EVALUATION OF THE AWARENESS AND ATTITUDE TOWARDS POLYPHARMACY AMONG ELDERLY AT ST. LUKE, UYO, AKWA IBOM STATE.

CHAPTER ONE

INTRODUCTION

1.1 Background of the study

Older individuals tend to be more vulnerable to ailments like hypertension, diabetes, and arthritis, which generally necessitate ongoing medication management. Nonetheless, this inclination towards numerous prescriptions has presented new challenges, particularly regarding medication safety, effectiveness, and patient adherence (Hajjar et al., 2007; Gnjidic et al., 2012; Charlesworth et al., 2015). Research indicates that the likelihood of adverse drug events (ADEs) and drug interactions escalates significantly with the quantity of medications administered, highlighting the necessity for enhanced awareness and informed perspectives among elderly patients regarding their medication management (Fick et al., 2011; Moriarty et al., 2016; Kaufman et al., 2015). The administration of multiple medications, commonly referred to as polypharmacy, may result in adverse effects, and certain medications are recognised for their potential interactions with one another (Balducci et al., 2016; Jørgensen et al., 2018). Older patients are more prone to polypharmacy than other age demographics, as they often contend with a greater number of medical conditions that necessitate medication management. The use of multiple medications among older adults presents considerable challenges to health; nonetheless, evading this issue proves to be complex (Lapi et al., 2020; Jørgensen et al., 2018)

The definition of polypharmacy remains a subject of debate, as there is no universally accepted meaning for the term. Nevertheless, the concept of polypharmacy can be defined from various perspectives. According to Hajjar et al. (2017), polypharmacy is defined as “the use of multiple medications and/or the administration of more medications than are clinically indicated, representing unnecessary drug use.” This phenomenon encompasses the total number of medications a patient is prescribed, the presence of inappropriate medications in a prescription, or a combination of both factors, which can elevate the risk of adverse drug events (ADEs), lead to underutilisation of necessary medications, and result in medication duplication (Hajjar et al., 2017). Polypharmacy refers to the administration of several medications or an excess of what is medically required, and it is an emerging issue among older adults (Maher et al., 2014). The concept of polypharmacy is often viewed unfavourably due to its association with adverse medication reactions and the increased risk of falls, particularly within the vulnerable elderly demographic (Mia et al., 2015).

Polypharmacy presents a range of challenges for patients across all age demographics, with a notable impact on the elderly population. For example, the presence of multiple comorbidities in older cancer patients may necessitate the combination of drug therapies. Additionally, the increased availability of over-the-counter, herbal, and complementary/alternative medicines—often unreported by patients to their specialists, doctors, or pharmacists—can lead to instances of polypharmacy (Moriarty et al., 2016; Charlesworth et al., 2015; Salazar et al., 2007). The populations in question continue to face significant risks associated with adverse drug events stemming from polypharmacy and drug-drug interactions. Older patients experience numerous physiological alterations that can influence various pharmacokinetic parameters, including absorption, first-pass metabolism, protein binding, distribution, metabolism, and drug elimination. Molecular and cellular fluctuations can influence the pharmacodynamics of drug metabolism variations and may change the effect of a drug on its target site, as well as the narrow therapeutic windows associated with chemotherapeutic agents due to the administered drugs (am-McDevitt, 2018; Sokol et al., 2018). The modifications in pharmacokinetic and pharmacodynamic parameters contribute to a heightened risk in older patients, primarily due to adverse drug reactions (ADRs).

The phenomenon of polypharmacy holds significant importance in Nigeria, a nation grappling with distinct challenges within its healthcare framework, such as restricted access to specialists in geriatric care and a lack of adequate healthcare literacy among the elderly population (Maher et al., 2014; Fried et al., 2014; Jyrkka et al., 2012). In environments such as St. Luke’s Hospital in Uyo, Akwa Ibom State, where resources are frequently limited, older adults may face challenges in comprehending and adhering to intricate medication schedules due to insufficient health literacy and a lack of educational resources for patients (Qato et al., 2008; Hajjar et al., 2007; Salazar et al., 2007). Moreover, the interplay of cultural beliefs and economic considerations can significantly impact the medication practices of elderly patients. These individuals may exhibit tendencies to self-medicate, share their medications with others, or depend on unregulated herbal supplements, which can exacerbate the risks associated with polypharmacy (Charlesworth et al., 2015; Kaufman et al., 2015; Gnjidic et al., 2012).

