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Becoming Old as a ‘Pharmaceutical Person’: Negotiation of Health and Medicines among Ethnoculturally Diverse Older Adults*

Published online by Cambridge University Press:  25 May 2011

Peri J. Ballantyne ,
Raza M. Mirza ,
Zubin Austin ,
Heather S. Boon  and
Judith E. Fisher
Peri J. Ballantyne*
Affiliation:
Department of Sociology, Trent University Department of Pharmaceutical Science, University of Toronto
Raza M. Mirza
Affiliation:
Department of Pharmaceutical Science, University of Toronto
Zubin Austin
Affiliation:
Department of Pharmaceutical Science, University of Toronto
Heather S. Boon
Affiliation:
Department of Pharmaceutical Science, University of Toronto
Judith E. Fisher
Affiliation:
College of Pharmacy, Dalhousie University
*
†Correspondence and requests for offprints should be sent to / La correspondance et les demandes de tirés-à-part doivent être adressées à: Peri J. Ballantyne, Ph.D. Department of Sociology Trent University 1600 West Bank Drive Peterborough, ON K9J 7B8 (periballantyne@trentu.ca)
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Abstract

Because medication prescribing and use have become a normative aspect of health care for older adults, we seek to understand how individuals navigate prescribed-medication use within the context of aging. We reasoned that, for those who are ambulatory, medication use is likely influenced by ethnocultural meanings of health and experiences with alternative approaches to health care. Accordingly, we conducted a qualitative study, with in-depth interviews, on a diverse sample of older adults in order to identify elderly persons’ perceptions and uses of medicines. Our findings depict older adults as active agents – who draw on a lifetime of experience and knowledge – who take responsibility for adherence (or non-adherence) to medicines and their associated effects on their own bodies. We represent the older person as a “pharmaceutical person” whose experiences of aging are inextricably tied up with the negotiation of medicine-reliant health care.

Résumé

Parce que la prescription et l’utilisation des médicaments sont devenus un aspect normatif des soins de santé pour les personnes âgées, nous cherchons à comprendre comment les individus gérer l’utilisation des médicaments d’ordonnance dans le contexte du vieillissement. Nous soutenons que, pour ceux qui sont ambulatoires, l’utilisation de médicaments est susceptible d’être influencée par des considérations ethno-culturelles en matière de la santé et des expériences avec d’autres approches aux soins de santé. En conséquence, nous avons méné une étude qualitative, avec des entrevues en profondeur, sur un échantillon diversifié de personnes âgées afin d’identifier leurs perceptions et utilisations de médicaments. Nos conclusions dépeignent les personne âgées comme des agents actifs – qui s’appuient sur une vie d’expérience et de connaissances – qui prennent la responsabilité de l’adhésion (our non-adhésion) aux médicaments et leurs effets liés sur leur propre corps. Nous représentons la personne âgée comme une « personne pharmaceutique » dont les expériences du vieillissement sont inextricablement liée à la négociation des soins de santé dépendent sur les médicaments.

Keywords

soins de santé pharmaceutiquesexpériences de patientsimmigrantsmigrationméthodes d’interprétationmédicamentspersonnes plus âgéespharmaceutical health carepatient experiencesimmigrantsmigrationinterpretive methodsmedicationolder people
Type
Articles
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 30 , Issue 2 , June 2011 , pp. 169 - 184
Copyright
Copyright © Canadian Association on Gerontology 2011

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Footnotes

*

A version of this paper was presented at the 15th International Social Pharmacy Workshop, Queenstown, NZ, in July 2008.We thank the study participants and translators who made this research possible, and for their design and logistical support we thank our study partners at Scadding Court Community Centre, Toronto, Ontario. G. Bonter, L. Hulcoop, J. Orsetto, V. Iafolla, J. McIlwain, and L. Sule provided research assistance. We thank two anonymous reviewers for suggestions on the paper. Funded by the Social Sciences and Humanities Research Council of Canada Grant# 410-2005-0595.

