GP’s advice on managing tablets for elderly
First of all, remember to take the tablets
70% of all admissions are due to long term conditions and one of the most important reasons that these conditions suddenly need hospital treatment is the fact that the drugs that are used to treat them get forgotten, or taken inappropriately
For example, half of those taking blood pressure tablets will forget to take them, or fail to take them as directed
Yet there is plenty of evidence that those who do take medication as directed live longer (puzzlingly this even applies if the medication being taken is a placebo!)
People will intuitively stop taking medication, sometimes that can be a good thing and it is reassuring that when someone experiences a side effect from medication they will often stop taking it much to the patient’s benefit and the doctor’s relief
However, at the other extreme, important lifesaving drugs can be highly dangerous to stop. HIV and TB will both recur or become resistant if their long term complex treatment regimes are forgotten or messed around with
There has been a lot of research on how patients take drugs and one figure seems constant- the rule of 80’s. 80% of patients will take their drugs for their long term condition for 80% of the time
That is quite an achievement on the part of many patients given the number of drugs that they are prescribed
One researcher worked out that an elderly patient with osteoporosis, high blood pressure, arthritis diabetes and COPD ( chronic bronchitis)- not an uncommon situation – would have to spend 2 hours a day just taking their medication if they stuck rigidly to instructions.
Being on tablets can mean very busy days!
So what can be done to make medicines easier to remember and easier to take?
As far as doctors are concerned, the first rule is to use a once a day drug whenever possible
The fewer doses in a day, the more likely that they are going to be remembered
In addition, some drugs last longer in the blood stream than others, they are more forgiving of forgetfulness and wherever possible, should be used
Smaller tablets are more acceptable to patients and making sure the name is easy to pronounce, or understand also helps
Another point is that the morning is the most ritual part of the day, so putting medication out by a toothbrush, razor, or in the same cupboard as the breakfast cereal, will provide a great reminder to take it
However, even more important is the approach taken by the doctor when prescribing the drug
The most important part of this is the discussion as to why the medication is needed and what it is trying to achieve.
If this is understood and a patient has been involved in and has agreed to the need for the medication then they are far more likely to take it
Finally, there are the devices which are intended to help patient remember their tablets
Some are pillboxes in which tablets can be put to make sure that they are remembered and to avoid that situation when someone is uncertain as to whether they have taken their tablets or not!
There are also the blister sheets which are available from the chemist. These will often need to be paid for as they are not an NHS service
All in all making sure that the right tablets, no more, no fewer are taken regularly can make a big difference to health.
Dr Michael Ingram
Dr Michael Ingram is a full time GP in a large practice in Hertfordshire and has 25 years experience of General practice
Born in Kingsbury in 1957 and educated at Latymer Upper School in London then Charing Cross Hospital medical School. Reading VTS and joined his present practice in 1986.
Member of Hertfordshire LMC and the National LMC Conference Agenda Committee; Associate Trainer in General Practice.He has special interest in Travel Medicine and Member of Faculty of Travel Medicine RCPS (Gla.) . Medical legal expertise and works as a medical expert, writes for the General Practice press and has broadcast extensively.
