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Factors Associated with Medicine Use and Non-use by Ontario Seniors

Published online by Cambridge University Press:  31 March 2010

Peri J. Ballantyne*
Affiliation:
Leslie Dan Faculty of Pharmacy, University of Toronto Department of Public Health Science, University of Toronto
J. Charles Victor
Affiliation:
Department of Public Health Science, University of Toronto
Judith E. Fisher
Affiliation:
Leslie Dan Faculty of Pharmacy, University of Toronto
Joan A. Marshman
Affiliation:
Leslie Dan Faculty of Pharmacy, University of Toronto
*
Requests for offprints should be sent to: / Les demandes de tirés-à-part doivent être addressées à : Peri J. Ballantyne, Leslie Dan Faculty of Pharmacy, University of Toronto, 19 Russell Street, Toronto, ON M5S 2S2. (p.ballantyne@utoronto.ca)

Abstract

While there is growing evidence of the increasing use of medicines by the elderly, research undertaken to critically examine differences among types of medicine users in this population is limited. Using population data, we examine the influence of social, demographic, and health-related factors on likelihood of being a non-user, a user of non-prescribed medicines only, or a user of prescription medicines only. We find some evidence of the rational use of drugs (i.e., those who are in better health are more likely to be non-users or to use non-prescribed medicines than those who are in poor health) and of rational explanations for reported use (i.e., being female is associated with less likelihood of non-use or exclusive use of non-prescription medicines than being male). Further analysis of the medicine-use patterns and decisions of elderly men and of those of elderly persons who are widowed or separated/divorced is warranted.

Résumé

Bien qu'il y ait de plus en plus de preuves d'une augmentation de la consommation de médicaments par les personnes âgées, il y a relativement peu de recherches entreprises pour effectuer un examen critique des différences entre les types de consommateurs de médicaments au sein de cette population. À l'aide de données sur la population, nous étudions l'influence des facteurs sociaux, démographiques et de santé sur la probabilité de ne pas consommer de médicaments, de consommer uniquement des médicaments sans ordonnance ou de consommer uniquement des médicaments délivrés sur ordonnance. Nous avons relevé des indications selon lesquelles les médicaments étaient utilisés de façon rationnelle (c'est-à-dire que ceux qui étaient en meilleure santé avaient plus de chances de ne pas en consommer ou de consommer des médicaments sans ordonnance que ceux qui avaient une mauvaise santé) ainsi que des explications rationnelles pour l'utilisation déclarée (c'est-à-dire que les femmes avaient moins de chances que les hommes de ne pas consommer de médicaments ou de consommer uniquement des médicaments sans ordonnance). D'autres analyses sur les habitudes et les décisions relatives à la consommation de médicaments par des hommes âgés ainsi que par des personnes âgées dont le conjoint est décédé, qui sont séparées ou divorcées, seraient nécessaires.

