The majority of the participants visited the acute hospital based on their physician’s referral (n=75, 53%), whereas five received acute care based on their home care workers suggestion. The main reasons for their visits were somatic symptoms or disease (n=124, 88%) and accident or injury (n=23, 16%). The subjects’ length of stay in the emergency department varied from a few hours (n=24, 17%) to three days (n=1). Visits usually lasted for 24 hours (n=113, 80%) and the most common reason for the length of the hospital treatment was to follow up on the participant’s condition (n=127, 90%). Eight subjects (6%) were waiting in the emergency
department because their primary care institution could not take more patients but after the follow up, they were discharged. Only 20 (14%) of the participants used a safety phone at home.
Revisits to the acute care unit were rare among participants; six of them (4%) returned to the same acute hospital after the first interview within 24 hours. However, over half of the participants reported that their last healthcare visit was within the same month (within a week, n=24, 17%; within two weeks, n=18, 13%; and within a month, n=33, 23%) (Table 14). The last health-care visit was most frequently at the participant’s own health centre (n=79, 56%) and for a control visit (n=75, 53%).
Table 14. The last healthcare visit of older people (n=141)
Time n %
In a week 24 17
In two weeks 18 13
In four weeks 33 23
In 12 weeks 19 14
In 24 weeks 27 19
In 52 weeks 4 3
Cannot remember 16 11
After the first interview 32 (23%) of the participants visited the health care centre within a week according to the medical records (n=129), usually for a follow-up visit after the emergency department unit visit.
5.3 OLDER PEOPLES´ SELF- MANAGEMENT OF THEIR MEDICATION
Over half (n=97, 69%) of the respondents (Table 15) answered that they had total responsibility for their own medication management; that is, they independently bought and dosed themselves with medicines.
Table 15. Older peoples´self-management of their medication (n=141)
n %
Total responsibility Him/herself 97 69
Partly him/herself 17 12
Relative 13 9
Homecare 3 2
Unclear 11 8
Buying medicines Him/herself 94 67
Relatives 34 24
Homecare 13 9
Use of dosing machine Yes 61 43
No (and no one to help) 67 48
No (and somebody else gives the medicine) 13 9
The patients’ descriptions of their illnesses and medications showed disparencies when they were compared to the information in their medical records (Table 16).
Patients reported more diagnosed illnesses and prescribed medicines than were recorded in their medical records. The biggest differences were in mentioning mental illness and insomnia and the medicines for those. There was also no record about possible OTC medication, complementary, or alternative medication and the use of herbal products in their medical records.
Table 16. Illnesses and medications prescribed regularly according to the older peoples´ own descriptions as recorded in the interview (n=141) and reported in medical records (n=129) __________________________________________________________________________________
Illness and medication Mentioned by patients in the interview Reported in the medical record Illness n (%) Medication n (%) Illness n(%) Medication n (%)
Cardiovascular disease 113 (80) 116 (82) 97 (75) 96 (74)
Muscoloskeletal disease 92 (65) 51(36) 16 (12) 6 (5)
Metabolism disease 34 (24) 34 (24) 28 (22) 23 (18)
Neurological disease 52 (37) 25 (18) 31 (24) 21 (16)
Cancer 16 (11) 6 (4) 13 (10) 4 (3)
Mental illness / insomnia 68 (48) 52 (37) 5 (4) 23 (18)
Other illness 93 (66) 45 (32) 58 (45) 49 (38)
Other medication 0 41 (29) 0 38 (29)
5.3.1 Cardiovascular disease and medication
A total of 113 (80%) of the participants were diagnosed with a cardiovascular disease (Table 16). Two (1%) participants did not know if they had a cardiovascular disease, and three (2%) did not remember if they had a cardiovascular disease. Nearly all (n=113) 102 (88%) remembered the name of their cardiovascular disease. Regular medication for cardiovascular disease had 116 (82%) of the participants (Table 16), and three (2%) of participants had on demand medication. Altogether, the participants mentioned 76 different kinds of prescribed cardiovascular disease medicines that were sold by pharmacies as medicine. The most commonly used medicines were ACE inhibitors and beta blockers. Over half of the participants (n=71, 61%) remembered their cardiovascular disease medicine (n=116) dosage by heart, 47 (41%) of the participants checked the dosage from the prescription and 24 (21%) did not remember their dosage at all. Only six (4%) of the participants reported the wrong medicine as a cardiovascular disease medicine. However, 16 (11%) of the participants mentioned a medicine whose origin remained unknown.
5.3.2 Musculoskeletal disease and medication
A total of 92 (65%) of the participants had a musculoskeletal disease (Table 16). Three (2%) participants did not remember if they had a musculoskeletal disease or not;
eight (9%) of the participants (n=92) did not remember the name of the musculoskeletal disease; 51 (36%) of the participants had regularly prescribed medication (Table 16), and 16 (11%) used on demand medication. The most
commonly used prescribed musculoskeletal disease medicines were different kinds of painkillers. The wrong medicine as a musculoskeletal disease medicine was reported by 4 (3%) of the participants. The dosage of the musculoskeletal disease medication (n=51) was remembered by heart by 41 (80%) of the participants, 14 (27%) checked it from the prescription and 8 (16%) did not remember the dosages.