The understanding and perceptions surrounding polypharmacy significantly influence the manner in which elderly patients handle their medications and comply with prescribed treatment plans. Studies indicate that older patients who possess a clearer comprehension of the risks linked to polypharmacy, including possible drug interactions and adverse drug events, tend to adhere more closely to medical recommendations and adopt safer medication practices (Maher et al., 2014; Moriarty et al., 2016; Fick et al., 2011). On the other hand, a lack of awareness frequently aligns with inadequate adherence to medication guidelines, improper dosages, and increased occurrences of adverse drug events, all of which can detrimentally influence the health outcomes of older adults (Fried et al., 2014; Salazar et al., 2007; Charlesworth et al., 2015). For example, individuals who view the use of multiple medications as essential for their health management might disregard the associated risks, while those with unfavourable views on taking several medications may neglect important prescriptions, leading to significant health concerns (Jyrkka et al., 2012; Kaufman et al., 2015; Gnjidic et al., 2012).

Considering the increasing elderly demographic in Nigeria, it is essential to assess the awareness and attitudes regarding polypharmacy among older adults to tackle these concerns and promote safer medication practices. Research demonstrates that when healthcare professionals engage in educating elderly patients regarding the risks and benefits associated with each medication, there is a notable enhancement in patient compliance and a decrease in the occurrence of adverse reactions (Fick et al., 2011; Fried et al., 2014; Maher et al., 2014). Gaining insight into the awareness and attitudes regarding polypharmacy within this demographic can inform the creation of targeted interventions, including educational initiatives and policy changes, designed to enhance medication management, reduce risks, and elevate health outcomes for the elderly in Akwa Ibom State and beyond. Thus, the necessity for this investigation

1.2 Statement of the problem

Polypharmacy presents an increasing issue within older demographics, who frequently face a heightened vulnerability to adverse drug reactions (ADRs) as a result of age-related physiological alterations and the common occurrence of chronic health conditions (Fried et al., 2014; Maher et al., 2014; Gnjidic et al., 2012). At institutions such as St. Luke's Hospital in Uyo, Akwa Ibom State, older patients often depend on intricate medication schedules to address various health issues, including hypertension, diabetes, and arthritis (Qato et al., 2008; Charlesworth et al., 2015; Jyrkka et al., 2012). In light of the significant occurrence of polypharmacy within this population, it is noteworthy that the understanding of the associated risks remains insufficient. This lack of awareness can result in adverse health consequences, including increased hospitalisations, diminished adherence to prescribed treatments, and escalating healthcare expenses (Hajjar et al., 2007; Fick et al., 2011; Salazar et al., 2007). The absence of awareness is exacerbated by the restricted availability of healthcare services tailored for the elderly in Nigeria, resulting in numerous older patients not obtaining thorough guidance regarding their medication usage (Maher et al., 2014; Kaufman et al., 2015; Fried et al., 2014).

The perspectives held by elderly patients regarding polypharmacy significantly influence their approaches to medication management. Studies have shown that negative perceptions or distrust towards medical prescriptions frequently result in inadequate adherence and self-medication behaviours (Moriarty et al., 2016; Charlesworth et al., 2015; Kaufman et al., 2015). At St. Luke's Hospital, the perceptions of polypharmacy among elderly patients can be shaped by a multitude of factors, including cultural beliefs, economic constraints, and varying levels of healthcare literacy. Research indicates that individuals who hold a negative view of polypharmacy might refrain from obtaining prescriptions, stop taking medications without the guidance of healthcare professionals, or pursue alternative therapies, consequently heightening their risk of complications and worsening health conditions (Gnjidic et al., 2012; Maher et al., 2014; Fried et al., 2014). Comprehending the perspectives of older patients regarding polypharmacy is crucial for recognising obstacles to adherence and guaranteeing that healthcare practices facilitate the safe and effective utilisation of medications.

