News Centre

27 Sep 2007

CUHK Discovers Poor Drug Compliance among the Elderly

27 Sep 2007

Advances in technology and medicine have significantly extended life expectancy. Consequently, Hong Kong, and many other countries around the world, are experiencing aging populations (age 65+). In the past 10 years alone, the percentage of elderly aged 65 and above in Hong Kong has increased from 10.1% to 12.4% of the total population. Three districts in particular have substantially higher elderly populations (65+): Wong Tai Sin (17.8%), Sham Shui Po (16.7%) and Kwun Tong (16%). Some elderly were found to be suffering from either single or multiple chronic diseases with hypertension, diabetes mellitus, dyslipidaemia and heart disease being the most common diseases. HKSAR Government population predictions show that by 2024 one in five of Hong Kong citizens will be 65 years of age or older. As a result, demand for medical services to care for Hong Kong’s aging population is rising rapidly.

To investigate the current health care needs of the elderly, the School of Pharmacy of The Chinese University of Hong Kong, along with the Pharmaceutical Society of Hong Kong, recently completed an elderly pharmacy outreach program in the Wong Tai Sin district. The outreach program also served as a pilot study to investigate pharmacists’ roles in community, and to collect data on the demographics, comorbidity and drug-related problems faced by the elderly. The study was conducted between mid-July and the end of August. A total of 304 elderly citizens, averaging 76 years of age, were questioned in five elderly centres on Saturday afternoons during the period. The program consisted of a presentation conducted by pharmacy students on the proper use of medications, a health checkup by qualified nurses, individual pharmacist consultation and a satisfaction survey to collect feedback from the elderly.

We discovered that three major chronic diseases were prevalent among the elderly, namely hypertension, diabetes mellitus and dyslipidaemia. We also found that around 75% of the elderly were on medication, and among them 21.8% were taking five or more medicines, which raised their vulnerability to the dangers of polypharmacy and drug-related problems. Polypharmacy (the concurrent use of 5 or more medications, resulting in too many or unnecessary medicines at dosages or frequencies higher than therapeutically essential) can result in non-adherence and can cause adverse drug reactions, drug-drug interaction, increased risk of hospitalization, medication errors and increased cost.

Only 40% of elderly said they were aware of side effects of their medications. It is important that the elderly have some knowledge about their medications to improve medication adherence and treatment outcomes. In addition, 28% of the elderly reported adjusted dosages on their own or stopped taking their treatment regimen completely. By adjusting dosages on their own, the elderly decreased the efficiency of their medications and expected outcomes based on clinical data. Furthermore, physicians could not accurately evaluate patients’ development, because they had not adhered to the original therapy prescribed. Only a small percentage of elderly discarded expired (34.7%) and obsolete (12%) medications. Storing obsolete and expired medications can confuse patients’ current prescription regimen and lead to medication errors. Almost one-quarter of subjects were identified as having drug-related problems resulting from improper storage of medications, including emergency medication, and nitroglycerin tablets for chest pain. Subjects also reported storing multiple medications in the same container, which is dangerous since most drugs look alike. Even medical professionals have difficulty identifying unlabelled pills, let alone elderly patients.

In monitoring their health, the program identified that 39% of patients suffering from hypertension and diabetes did not reach their target blood pressure. Some 12% of subjects claimed that they did not have hypertension but conceded that they had high blood pressure. In addition, 31% of elderly had a high body mass index. Hypertension and obesity are both cardiovascular risk factors that increase the risk of heart attack and stroke.

Based on the observations of this pilot study, we concluded that improvements can be made in the disease management of elderly subjects in the community, with pharmacists being able to contribute to all the following areas. We urge both the government and policy makers to pay more attention to this problem and to strengthen support of health management services for our elderly.



1. Polypharmacy

‧Avoid unnecessary medications by checking with pharmacists and communicating with physicians

‧Pharmacists can be the bridge between patients and physicians

‧Provide tools to assist in medication adherence such as pill boxes, patient specific calendar and dairy

2. Lack of drug knowledge

‧Enhance knowledge of drugs by providing systematic patient education using innovative educational tools

‧Increase patients’ confidence in therapy with better understanding of their current medications

3. Self adjusted/self terminated regimen

‧Stress the importance of medication adherence for better clinical outcomes

‧Explain the consequences of not adhering to a treatment regimen

‧Provide patients with appropriate information for disease management and medication adherence

4. Storage problem

‧Educate patients of the consequences of poor medication storage

‧Stress the problems of overstocking unnecessary medications

5. Inadequate blood pressure control

‧Explain the fundamentals of hypertension and its management to patients in terms that patients can understand

‧Provide patients educational materials as needed to clarify concepts

‧Advise them on modifying their lifestyle

6. Obesity

‧Explain the fundamentals of obesity and its management to patients in terms that they can understand

‧Advise them on modifying their lifestyle