Daiki Hira1, Yuko Komase2, Setsuko Koshiyama3, Tetsuya Oguma4, Tetsuo Hiramatsu5, Akira Shiraki6, Masanori Nishikawa7, Masanori Nakanishi8, Takao Tsuji9, Hisako Matsumoto10, Koichi Ichimura11, Takashi Iwanaga12, Miwa Morikawa13, Hirotaka Yasuba14, Fumiko Sugaya15, Yukako Arakawa16, Yoshiki Kobayashi17, Toshiyuki Kato18, Yutaka Futamura19, Fumio Tsuji20, Tomohiro Terada21. 1. Department of Pharmacy, Shiga University of Medical Science Hospital, Shiga, Japan. Electronic address: hirad@belle.shiga-med.ac.jp. 2. Department of Respiratory Internal Medicine, St. Marianna University, School of Medicine, Yokohama-City Seibu Hospital, Kanagawa, Japan. 3. Kinki-Chozai Kadono Sanjo Pharmacy, Kyoto, Japan. 4. National Hospital Organization Higashi-Ohmi General Medical Center, Shiga, Japan. 5. Hiramatsu Clinic, Aichi, Japan. 6. Department of Respiratory Medicine, Ogaki Municipal Hospital, Gifu, Japan. 7. Fujisawa City Hospital, Kanagawa, Japan. 8. Third Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan. 9. Department of Respiratory Medicine, Tokyo Medical University Ibaraki Medical Center, Ibaraki, Japan. 10. Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan. 11. Ichimura Clinic, Tokyo, Japan. 12. Department of Respiratory Medicine and Allergology, Faculty of Medicine, Kinki University, Osaka, Japan. 13. Third Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan. 14. Department of Airway Medicine, Mitsubishi Kyoto Hospital, Kyoto, Japan. 15. Department of Respiratory Medicine, Teine Keijinkai Hospital, Hokkaido, Japan. 16. Sleep and Respiratory Disease Center, KKR Takamatsu Hospital, Kagawa, Japan. 17. Department of Otolaryngology, Kansai Medical University, Osaka, Japan. 18. Department of Respiratory Medicine and Allergology, Kariya Toyota General Hospital, Aichi, Japan. 19. Kagawa Pharmaceutical Association, Kagawa, Japan. 20. Suita Municipal Hospital, Osaka, Japan. 21. Department of Pharmacy, Shiga University of Medical Science Hospital, Shiga, Japan.
Abstract
BACKGROUND: There is no systematic analysis to identify problems involved with instruction on inhalation therapy for elderly patients. We conducted a nationwide questionnaire survey for patients and medical professionals. METHODS: A questionnaire survey was conducted of adult patients on inhaled drugs (ages 18-92 years, 820 individuals) and medical professionals (pharmacists or nurses) who provided instruction on inhalation therapy to these patients in 23 institutions in Japan to investigate the technique and the level of understanding (knowledge) of the inhalation therapy. Changes in the recognition of performance of inhalation technique and inhalation knowledge with increasing age were analyzed. RESULTS: According to patients' subjective assessment, there was no deterioration in the performance of the inhalation technique or loss of the knowledge with increasing age. On the other hand, medical professionals' objective assessment revealed a significant loss of both inhalation technique and knowledge with increasing age. Not many elderly patients noticed their own problems themselves, revealing a great perception gap between elderly patients and medical professionals. Thus, there was concern that patients would unconsciously practice the inhalation procedure improperly. On the other hand, in comparison with non-elderly patients, elderly patients were less resistant to continuation of therapy, suggesting that they would be more likely to accept instruction on inhalation therapy. CONCLUSIONS: Elderly patients are apt to assume that they "understand well", therefore, in order to recognize and close the perception gap between elderly patients and medical professionals, it is necessary to provide them with more aggressive (frequent) instructions on inhalation therapy.
BACKGROUND: There is no systematic analysis to identify problems involved with instruction on inhalation therapy for elderly patients. We conducted a nationwide questionnaire survey for patients and medical professionals. METHODS: A questionnaire survey was conducted of adult patients on inhaled drugs (ages 18-92 years, 820 individuals) and medical professionals (pharmacists or nurses) who provided instruction on inhalation therapy to these patients in 23 institutions in Japan to investigate the technique and the level of understanding (knowledge) of the inhalation therapy. Changes in the recognition of performance of inhalation technique and inhalation knowledge with increasing age were analyzed. RESULTS: According to patients' subjective assessment, there was no deterioration in the performance of the inhalation technique or loss of the knowledge with increasing age. On the other hand, medical professionals' objective assessment revealed a significant loss of both inhalation technique and knowledge with increasing age. Not many elderly patients noticed their own problems themselves, revealing a great perception gap between elderly patients and medical professionals. Thus, there was concern that patients would unconsciously practice the inhalation procedure improperly. On the other hand, in comparison with non-elderly patients, elderly patients were less resistant to continuation of therapy, suggesting that they would be more likely to accept instruction on inhalation therapy. CONCLUSIONS: Elderly patients are apt to assume that they "understand well", therefore, in order to recognize and close the perception gap between elderly patients and medical professionals, it is necessary to provide them with more aggressive (frequent) instructions on inhalation therapy.