RESUMEN
BACKGROUND: Older people (aged 60 years and older) are more susceptible than younger people to multiple medical disorders and are therefore more frequently exposed to polypharmacy. We investigated prevalence of chronic diseases and medical conditions, medications used, and associated sociodemographic factors among older adults of the Palestinian population. METHODS: A cross-sectional study was done between June, 2013, and January, 2014. The study population was Palestinians aged 60 years and older living in the West Bank and East Jerusalem. Study participants were selected in a stratified random manner. The sample was selected from all governorates (strata) according to the size of the population of each governate on the basis of census data from the Palestinian Central Bureau of Statistics. The research team visited and interviewed older residents in their houses. Questionnaire items were explained in informal language to participants by the interviewer, to ensure complete understanding, and answers were recorded by the interviewer. Informed written consent was obtained from each participant. The study design and protocols were revised and approved by the Research Ethics Committee at Al-Quds University. FINDINGS: 1574 older Palestinian adults were invited to participate, of whom 1192 (76%) enlisted. The mean age was 70·3 years (SD 8·58, range 60-110 years). 55% (659 of 1192) were female and 45% (533) were male. The majority (84%; 996) were non-workers or retired; monthly income for 78% of participants (930) was less than 2500 NIS, which falls in the low-income group. More participants (78%; 934) had governmental health insurance than had private insurance (8%; 89) or no insurance (14%; 169). 40 chronic diseases and conditions were reported. The mean number of diseases reported per participant was 2·33 (SD 1·68, range 0-11). Cardiovascular, endocrine, and musculoskeletal conditions were the most frequently reported. 66% of participants (787 of 1192) reported at least one cardiovascular condition, 40% (480) at least one endocrine condition, and 32% (385) at least one musculoskeletal condition. The most prevalent cardiovascular condition was hypertension, which affected 54% of participants (647); the most prevalent endocrine condition was diabetes (38·2%, 455); and the most prevalent musculoskeletal condition was arthritis (13·7%, 163). The total number of different types of medication (both prescribed and over-the-counter drugs) was 175. The mean number of medications per participant was 4·54 (SD 2·83), and the highest number of different medications being taken by one participant was 17. Commonly prescribed therapeutic agents were aspirin (prescribed to 48% of participants, 575 of 1192), angiotensin-converting-enzyme inhibitors (34%, 403), diuretics (34%, 409), metformin (27%, 323), paracetamol (23%, 270), and protein pump inhibitors (23%, 275). INTERPRETATION: The findings provide insights into the most prevalent chronic diseases and conditions, as well as the most commonly used medications among older Palestinians. Cardiovascular, endocrine, and musculoskeletal conditions were the most prevalent diseases. Older Palestinians adults are subjected to polypharmacy, which should be assessed whenever they are evaluated for health problems, and drug interactions should be carefully checked. Physicians, pharmacists, health professionals, and health policymakers in Palestine should consider increasing citizens' health awareness and encourage healthy lifestyles to decrease the incidence of these diseases. In addition, intersectoral cooperation between the governmental and non-governmental organisations will be key in the fight against chronic diseases in older Palestinian adults. FUNDING: None.
RESUMEN
BACKGROUND: Adequate patient knowledge about medications is essential for appropriate drug taking behavior and patient adherence. This study aims to assess and quantify the level of knowledge and adherence to medications among Palestinian geriatrics living with chronic diseases and to investigate possible associated socio-demographic characteristics. METHODS AND FINDINGS: We conducted a cross-sectional study during June 2013 and January 2014 among Palestinian geriatrics ≥ 60 years old living with chronic disease in the West Bank and East Jerusalem. A stratified random sample was selected and a questionnaire-assisted interview was applied for data collection. T-test was applied for bivariate analyzing and one-way ANOVA test was applied for multivariate analyses. RESULTS: A total of 1192 Palestinian geriatrics were studied. The average age was 70.3 (SD = 8.58) years and ranged from 60-110 years. The sample comprised 659 (55.3%) females and 533 (44.7%) males. The global knowledge and global adherence scores were (67.57%) and (89.29%), respectively. Adequate levels of knowledge were 71.4%, and of adherence 75%, which were recorded for 705 (59.1%) and 1088 (91.3%) participants, respectively. Significant higher levels of global knowledge and global adherence were recorded for males, and for participants who hold a Bachelor's degree, those who live on their own, and did physical activity for more than 40 hours/week (p-value < 0.05). Furthermore, workers, participants with a higher monthly income, and non-smokers have a higher knowledge level with (p-value < 0.05). We found positive correlation between participants' global adherence and global knowledge (r = 0.487 and p-value < 0.001). Negative correlation was found between participants' global knowledge and adherence with age (r = -0.236, p-value < 0.001 and r = -0.211 and p-value < 0.001, respectively. Negative correlation between global knowledge and the number of drugs taken (r = -0.130, p-value < 0.001) was predicted. CONCLUSION: We concluded that patients with a higher level of knowledge are more adherent to their medications and that better understanding of socio-demographic factors has a clear influence on the level of knowledge and adherence to medications and thus contributes to the development of guidelines for treatment and may consequently lead to favourable clinical outcomes and savings of health care costs.