5.3.3 Metabolism disease and medication
Metabolic disease was diagnosed in 34 (24%) of participants and the same amount (34, 24%) of participants were on regularly prescribed medicines (Table 16). Five (4%) participants did not remember if they had a metabolic disease or not. The name of the metabolic disease was not remembered by 8 (24%) of the participants (n=34), and 23 (68%) of the participants did not remember the name of the medicines. Products that included insulin were usually called “insulin,” and were not referred to by the trade name. The most common metabolic disease medicines were prescribed for diabetes. Over half, 20 (59%) of the participants (n=34) remembered the dosage for their metabolic disease by heart, and 10 (29%) checked it every time from the prescription.
5.3.4 Neurological disease and medication
Neurological disease was diagnosed in 52 (37%) of the participants (Table 16). Four (3%) participants did not remember if they had a neurological disease or not and the name of the neurological disease was not specified by eight (15%) participants (n=52) Regularly prescribed medicines had 25 (18%) of the participants (Table 16) and two persons (4%) were using on-demand medication. The name of the neurological medicine (n=25) was forgotten by 9 (36%) of the participants. The dosage of the neurological medicine was forgotten by 6 (24%) of the participants, while 15 (60%) checked it from the prescription. Medicines for arteriosclerosis were the most common mentioned prescribed medicines that were mistakenly mentioned (n=7, 5%) with regard to neurological disease.
5.3.5 Cancer and medication
A total of 16 (11 %) of the participants had cancer (Table 16), while five persons (4%) did not remember if they had cancer or not. Usually the medicines were called
“cytotoxic drug” or “injection.” Six participants (4%) had regularly prescribed medication (Table 16). The dosage was usually checked from the prescription.
5.3.6 Mental illness, insomnia and medications
A total of 68 (48%) of the participants reported suffering from mental illness or insomnia (Table 16). The most commonly mentioned problems were insomnia (n=68, 48%) and depression (n=27, 19%); 52 (37%) of the participants were on regularly prescribed mental illness or insomnia medication (Table 16) and nine (6%)
participants used on-demand medication. The dosage was forgotten by 7 (13%) of the participants (n=52), while 15 (29%) of the participants always checked the dosage from the prescription. The most commonly used medications prescribed for mental illness were hypnotics; anxiolytics were used by five persons (10%) and antidepressant medication by six (12%). One of the older people was on antipsychotic medication. When asked about insomnia medicine, 47 (33%) of the participants mentioned they had been prescribed hypnotics or sedative medication for the complaint.
5.3.7 Other illnesses and medication
In addition to the above-mentioned medication and illnesses, 93 (66%) of the participants had another illness, or illnesses that their physician had diagnosed (Table 16). Four (3%) participants did not remember if they had any other illnesses.
Regular medication for other illnesses was used by 45 (32%) of the participants, and on-demand medication was used by three people (2%). Altogether, the participants used 47 different kinds of other illness medicines. Gastrointestinal medicines (n=14, 30%) and medicines for chronic obstructive pulmonary disease or asthma (n=13, 28%) were typically mentioned as other illness medicines (n=47). Falls (n=23, 25%) and cataracts (n=16, 17%) were the most frequently mentioned other illnesses (n=93) or symptoms without medication.
Other medication
A total of 41 (29%) of the participants described another prescription medication not mentioned in their medical records while 7 (5%) of the participants did not remember if they had another medication. The other prescribed medications were mostly anti-inflammatory and other painkillers (n=13, 9%), anxiety drugs (n=3, 2%) and cardiovascular system medication (n=4, 3%).
OTC, complementary and alternative medications and herbal products
The participants were also asked about the use of OTC-drugs and complementary and alternative medication and the use of herbal products. Over half, 85 (60%) of the participants used those products. Six participants (4%) did not remember if they were using OTC medicines, and two (1%) participants mentioned prescription medicine as an OTC medicine. Altogether, the participants took 41 different kinds of OTC medicines, complementary and alternative medication and herbal products.
The most often used OTC medications were vitamins, minerals and painkillers. The use of herbal products was also quite common.
There were no mentions of possible OTC medication, complementary or alternative medication and the use of herbal products in the participants’ medical records.
5.3.8 Refusal to take the prescribed medication
A total of 38 (27%) of the participants had refused the prescribed medication. The most common reason for refusal was due to the physical side effects (n=17, 12%) caused by the prescribed medicine, a common reason for the participants’ (n=17, 12%) unwillingness to use prescribed medicine. The most frequently refused medications were insomnia and sedative medications. Osteoporosis medication was also mentioned a few times. Other reasons for the refusal of medication included a lack of need, a willingness to use only prescribed medicine from familiar physicians, and expense. Four (3%) participants mentioned they had already forgotten their reason for refusing medication.