Type
Articles
Copyright
Copyright © Canadian Association on Gerontology 2005

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References

Al-Windi, A., Elmfeldt, D., & Svärdsudd, K. (2000). The relationship between age, gender, well-being and symptoms, and the use of pharmaceuticals, herbal medicines and self-care products in a Swedish municipality. European Journal of Clinical Pharmacology, 56, 311317.CrossRefGoogle Scholar
Amoako, E.P., Richardson-Campbell, L., & Kennedy-Malone, L. (2003). Self-medication with over-the-counter drugs among elderly adults. Journal of Gerontological Nursing, 29(8), 1015.CrossRefGoogle ScholarPubMed
Anderson, G.F., Petrosyan, V., & Hussey, P.S. (2002). Multinational comparisons of health systems data, 2002. New York: Commonwealth Fund.Google Scholar
Anis, A., Guh, D., & Wang, X. (2001). A dog's breakfast: Prescription drug coverage varies widely across Canada. Medical Care, 39(4), 315326.CrossRefGoogle ScholarPubMed
Ballantyne, P.J., Clarke, P.J., Marshman, J.A., Victor, J.C., & Fisher, J.E. (2005). Use of prescribed and non-prescribed medicines by the elderly: Implications for who chooses, who pays and who monitors the risks of medicines. International Journal of Pharmacy Practice, 13(2), 133140.CrossRefGoogle Scholar
Ballantyne, P.J., Hawker, G., & Radoeva, D. (2001). The extended self: Illness experiences of older married arthritis sufferers. Research in the Sociology of Health Care, 19, 261282.CrossRefGoogle Scholar
Canadian Institute for Health Information (2002). Health care in canada. Ottawa, ON: Canadian Institute for Health Information. Retrieved 12 September 2005 from http://www.cihi.ca.Google Scholar
Canadian Institute for Health Information (2003). Drug expenditure in Canada 1985–2002. Ottawa, ON: Author.Google Scholar
Carder, P.C., Vuckovic, N., & Green, C.A. (2003). Negotiating medications: Patient perceptions of long-term medication use. Journal of Clinical Pharmacy and Therapeutics, 28, 409417.CrossRefGoogle ScholarPubMed
Chen, Y.F., Dewey, M.E., Avery, A.J., & the Analysis Group of the MRCCFA Study (2001). Self-reported medication use for older people in England and Wales. Journal of Clinical Pharmacy and Therapeutics, 26, 129140.CrossRefGoogle ScholarPubMed
Chung Pang, K.Y. (1996). Self-care strategy of elderly Korean immigrants in the Washington, DC, metropolitan area. Journal of Cross-Cultural Gerontology, 11, 229254.CrossRefGoogle ScholarPubMed
Coambs, R.B., Jensen, P., Hao, Her M., Ferguson, B.S., Jarry, J.L., Wong, J.S.W. et al. (1995). Review of the scientific literature on the prevalence, consequences and health costs of noncompliance and inappropriate use of prescription medication use in Canada. Ottawa: Pharmaceutical Manufacturers Association of Canada.Google Scholar
Commission on the Future of Health Care in Canada (2002). Building on values: The future of health care in Canada — final report. Retrieved 12 September 2005 from http://www.commissionsoinsdesante.ca.Google Scholar
Covington, T.R. (2000). Self-care and nonprescription pharmacotherapy. In Young, Linda L. (Ed.), Handbook of nonprescription drugs (12th ed., pp. 314). Washington, DC: American Pharmaceutical Association.Google Scholar
Coyte, P.C., Catz, M., & Stricker, M. (1997). Distribution of physicians in Ontario: Where are there too few or too many family physicians and general practitioners? Canadian Family Physician, 43, 10471049.Google ScholarPubMed
De Smet, P.A.G.M., Keller, K., Hansel, R., & Chandler, R.F. (Eds.). (1997). Adverse effects of herbal drugs (Vol. 3). Berlin: Springer.CrossRefGoogle Scholar
Evans, R.G., Barer, M.L., & Marmor, T.R. (1994). Why are some people healthy and others not? The determinants of health of populations. New York: Aldine de Gruyter.CrossRefGoogle Scholar
Fischer, M.A., & Avorn, J. (2004). Potential savings from increased use of generic drugs in the elderly: What the experience of Medicaid and other insurance programs means for a medicare drug benefit. Pharmacoepidemiology and Drug Safety, 13(4), 207214.CrossRefGoogle ScholarPubMed
