摘要:

Noncompliance is not a specific problem of old people but extremely important for them and for their doctors. This statement refers primarily to therapeutic compliance (or adherence) but also to preventive compliance – adherence to recommendations and medical advices dealing with disease prevention and early detection. The basic psychological concept undoubtedly is: compliance behavior is determined by positive expectations of the patient towards the recommended actions of treatment. To maintain compliance behavior these positive expectations have to be experienced by the patient. The scientific literature does not show compliance, generally being less in older people than in younger patients; nevertheless, a number of studies show age-correlated changes in factors which influence compliance. Older people more often have contacts with the medical system, increasing morbidity is the most important reason. In a representative survey performed in Austria, 64% of the respondents of the age group 60–69 reported drug treatment, 19% a medically caused dietary regimen. Older patients very often take different drugs on a regular basis, this is one of the reasons for possible noncompliance or other behavioral errors. The following factors are especially important for the compliance problem in old age: (a) reduced memory capacity, increased forgetfulness; (b) lack of assistance by family members when living single; (c) impaired doctor-patient relationship (semantic problems, intellectual capacity). Compliance is the main problem of hypertension management, Austrian studies show, for example, (a) that there is also the question of doctor’s compliance with therapeutic recommendations which are not applied by a considerable percentage of them, and (b) that frequent contacts of older people with doctors improve health knowledge (one important factor in compliance behavior), this can be demonstrated by the fact that 70% of all men and 84% of all women of age group 60–69 at least know one indicator of their blood pressure. Improved compliance in old age could be reached by measures like these: (a) simple treatment schemes; (b) individual and age-adjusted information as well as application of new information techniques (intra- and extramural) including simple instructions for everyday use with definite reminding techniques, and involvement of family members and other contact

ISSN:0304-324X    

DOI:10.1159/000212579

出版商:S. Karger AG    

年代:1982

数据来源: Karger

摘要:

The prescription of drugs is the first step towards the factual realization of a therapeutic goal. In order to arrive at this step the physician deals with three conceptually distinguishable levels of decisions: The first comprises the evaluation of physical and mental health and the assessment of social crises often closely interrelated in elderly patients. Thus, in defining the therapeutic goal the interactions on the system level have to be considered. A hierarchy of therapeutic steps is established from vital over necessary to desirable medication and judged in the light of effectiveness and necessity (e.g. oral antidiabetics are effective but often not necessary, drugs improving cognitive function are desirable but probably not very effective). The second level deals with the pharmacological aspects of medication taking into account increased biological variance, altered pharmacokinetics, interactions and side effects of drugs, particularly adverse effects on cognitive functions (e.g. anticholinergic effects, sedation) or injury potential (e.g. orthostatic hypotension, arrhythmias) and danger of self-medication. The third level deals with communication. The physician has to communicate the therapeutic goal to the patient. The patient has (a) to understand and (b) to agree to the therapeutic goal. The physician has to ascertain that the patient is able (number of drugs, time of intake, galenic properties of drugs, help by family members, etc.) to follow the medication. Finally the physician has to accept that noncompliance is a form of constructive criticism by the patient signalling that (a) the therapeutic goal is inadequate or not perceived by the patient; (b) the chosen medication is unsuitable (e.g. digitalis intoxication), or (c) the reality orientation of the patient is insufficient in order to follow the prescription. The conceptual framework may be summarized by the following guidelines: (1). Establish the most accurate diagnosis achievable! (2) Define the therapeutic goal! (3) Establish the hierarchy of medication required to treat! (4) Select appropriate means to communicate aim and medication to patient: prescribe minimal number of drugs and tablets, ask for medicine prescribed by other physicians, and plan drug holidays! (5) Accept noncompliance as feedback to improve your therapeutic goal!

ISSN:0304-324X    

DOI:10.1159/000212580

出版商:S. Karger AG    

年代:1982

数据来源: Karger

ISSN:0304-324X    

DOI:10.1159/000212581

出版商:S. Karger AG    

年代:1982

数据来源: Karger

ISSN:0304-324X    

DOI:10.1159/000212582

出版商:S. Karger AG    

年代:1982

数据来源: Karger

ISSN:0304-324X    

DOI:10.1159/000212583

出版商:S. Karger AG    

年代:1982

数据来源: Karger

ISSN:0304-324X    

DOI:10.1159/000212569

出版商:S. Karger AG    

年代:1982

数据来源: Karger