References

Banerjee, S. (2009). The use of antipsychotic medication for people with dementia: Time for action. A Report for the Minister of State for Care Services. London, UK: UK Department of Health.Google Scholar
Barry, C.A., Stevenson, F.A., Britten, N., Barber, N., & Bradley, C.P. (2001). Giving voice to the lifeworld. More humane, more effective medical care? A qualitative study of doctor-patient communication in general practice. Social Science and Medicine, 53, 487–505.CrossRefGoogle Scholar
Bates, M.S., Rankin-Hill, L., & Sanchez-Ayendez, M. (1997). The effects of cultural context of health care on treatment of and response to chronic pain and illness. Social Science and Medicine, 45(9), 1433–1447.CrossRefGoogle ScholarPubMed
Beck, L.H. (1998). Changes in renal function with aging. Clinics in Geriatric Medicine, 14, 199–209.CrossRefGoogle ScholarPubMed
Becker, B. (1999). Narratives of pain in later life and conventions of storytelling. Journal of Aging Studies, 13(1), 73–87.CrossRefGoogle Scholar
Berry, S.D., Quach, L., Procter-Gray, E., Kiel, D.P., Wenjun, L., Samelson, E.J., et al. . (2010). Poor adherence to medications may be associated with falls. Journals of Gerontology A: Biological Science/Medical Science, 65A(5), 553–558.Google Scholar
Bezansan, B.J., Foster, G., & James, S. (2005). Herbalistas, curandeiros and bruxas. Valuable lessons from traditional healing systems. In Moodlye, R., & West, W. (Eds.), Integrating traditional healing practices into counseling and psychotherapy (pp. 305–315). Thousand Oaks, CA: Sage.CrossRefGoogle Scholar
Bissell, P., May, C., & Noyce, P. (2004). From compliance to concordance: Barriers to accomplishing a re-framed model of health care interactions. Social Science and Medicine, 58, 851–862.CrossRefGoogle ScholarPubMed
Bloor, M., Monaghan, L., Dobash, R.P., & Dobash, R.E. (1998). The body as a chemistry experiment. Steroid use among South Wales body builders. In Nettleton, S., & Watson, J. (Eds.), The Body in everyday life (pp. 27–44). London, UK: Routledge.Google Scholar
Bodenheimer, T., Lorig, K., Holman, H., & Grumbach, K. (2002). Patient self-management of chronic disease in primary care. Journal of the American Medical Association, 288(19), 2469–2474.CrossRefGoogle ScholarPubMed
Britten, N. (1996). Lay views of drugs and medicines: Orthodox and unorthodox accounts. In Williams, S.J., & Calnan, M. (Eds.), Modern medicine – Lay perspectives and experiences (pp. 48–73). London, UK: UCL Press.Google Scholar
Britten, N., Stevenson, F., Gafaranga, J., Barry, C., & Bradley, C. (2004). The expression of aversion to medicines in general practice consultations. Social Science and Medicine, 59, 1495–1503.CrossRefGoogle ScholarPubMed
Bury, M. (2001). Illness narratives: Fact or fiction? Sociology of Health and Illness, 23(3), 263–285.CrossRefGoogle Scholar
Canadian Institute of Health Information (CIHI) (2009). Health care in Canada, 2009. Ottawa, Ontario, Canada: CIHI. ISBN 978-1-55465-631-8.Google Scholar
Canadian Institute of Health Information (CIHI) (2010). Drug use among seniors on public drug programs in Canada, 2002-2008. Ottawa, Ontario, Canada: CIHI.Google Scholar
City of Toronto. (2008) 2006 City of Toronto Ward Profiles. Ward 20. Toronto: (produced by City Planning, Policy and Research).Google Scholar
