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

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.

Health Status and Health Determinants of Older Immigrant Women in Canada: A Scoping Review

“…Lai and Kalyniak's [ 33 ] study of predictors related to accessing annual physical examinations among older Chinese immigrants revealed that, in addition to lack of knowledge about healthcare coverage and service availability, the low rates of accessing healthcare could be related to a lack of understanding about the importance and benefits of preventive annual physical examinations. Ballantyne et al [ 34 ] investigated medication use among a diverse group of older immigrants and found that older immigrants from China, Hong Kong, Vietnam, and Portugal often avoided discussing their self-care and alternative healthcare practices with their physicians; they also found that the participants often disagreed with the assessment and the recommended treatment and sought out and tried alternative treatments.…”

Understanding Users in the ‘Field’ of Medications

“…As active, reflective consumers and ‘expert patients’, members of the public evaluate and have the potential to accept, challenge or resist the profession’s claims about the value of medicines [2,21]. People’s beliefs about medicines, their direct or vicarious experiences of them, their attention to or knowledge of documented side effects and risks associated with specific medicines—all influence their interests in and alignment with medical opinion or an individual physician’s medication recommendations [13,36]. In addition, physicians have been shown to respond to patients’ medication expectations or demands for a prescription, even if these contradict the physician’s intended actions [37] (Figure 1h).…”

“…, non-adherent) patient’ [69]. Research on lay-perspectives on medicines has come to show users to be thoughtful, considered agents of medicine use and consumption, who take responsibility for medication decisions about the suitability of medicines for specific conditions and contexts [13,17,70,71,72,73,74,75,76,77,78] (Figure 1h).…”

“…Research has revealed users’ ambivalence about medicines to be a central theme, one that captures the reasoned view of medicines as both helpful and harmful, as potentially ‘remedy and poison’ [79], as producing not only physical but emotional side effects [80], and as requiring, among lay-users, the practice of testing medicines and managing their effects as they are integrated into lives over time [13]. As shown in a synthesis of thirty-seven qualitative studies of medicine taking, concern over such issues as dependence, tolerance, addiction, the potential harm from taking medicines on a long-term basis, the possibility of medicines masking other symptoms, or harms related to stigma of chronic medicine use accounts for users’ ambivalence toward and resistance to medicine-use [36].…”

“…This is because medicines proliferation has emerged in an environment where, increasingly, medicines are provided in ambulatory and community settings. This has the consequence of restricting the capacity of health professionals such as physicians and pharmacists to monitor medication use and effects; and of locating the control of pharmaceuticals in the hands and homes of users [13,14]. Thus, while physicians (and pharmacists) control users’ access to prescription medicines, they do not control their uses once a prescription is issued (with some exceptions [15].…”