member of a hospital-based home intervention team. The patients' reports of their drug therapy was compared with those by their family doctors.

Of all tested patients 10.1% failed to open at least one container. This inability was associated with poor vision, impaired cognitive function and low manual dexterity. Compliance with prescribed medication was associated with cognitive function, ability to handle medication containers, number of prescribed drugs and recent changes in drug prescriptions. Of the patients only 39.5% had stable drug prescriptions during the 3-month study period. Doctor/patient agreement concerning drug therapy was low in all age groups. The agreement rate and patients' knowledge of their treatment was correlated with cognitive function and the number of prescribed drugs.

Patients' ability to open and remove tablets from common commercial packages/containers should be tested routinely during a stay in hospital. Management of medication should be taught and supervised within the first few days after discharge from hospital.