Dilemmas: Exploring the everyday experiences of older Māori and their medication

Key Points:

• Enquire about the views and perceptions of health and well-being of older Māori
• Reassure older Māori about the need for the medication in a way they can relate to
• Provide information that aligns with Māori beliefs, values and understandings
• Provide written information including the safe use, storage and disposal of the medication

Older Māori negotiate the complexities of medication and its use through self-regulation and self-management - guided by their beliefs, values, and attitudes along with the issues they face on a day-to-day basis.

The 1997 Oranga Kaumatua Study about the health and well-being of older Māori people revealed a number of factors (adjacent box).¹ There are a number of issues that need to be addressed.

Older Māori are likely to follow instructions, driven by trust and respect for the doctor's authority. This may lead to older Māori continuing to take medication when it is no longer needed.^{2, 3}

Older Māori are more likely than non-Māori to be treated for the symptoms of chronic conditions rather than the conditions themselves.^{4, 5, 6, 7}

Insufficient information is provided to Māori concerning the safe use, storage and disposal of medicine. This is a particular concern if there are communication issues, they are living alone, are without social support, or are caring for mokopuna (grandchildren).⁸

Considerations for Older Māori and their Medication

Medication for Māori is more than just pharmacological and physical. For older Māori, medication may be viewed as a conduit to facilitate other important factors and events in their lives that enhance their well-being and enable them to live active and self-dependant lifestyles. Therefore medication use is not considered in isolation.

When prescribing for older Māori, it may be best to link the benefits of the medication with their ability to carry on with their lives - preserving and strengthening their social space and networks, their sense of well-being, their productiveness for themselves, their whānau and their community and their ability to function optimally. What may be important for older Māori are the improved health outcomes that result from taking medication rather than, for example, knowing their glycosylated haemoglobin is 8% after taking metformin for six months.

Understanding how older Māori perceive their well-being, by asking what is important for them may be an alternative approach to promote the benefits of their medication. Stressing patient-centered priorities, aligned with their health beliefs, goals and expectations rather than that of their doctor, is useful. The example using asthma and utilising Durie's whare tapa wha framework⁹ explains this further (Table 1).

Table 1: Managing asthma using the whare tapa wha framework

Conclusion

For older Māori, being provided with information about their medication that aligns with their needs, beliefs and understanding is essential. This optimises the benefits of the medication and ultimately improves health and wellbeing.