Charmaz, K. (2000). Grounded theory. Objectivist and constructivist methods. In Denzin, N.K., & Lincoln, Y.S. (Eds.), Handbook of qualitative research, second edition (Chapter 19, pp. 509–536). Thousand Oaks, CA: Sage.Google Scholar
Denton, F.T., & Spencer, B.G. (2010). Chronic health conditions: Changing prevalence in an aging population and some implications for the delivery of health care services. Canadian Journal on Aging, 29(1), 11–21.CrossRefGoogle Scholar
DiMatteo, M.R. (2004). Variations in patients’ adherence to medical recommendations: A quantitative review of 50 years of research. Medical Care, 42, 2000–2209.CrossRefGoogle ScholarPubMed
Ezzy, D. (1997). Subjectivity and the labour process. Conceptualizing ‘good work’. Sociology, 31(3), 427–444.CrossRefGoogle Scholar
Garber, M., Nau, D., Erickson, S., Aikens, J., & Lawrence, J. (2004). The concordance of self-report with other measures of medication adherence. Medical Care, 42(7), 649–652.CrossRefGoogle ScholarPubMed
Greco, M. (1993). Psychosomatic subjects and the ‘duty to be well’; Personal agency within medical rationality. Economy and Society, 22(3), 357–371.CrossRefGoogle Scholar
Hansson Scherman, M., & Löwhagen, O. (2004). Drug compliance and identity: Experiences of medication from persons with asthma/allergy. Patient Education and Counseling, 54, 3–9.CrossRefGoogle ScholarPubMed
Haynes, R.B., Ackloo, E., Sahota, N., McDonald, H.P., & Yao, X. (2008). Interventions for enhancing medication adherence (Review). The Cochrane Library, 4, 1–159.Google Scholar
Horne, R., Graupner, L., Frost, S., Weinman, J., Wright, S.M., & Hankins, M. (2004). Medicine in a multi-cultural society: The effect of cultural background on beliefs about medications. Social Science and Medicine, 59, 1307–1313.CrossRefGoogle Scholar
Howson, A. (1998). Embodied obligation: The female body and health surveillance. In Nettleton, S. & Watson, J. (Eds.), The Body in everyday life (pp. 219–240). London, UK: Routledge.Google Scholar
IMS Health (2006). Prescription drug purchases by Canadian hospitals and pharmacies reach $16.57 billion in 2005. Press Release, Montreal, Quebec, Canada: March 15, 2006. Retrieved 14 April 2011. http://www.imshealth.com/portal/site/imshealth/menuitem.a46c6d4df3db4b3d88f611019418c22a/?vgn.Google Scholar
Jenkins, R. (2002). Pierre Bourdieu. Revised Edition. London, UK: Routledge.Google Scholar
Jyrkka, J., Enlund, H., Korhonen, M.J., Sulkava, R., & Hartikainen, S. (2009). Polypharmacy status as an indicator of mortality in an elderly population. Drugs and Aging, 26(12), 1039–1048.CrossRefGoogle Scholar
Kaptchuk, T. (1983). The web that has no weaver. Understanding Chinese medicine. Chicago, IL: Congdon & Weed.Google Scholar
Kennerfalk, A., Ruigómez, A., Wallander, M.A., Wilhelmsen, L., & Johansson, S. (2002). Geriatric drugs therapy and healthcare utilization in the United Kingdom. Annals of Pharmacotherapy, 36, 797–803.CrossRefGoogle ScholarPubMed
Kim, M., Hae-Ra, H., Kim, K.B., & Duong, D.N. (2002). The use of traditional and western medicine among Korean American Elderly. Journal of Community Health, 27(2), 109–120.CrossRefGoogle ScholarPubMed
Kripalani, S., Yao, X., & Haynes, B. (2007). Interventions to enhance medication adherence in chronic medical conditions. Archives of Internal Medicine, 167, 540–550.CrossRefGoogle ScholarPubMed
Kuijpers, M.A., van Marum, R.J., Egberts, A.C.G., Jansen, P.A.F., & the OLDY study group. (2007). Relationship between polypharmacy and underprescribing. British Journal of Clinical Pharmacology, 65(1), 130–133.CrossRefGoogle ScholarPubMed
