Self-medication

In the treatment of the elderly, as in other ages, or even more, it is essential that the guidelines for taking the drugs are respected, so the effects of the drugs will be more predictable. Self-medication is defined as the taking or administration of drugs or substances with therapeutic intent, without the intervention of healthcare professionals. The drugs most implicated in self-medication are analgesics and anti-inflammatories, laxatives, bronchodilators, antacids and anxiolytics. These categories include both industrial drugs and herbal or traditional remedies. The symptoms for which patients most frequently self-medicate are headache, musculoskeletal pain, cold and flu symptoms, stomach discomfort, constipation, skin problems, and insomnia. More than 40% of the geriatric population self-medicate in some way; that is, about half of the elderly take treatments that are not known to their doctors, with the clear risks of adverse effects, drug reactions and interactions. For this reason, it is essential that, in the medical evaluation, in addition to the prescribed medication, it is questioned about the treatments that the patient takes (or has a habit of taking) on ​​their own. The origin of self-medication is usually, in the first place, previous experience, a similar previous medical prescription for similar symptoms, indication of pharmacists, advice from family and friends and, finally, advertising. The reason for self-medication is complex; Psychological, social and even economic factors come into play. An individual makes the decision to take a drug without consulting the doctor for multiple reasons:

• Difficulty in accessing the consultation: waiting lists, lack of time, difficulties in moving outside the home.
• Distrust of medical professionals.
• Fear of what the doctor will say, to start a new diagnostic process.
• Fear or prevention of side effects of new drugs.
• Reliance on drugs and treatments already known.

Having controlled, or at least known, the self-medication that a patient can do will help doctors a lot to prevent side effects and interactions. For this reason, it is very important to inform the physicians who treat any person which medicines or home or traditional remedies are usually taken for common symptoms, so that they can be taken into account in the general therapeutic regimen. Another problem of great importance in the treatment of the elderly is therapeutic non-compliance. Therapeutic compliance is the degree to which patients follow medical instructions (both medication and otherwise). In chronic diseases, compliance is reduced between 43 and 75% after 6 months of treatment. And in serious diseases, such as heart failure or diabetes mellitus, taking less than 80% of the doses greatly worsens the prognosis.

Not following the recommended guidelines has consequences: worse evolution of the disease, increased mortality, increased healthcare costs and increased hospital admissions due to complications. The origin of the breach is multiple; depends on:

• Treating medical team: accessibility, adequacy of treatment, communication skills, delivery of informative material, ease of administrative procedures, etc.
• Of the disease itself, comorbidity and the drugs themselves: adverse effects and interactions or fear of presenting them, complex dosage guidelines, the cost of treatment and the complexity of the procedures to achieve them.
• The patient himself: prior health education, lifestyles, family and environmental support, cognitive level and independence.

Treatment adherence can be improved with simple interventions:

• Work on the health education of the patient, adequately explaining the pathologies and treatment needs, the how and why of the different drugs. Involve the patient in the choice of medication, as far as possible (if they prefer sachets to tablets, for example), and respect their preferences as much as possible.
• Simplification of therapeutic guidelines: enhance the oral route, ensure that the inhalers are all of the same type, if possible single doses, related to daily activities (intake, lying down, ...). Guidelines should be given in writing clearly and simply.
• Greater accessibility to medical equipment, both in consultation and by telephone contact. It will be interesting to see in the coming years what role the new communication technologies (email, videoconferencing, etc.) play here.
• Improved communication between doctors and patients. Boost confidence; an adequate doctor-patient relationship, with respect and empathy is one of the best weapons against therapeutic non-compliance.