Older peoples' views on cardiovascular disease medication: a qualitative study. (25th January 2022)

• Record Type: Journal Article
• Authors: Wallis, Katharine A; Taylor, Denise A; Fanueli, Elizabeth F; Saravanakumar, Priya; Wells, Susan
• Is Part Of: Family practice. Volume 39:Number 5(2022)
• Page Start: 897
• Page End: 902
• Publication Date: 2022-01-25
• Subjects: cardiovascular disease -- ischaemic stroke -- medication review -- mortality -- older adult -- prevention; Primary care (Medicine) -- Periodicals; Clinical medicine -- Periodicals; 616.005
• DOI: 10.1093/fampra/cmab186
• Languages: English
• ISSNs: 0263-2136

Abstract

Abstract: Background: There is increasing evidence for the potential benefits and harms of cardiovascular disease (CVD) medications in older people (>75 years) prompting updating of clinical guidelines. We explored the views of older people about CVD medication to inform guideline development. Methods: Qualitative study using semistructured interviews and focus groups. An ethnically diverse group of community dwelling older people were purposefully recruited from northern New Zealand using flyers in primary care clinics, local libraries, social groups, and places of worship, and by word of mouth. Interviews and focus groups were digitally recorded, transcribed verbatim, and analysed using an iterative and inductive approach to thematic analysis. Results: Thirty-nine participants from 4 ethnic groups were recruited (mean 74 years; range 61–91 years; Māori (7), South Asian (8), European (9), and Pasifika (15)). Most participants were taking CVD medication/s. Four main themes emerged: (i) emphasizing the benefits of CVD medication and downplaying the harms; (ii) feeling compelled to take medication; (iii) trusting "my" doctor; and (iv) expecting medication to be continued. Conclusion: Findings raise questions about older people's agency in decision-making regarding CVD medication. CVD risk management guidelines for older people could include strategies to support effective communication of the potential benefits and harms of CVD medication in older people, balancing life expectancy, and the expected duration of therapy. Lay Summary: We explored the views of older people about cardiovascular disease (CVD) medication. Qualitative study using semistructured interviews and focus groups. An ethnically diverse group of community dwelling older people were purposefully recruited from northern New Zealand. Interviews and focus groups were digitally recorded, transcribed verbatim, and analysed. Thirty-nine participants from 4 ethnic groups were recruited (mean 74 years; range 61–91 years; Māori (7), South Asian (8), European (9), and Pasifika (15)). Most participants were taking CVD medication/s. Participants emphasized the benefits of medication and downplayed the harms; they did not want to take medication but felt compelled to; they trusted their doctor to know best regarding medication; and they believed their doctor wanted them to keep taking medication. Findings raise questions about older people's agency in decision-making regarding medication. Work is needed to identify strategies to support effective communication of the potential benefits and harms of medication in older people, balancing life expectancy, and the expected duration of therapy.