Fugh-Berman, A. (2000). Herb-drug interactions. The Lancet, 355, 134138.CrossRefGoogle ScholarPubMed
Fuller, R., Dudley, N., & Blacktop, J. (2004). Avoidance hierarchies and preferences for anticoagulation: Semiqualitative analysis of older patients' views about stroke prevention and the use of Warfarin. Age and Ageing, 33, 608611.CrossRefGoogle ScholarPubMed
Gijsbers, van W.C., Kolk, A., van den Bosch, W., & van den Hoogen, H. (1995). Male and female health problems in general practice: The differential impact of social position and social roles. Social Science and Medicine, 40, 597611.CrossRefGoogle Scholar
Greene, VL. (1983). Substitution between formally and informally provided care for the impaired elderly in the community. Medical Care, 21, 609619.CrossRefGoogle ScholarPubMed
Green, C.A., & Pope, C.R. (1999). Gender, psychosocial factors and the use of medical services: A longitudinal analysis. Social Science and Medicine, 48, 13631372.CrossRefGoogle ScholarPubMed
Grootendorst, P., Goldsmith, L., Hurley, J., O'Brien, B., & Dolovich, L. (1996). Financial incentives to dispense low cost drugs: A case study of British Columbia Pharmacare (McMaster University Centre for Health Economics and Policy Analysis Working Paper 96-08).Google Scholar
Grootendorst, P.V., O'Brien, B.J., & Anderson, G.M. (1997). On becoming 65 in Ontario: Effects of drug plan eligibility on use of prescription medicines. Medical Care, 35, 386398.CrossRefGoogle ScholarPubMed
Hanlon, J.T., Fillenbaum, G.G., Ruby, C.M., Gray, S., & Bohannon, A. (2001). Epidemiology of over-the-counter drug use in community dwelling elderly: United States perspective. Drugs and Aging, 18(2), 123131.CrossRefGoogle ScholarPubMed
Harten, C., & Ballantyne, P. (2004). Impact of cost-sharing within provincial drug benefit programs: A review. Journal of Pharmaceutical Finance, Economics and Policy, 13(1), 3553.CrossRefGoogle Scholar
Hays, J.C., Pieper, C.F., & Purser, J.L. (2003). Competing risk of household expansion or institutionalization in late life. Journal of Gerontology: Social Sciences, 58B(1), S11S20.CrossRefGoogle Scholar
Health Canada, Division of Aging and Seniors (1999). Canada's seniors. Retrieved 19 Sept 2005 from http://www.phac-aspc.gc.ca/seniors-aines/pubs/factoids/1999/pdf/entire_e.pdfGoogle Scholar
Hervé, C., Mullet, E., & Sorum, P.C. (2004). Age and medication acceptance. Experimental Aging Research, 30, 253273.CrossRefGoogle ScholarPubMed
Horne, R., Graupner, L., Frost, S., Weinman, J., Wright, S.M., & Hankins, M. (2004). Medicine in a multicultural society: The effect of cultural background on beliefs about medications. Social Science and Medicine, 59, 13071313.CrossRefGoogle Scholar
Hughes, C.M., McElnay, J.C., Fleming, G.F. (2001). Benefits and risks of self-medication. Drug Safety, 24(14), 10271037.CrossRefGoogle ScholarPubMed
Hurwitz, M.L. (1995). Physicians' norms and health care decisions of elderly medicare recipients. Medical Anthropology Quarterly, 9(2), 211235.CrossRefGoogle Scholar
Hux, J., & Fielding, D. (1997). The Ontario Drug Benefit Program co-payment: Its impact on access for Ontario seniors and charges to the program (Institute for Clinical Evaluative Sciences in Ontario Working Paper).Google Scholar
Johnson, M.M.S., & Drungle, S.C. (2000). Purchasing over-the-counter medications: The influence of age and familiarity. Experimental Aging Research, 26, 245261.Google ScholarPubMed
Joung, I.M., van der Meer, J.B., & Mackenbach, JP. (1995). Marital status and health care utilization. International Journal of Epidemiology, 24, 569575.CrossRefGoogle ScholarPubMed
Kaufman, D.W., Kelly, J.P., Rosenberg, L., Anderson, T.E., & Mitchell, A.A. (2002). Recent patterns of medication use in the ambulatory adult population of the United States: The Slone Survey. Journal of the American Medical Association, 287(3), 337344.CrossRefGoogle ScholarPubMed