The interplay of restricted awareness and diverse perspectives on polypharmacy among older patients carries significant consequences, impacting not only personal health results but also the wider healthcare framework at St. Luke's and further afield. Insufficient awareness and unfavourable attitudes lead to a rise in drug-drug interactions, adverse events, and a greater reliance on healthcare resources for addressing preventable complications (Fick et al., 2011; Hajjar et al., 2007; Maher et al., 2014). In light of these risks, it is imperative to conduct an evaluation of awareness and attitudes regarding polypharmacy among elderly patients at St. Luke's Hospital. This assessment will guide the development of targeted interventions designed to enhance medication literacy, adherence, and overall patient safety. Comprehending the distinct challenges encountered by elderly patients, will allow healthcare professionals formulate approaches to elevate awareness, modify perceptions, and ultimately mitigate the adverse effects of polypharmacy on this at-risk demographic. Therefore, this study is essential.

1.3 Objectives of the study

The primary objective of this study is to evaluate the awareness and attitude towards polypharmacy among elderly at St. Luke, Uyo, Akwa Ibom State. Specific objectives of this study are to:

1. To assess the level of awareness of polypharmacy among elderly patients at St. Luke, Uyo, Akwa Ibom State

2. To examine the attitudes of elderly patients towards polypharmacy at St. Luke, Uyo, Akwa Ibom State

3. To identify factors influencing the awareness and attitude towards polypharmacy among elderly patients at St. Luke, Uyo, Akwa Ibom State

4. To determine the impact of awareness and attitude on medication adherence among elderly patients at St. Luke, Uyo, Akwa Ibom State.

1.4 Research Questions

The following research questions which are in line with the objectives of this study will be answered in this study:

1. 1. 1. What is the level of awareness of polypharmacy among elderly patients at St. Luke, Uyo, Akwa Ibom State?

      2. What are the attitudes of elderly patients towards polypharmacy at St. Luke, Uyo, Akwa Ibom State?

      3. What are the factors influencing the awareness and attitude towards polypharmacy among elderly patients at St. Luke, Uyo, Akwa Ibom State?

      4. What is the impact of awareness and attitude on medication adherence among elderly patients at St. Luke, Uyo, Akwa Ibom State?

1.5 Research Hypotheses

To determine the effectiveness of this study, the following research null hypotheses will be formulated to guide the study and it will be tested at 0.05% levels of significance.:

Ho: The level of awareness of polypharmacy among elderly patients at St. Luke, Uyo, Akwa Ibom State is low

Ha: The level of awareness of polypharmacy among elderly patients at St. Luke, Uyo, Akwa Ibom State is high

1.6 Significance of the study

This research holds considerable importance, especially in improving patient safety and the quality of healthcare for elderly individuals at St. Luke’s Hospital, Uyo, and in broader contexts. Older adults represent a population with distinct healthcare requirements, and the use of multiple medications offers both potential benefits and challenges in the management of their health issues. Assessing their understanding and perspectives on polypharmacy is essential for identifying knowledge deficiencies and unfavourable views that could obstruct effective medication adherence and safety. The findings from this study have the potential to enhance healthcare practices by promoting the creation of interventions and educational initiatives that empower elderly patients with the essential knowledge to better manage their multiple medications. This is essential in mitigating medication errors, adverse drug reactions, and other risks linked to polypharmacy in the elderly, resulting in improved health outcomes for this population. This research will establish a foundational reference for healthcare practitioners, policymakers, and others in the field.

Healthcare providers, such as physicians, chemists, and nursing professionals, are essential participants who are likely to gain insights from the outcomes of this research. Comprehending the various levels of awareness and attitudes in elderly patients allows healthcare providers to customise their strategies for patient education and medication management. Healthcare providers at St. Luke’s Hospital and comparable institutions can utilise these insights to enhance communication strategies, ensuring that elderly patients grasp the significance of each medication in their regimen. Moreover, this research has the potential to shape policy decisions in healthcare settings by emphasising the importance of organised counselling sessions and readily available informational resources tailored for senior patients. As healthcare providers deepen their comprehension of patients' viewpoints, they become more adept at involving them in collaborative decision-making, leading to enhanced adherence and greater patient satisfaction.