Laroche, M.L., Charmes, J.P., Nouaille, Y., Picard, N., & Merle, L. (2007). Is inappropriate medication use a major cause of adverse drug reactions in the elderly? British Journal of Clinical Pharmacology, 63, 177–186.CrossRefGoogle Scholar
Lau, D.T., Kasper, J.D., Potter, D.E., Lyles, A., & Bennett, R.G. (2005). Hospitalization and death associated with potentially inappropriate medication prescriptions among elderly nursing home residents. Archives of Internal Medicine, 165, 68–74.CrossRefGoogle ScholarPubMed
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), 654–660.CrossRefGoogle ScholarPubMed
Linjakumpu, T., Hartikainen, S., Klaukka, T., Koponen, H., Kivela, S.L., & Isoaho, R. (2002). Psychotropics among the home-dwelling elderly – increasing trends. International Journal of Geriatric Psychiatry, 17, 874–883.CrossRefGoogle ScholarPubMed
Lo, M.M., & Stacey, C.L. (2008). Beyond cultural competency: Bourdieu, patients and clinical encounters. Sociology of Health and Illness, 30(5), 741–755.CrossRefGoogle ScholarPubMed
Lumme-Sandt, K., & Virtanen, P. (2002). Older people in the field of medication. Sociology of Health and Illness, 24(3), 285–304.CrossRefGoogle Scholar
Lǖthje, P., Nurmi-Lǖthje, I., Kaukonen, J.P., Kuurne, S., Naboulsi, H., & Kataja, M. (2009). Undertreatment of osteoporosis following hip fracture in the elderly. Archives of Gerontology and Geriatrics, 49, 153–157.CrossRefGoogle ScholarPubMed
Martin, E. (2006). The pharmaceutical person. Biosocieties, 1, 273–287.CrossRefGoogle Scholar
McElnay, J. (2005). Who cares about compliance, adherence or concordance? The Pharmacist cares. Pharmacist Journal, 275(Suppl.), p2.Google Scholar
Page, R.L. II, & Ruscin, J.M. (2006). The risk of adverse drug events and hospital-related morbidity and mortality among older adults with potentially inappropriate medication use. American Journal Geriatric Pharmacotherapy, 4, 297–305.CrossRefGoogle ScholarPubMed
Pang, K.Y.C. (1996). Self care strategy of elderly Korean immigrants in the Washington DC Metropolitan area. Journal of Cross-cultural Gerontology, 11, 229–254.CrossRefGoogle Scholar
Passarelli, M.C., Jacob-Filho, W., & Figueras, A. (2005). Adverse drug reactions in an elderly hospitalized population: Inappropriate prescription is a leading cause. Drugs and Aging, 22, 767–777.CrossRefGoogle Scholar
Pound, P., Britten, N., Morgan, M., Yardley, L., Pope, C., Daker-White, G., et al. . (2005). Resisting medicines: A synthesis of qualitative studies of medicine taking. Social Science and Medicine, 61, 133–155.CrossRefGoogle ScholarPubMed
QRS International (2007). NVivo 7.0 [Software for qualitative research]. Melbourne, Victoria: QSR International PTy.Google Scholar
Rodriguez, K.L., Hanlon, J.T., Perera, S., Jaffe, E.J., & Sevick, M.A. (2010). A cross sectional analysis of the prevalence of undertreatment of non-pain symptoms and factors associated with undertreatment in older nursing home, hospice/palliative care patients. American Journal of Geriatric Pharmacotherapy, 8(3), 225–232.CrossRefGoogle Scholar
Rose, N. (2003). The neurochemical self and its anomalies. In Ericson, R. (Ed.), Risk and morality (pp. 407–437). Toronto, Ontario, Canada: University of Toronto Press.CrossRefGoogle Scholar