Kim, M., Hae-Ra, H., Kim, B.K., & Duong, D.N. (2002). The use of traditional and western medicine among Korean-American elderly. Journal of Community Health, 27(2), 109120.CrossRefGoogle ScholarPubMed
Kraut, A.M. (1990). Healers and strangers — Immigrant attitudes toward the physician in America: A relationship in historical perspective. Journal of the American Medical Association, 263, 18071811.CrossRefGoogle Scholar
Lee, G.B.W., Charn, T.C., Chew, Z.H., & Ng, T.P. (2004). Complementary and alternative medicine use in patients with chronic diseases in primary care is associated with perceived quality of care and cultural beliefs. Family Practice, 21(6), 654660.CrossRefGoogle ScholarPubMed
Lexchin, J. (1997). After compulsory licensing: Coming issues in Canadian pharmaceutical policy and politics. Health Policy, 40, 6980.CrossRefGoogle ScholarPubMed
Lexchin, J., & Grootendorst, P. (2004). Effects of prescription drug user fees on drug and health services use and on health status in vulnerable populations: A systematic review of the evidence. International Journal of Health Services, 34(1), 101122.CrossRefGoogle ScholarPubMed
Linjakump, T., Hartikainen, S., Klaukka, T., Veijola, J., Kivela, S., & Isoaho, R. (2002). Use of medications and polypharmacy are increasing among the elderly. Journal of Clinical Epidemiology, 55, 809817.CrossRefGoogle Scholar
Lumme-Sandt, K., & Virtanen, P. (2002). Older people in the field of medication. Sociology of Health and Illness, 24(3), 285304.CrossRefGoogle Scholar
Ma, G.X. (1999). Between two worlds: The use of traditional and western health services by Chinese immigrants. Journal of Community Health, 24, 421437.CrossRefGoogle ScholarPubMed
Mamdani, M.M., Parikh, S.V., Austin, P.C., & Upshur, R.E. (2000). Use of antidepressants among elderly subjects: Trends and contributing factors. American Journal of Psychiatry, 157(3), 360367.CrossRefGoogle ScholarPubMed
Mintzes, B., Barer, M., Kravitz, R.L., Bassett, K., Lexchin, J., Kazanjian, A. et al. (2003). How does direct-to-consumer advertising (DTCA) affect prescribing? A survey in primary care environments with and without legal DTCA. Canadian Medical Association Journal, 169(5), 405412.Google ScholarPubMed
Morris, L.S., & Schultz, R.M. (1992). Patient compliance: An overview. Journal of Clinical Pharmacy & Therapeutics, 17, 283295.CrossRefGoogle ScholarPubMed
Nilsson, J.L.G., Johansson, H., & Wennberg, M. (1995). Large differences between prescribed and dispensed medications could indicate under-treatment. Drug Information Journal, 29, 12431246.CrossRefGoogle Scholar
O'Neill, C., Hughes, C.M., Jamison, J., & Schweizer, A. (2003). Cost of pharmacological care of the elderly: Implications for healthcare resources. Drugs and Aging, 20(4), 253261.CrossRefGoogle ScholarPubMed
Ontario College of Pharmacists (1996). Changes to the Ontario Drug Benefit Program. Pharmacy Connection, 3(3), 2223.Google Scholar
Ontario Ministry of Finance (2003). Census 2001 Highlights: visible minorities and ethnicity in Ontario factsheet 6. Office of Economic Policy, Labour and Demographic Analysis Branch. Retrieved 12 September 2005 from http://www.gov.on.ca/FIN/english/demographics/cenhi6e.htm.Google Scholar
Parslow, R., Jorm, A., Christensen, H., Jacomb, P., & Rodgers, B. (2004). Gender differences in factors affecting use of health services: An analysis of a community study of middle-aged and older Australians. Social Science and Medicine, 59, 21212129.CrossRefGoogle ScholarPubMed
Pearl, W.S., Leo, P., & Tsang, W.O. (1995). Use of Chinese therapies among Chinese patients seeking emergency department care. Annals of Emergency Medicine, 26, 735738.CrossRefGoogle ScholarPubMed
Pound, P., Compertz, P., & Ebrahim, S. (1998). Illness in the context of old age: The case of stroke. Sociology of Health and Illness, 20, 489506.CrossRefGoogle Scholar
Prior, P.M., & Hayes, B.C. (2003). The relationship between marital status and health: An empirical investigation of differences in bed occupancy within health and social care facilities in Britain, 1921–1991. Journal of Family Issues, 24(1), 124148.CrossRefGoogle Scholar