This study offers valuable insights for those in positions of authority, presenting evidence-based data regarding the awareness and attitudes of elderly patients towards polypharmacy, a significant concern in public health. The findings of this study can assist policymakers in developing strategies that encourage the safe use of medications among older adults. Policies of this nature could encompass the requirement for regular medication assessments for senior individuals, the establishment of explicit protocols for managing multiple medications, and the integration of educational initiatives for patients within healthcare frameworks. Equipped with this understanding, decision-makers can establish a structured approach to geriatric care that tackles the challenges of polypharmacy, guaranteeing that elderly patients obtain thorough, secure, and superior care. Furthermore, the research highlights the necessity of incorporating age-related factors into national healthcare policies, potentially resulting in enhanced health outcomes for the senior demographic in Akwa Ibom State and across Nigeria.

This study will serve as a significant resource for organisations dedicated to healthcare and eldercare, aiding in the development of their outreach and intervention initiatives. As proponents for marginalised and vulnerable groups, non-governmental organisations can leverage the study’s insights to create focused programs designed to inform elderly individuals about polypharmacy. These organisations can also provide training for carers and family members, equipping them to assist elderly individuals in navigating intricate medication regimens. This research can serve as a valuable tool for organisations to promote the necessity of enhanced resources, including funding and support for medication counselling programs, thereby enabling elderly individuals to make well-informed choices regarding their health. Furthermore, collaborations between non-governmental organisations and healthcare institutions such as St. Luke’s Hospital can facilitate the execution of awareness initiatives and workshops that specifically tackle the distinct challenges linked to polypharmacy, thereby fostering safer medication practices in the community.

This study provides significant advantages for both students and researchers, offering essential data regarding polypharmacy awareness and attitudes within a population that has not been extensively examined. This research provides valuable insights for students in health-related disciplines, addressing the intricate issues surrounding the management of polypharmacy in older adults. It emphasises the significance of understanding real-world challenges and the critical role of empathy and patient education in the healthcare process. The findings of this study provide a foundation for further exploration into polypharmacy-related concerns and can serve as a basis for comparative analyses in diverse geographic or demographic contexts. This study establishes a basis for subsequent investigations focused on identifying effective interventions and policies for addressing polypharmacy, thereby enriching the scholarly conversation surrounding healthcare management for the elderly. Ultimately, this study could serve as a significant resource for policymakers in crafting guidelines and policies aimed at enhancing safe medication practices and bolstering healthcare accessibility and support for elderly patients, extending its relevance beyond St. Luke’s to comparable healthcare institutions throughout Nigeria.

1.7 Scope of the study

Broadly, this study focus is to critically evaluate the awareness and attitude towards polypharmacy among elderly in Nigerian hospitals. Empirically, the study will the level of awareness of polypharmacy among elderly patients in Nigerian hospitals, the attitudes of elderly patients towards polypharmacy in Nigerian hospitals, factors influencing the awareness and attitude towards polypharmacy among elderly patients in Nigerian hospitals and the impact of awareness and attitude on medication adherence among elderly patients in Nigerian hospitals

Geographically, the study will be carried out at St. Luke, Uyo, Akwa Ibom State.

1.8 Limitations of the study

During the examination, the researchers carefully examined the inherent limitations that are present in all human behaviours. One of the main challenges we faced was the lack of extensive scholarly research on the subject. A notable factor that contributed to the issue was the limited data available regarding evaluation of the awareness and attitude towards polypharmacy among elderly at St. Luke, Uyo, Akwa Ibom State. Given the task at hand, it was quite demanding to find the required materials, books, or information and organise the data, requiring a significant investment of time and effort.

In addition, the study's findings may be constrained by the small number of participants and the limited scope of the research, which mainly revolves around St. Luke, Uyo, Akwa Ibom State. Therefore, the findings of the study have limited practical implications, highlighting the need for further research.

In addition, the individual experienced significant constraints due to financial constraints. As a student with limited financial resources, they had to carefully navigate these constraints throughout their study. The exorbitant transportation fees at the research site proved to be a significant hindrance in meeting the financial obligations tied to travel expenses.

Furthermore, the person had a packed schedule due to their scholarly obligations, including attending lectures and participating in a range of educational pursuits.

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