Ryan, K., Bissell, P., & Morecroft, C. (2007). Narratives about illness and medications: A neglected theme/new methodology within pharmacy practice research. Part II: Medication narratives in practice. Pharmacy World and Science, 29, 353–360.CrossRefGoogle ScholarPubMed
Schoenberg, N., Amey, C.H., & Coward, R.T. (1998). Stories of meaning: Lay perspectives on the origin and management of non-insulin dependent diabetes mellitus among older women in the United States. Social Science and Medicine, 47(12), 2113–2125.CrossRefGoogle ScholarPubMed
Schwartz, J.B. (2007). The current state of knowledge on age, sex, and their interactions on clinical pharmacology. Clinical Pharmacology and Therapeutics, 82, 87–96.CrossRefGoogle ScholarPubMed
Shi, S., Mörike, K., & Klotz, U. (2008). The clinical implications of ageing for rational drug therapy. European Journal of Clinical Pharmacology, 64, 183–199.CrossRefGoogle ScholarPubMed
Sleath, B., Rubin, R.H., Campbell, W., Gwyther, L., & Clark, T. (2001). Physician-patient communication about over-the-counter medications. Social Science and Medicine, 53, 357–369.CrossRefGoogle ScholarPubMed
Sloane, P.D., Gruber-Baldini, A.L., Zimmerman, S., Roth, M., Watson, L., Boustani, M., et al. . (2004). Medication undertreatment in assisted living settings. Archives of Internal Medicine, 164(18), 2031–2037.CrossRefGoogle ScholarPubMed
Statistics Canada (2007). Census snap-shot of Canada – Population, age and sex. Canadian Social Trends, 84, 37–38.Google Scholar
Straand, J., & Rokstad, K. (1997). General practitioners’ prescribing patterns of benzodiazepine hypnotics: Are elderly patients at particular risk for over-prescribing? Scandinavian Journal of Primary Health Care, 15, 16–21.CrossRefGoogle Scholar
Stryker, S. (2008). From Mead to a structural symbolic interactionism and beyond. Annual Review of Sociology, 34, 15–31.CrossRefGoogle Scholar
Tamblyn, R., Abrahamowicz, M., du Berger, R., McLeod, P., & Bartlett, G. (2005). A 5-year prospective assessment of the risk associated with individual benzodiazepines and doses in new elderly users. Journal of the American Geriatric Society, 53(2), 233–241.CrossRefGoogle ScholarPubMed
Temple, B., & Young, A. (2004). Qualitative research and translation dilemmas. Qualitative Research, 4, 161–178.CrossRefGoogle Scholar
Thorne, S.E., Nyhlin, K.T., & Paterson, B.L. (2000). Attitudes toward patient expertise in chronic illness. International Journal of Nursing Studies, 37, 303–311.CrossRefGoogle ScholarPubMed
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, 1–12.CrossRefGoogle ScholarPubMed
Vik, S.A., Hogan, D.B., Patten, S.B., Johnson, J.A., Romonko-Slack, L., & Maxwell, C.J. (2006). Medication non-adherence and subsequent risk of hospitalization and mortality among older adults. Drugs and Aging, 23, 345–356.CrossRefGoogle ScholarPubMed
Wolff, J.L., Starfield, B., & Anderson, G. (2002). Prevalence, expenditures and complications of multiple chronic conditions in the elderly. Archives of Internal Medicine, 162, 2269–2276.CrossRefGoogle ScholarPubMed
Wynne, H. (2005). Drug metabolism and aging. Journal of the British Menopause Society, 11, 51–56.CrossRefGoogle Scholar
Zuckerman, I.H., Langenberg, P., Baumgarten, M., Orwig, D., Byrns, P.J., Simoni-Wastila, L., et al. . (2006). Inappropriate drug use and risk of transition to nursing homes among community dwelling older adults. Medical Care, 44, 722–730.CrossRefGoogle ScholarPubMed