Ramsay, C., Walker, M., & Alexander, J. (1999). Alternative medicine in Canada: Use and public attitudes (Public Policy Sources Number 21). Vancouver, BC: Fraser Institute.Google Scholar
Rubin, D.B. (1987). Multiple Imputation for Non-response in Surveys. New York: Wiley.CrossRefGoogle Scholar
Scherman, M.H., & Löwhagen, O. (2004). Drug compliance and identity: Reasons for non-compliance — Experiences of medication from persons with asthma/allergy. Patient Education and Counseling, 54, 39.CrossRefGoogle Scholar
Shah, N.D., Hoffman, J.M., Vermeulen, L.C., Hunkle, R.J., & Hontz, K.M. (2003). Projecting future drug expenditures — 2003. American Journal of Health System Pharmacy, 60, 137149.CrossRefGoogle ScholarPubMed
Statistics Canada (1995). National Population Health Survey overview 1994–1995. Ottawa: Minister of Supply and Services.Google Scholar
Statistics Canada (1996). A national overview: Population and dwelling counts (Data products: 1996 Census of population) (Catalogue No: 93-357-XPB). Retrieved 12 September 2005 from http://www.statcan.ca/english/census96/table15.htm.Google Scholar
Stephens, E.C., & Johnson, M.M.S. (2000). Dr. Mom and other influences on younger and older adults' OTC medication purchases. The Journal of Applied Gerontology, 19(4), 441459.CrossRefGoogle Scholar
Stoller, E.P., Forster, L.E., & Portugal, S. (1993). Self-care responses to symptoms by older people: A health diary study of illness behavior. Medical Care, 31, 2442.CrossRefGoogle ScholarPubMed
Stuart, B., & Grana, J. (1998). Ability to pay and the decision to medicate. Medical Care, 36(2), 202211.CrossRefGoogle ScholarPubMed
Sung, C.L. (1999). Asian patients' distrust of western medical care: One perspective. Mt. Sinai Journal of Medicine, 66, 259261.Google ScholarPubMed
Swain, L., Catlin, G., & Beaudet, M. (1999). The National Population Health Survey: Its longitudinal nature. Health Reports, 10(4), 6981.Google ScholarPubMed
Tambay, J.L., & Catlin, G. (1995). Sample design of the National Population Survey. Health Reports, 7(1), 111.Google Scholar
Tamblyn, R., Laprise, R., Hanley, J., Abrahamowicz, M., Scott, S., Mayo, N. et al. (2001). Adverse events associated with prescription drug cost-sharing among poor and elderly persons. Journal of the American Medical Association, 285(4), 421429.CrossRefGoogle ScholarPubMed
Tamblyn, R.M., McLeod, P.J., Abrahamowicz, M., Monette, J., Gayton, D.C., Berkson, L. et al. (1994). Questionable prescribing for elderly patients in Quebec. Canadian Medical Association Journal, 150(11), 18011809.Google ScholarPubMed
Thorne, S., Paterson, B., Russell, C., & Schultz, A. (2002). Complementary/alternative medicine in chronic illness as informed self-care decision-making. International Journal of Nursing Studies, 39, 671683.CrossRefGoogle ScholarPubMed
van der Meer, J.B.W., & Mackenbach, J.P. (1998). Low education, high GP consultation rates: The effect of psychosocial factors. Journal of Psychosomatic Research, 44(5), 587597.CrossRefGoogle ScholarPubMed
van der Meer, J.B.W., & Mackenbach, J.P. (1999). The care and course of diabetes: Differences according to level of education. Health Policy, 42(2), 127141.CrossRefGoogle Scholar
Verbrugge, L. (1979). Marital status and health. Journal of Marriage and the Family, 41, 267285.CrossRefGoogle Scholar
Vermeire, E., Hearnshaw, H., van Royen, P., & Denekens, J. (2001). Patient adherence to treatment: Three decades of research — A comprehensive review. Journal of Clinical Pharmacy and Therapeutics, 26, 112.CrossRefGoogle ScholarPubMed
Wiggers, J.H., Sanson-Fisher, R.W., & Halpin, S.J. (1995). Prevalence and frequency of health service use: Associations with occupational prestige and educational attainment. Australian Journal of Public Health, 19, 512519.CrossRefGoogle ScholarPubMed
Wyke, S., & Ford, G. (1992). Competing explanations for associations between marital status and health. Social Science and Medicine, 34, 523532.CrossRefGoogle Scholar