Writing: a Factor That Can Influence Understanding of Prescriptions in the Geriatric Population

Patients over 75 years of age represent the largest group of drug users. This is also the group with the highest risk of medication-use errors. These elderly, polymedicated people are subject to frequent changes in treatment, particularly when discharged from hospital, where on average 2 out of 3 prescriptions are changed, with more than 6 changes per prescription. Furthermore, up to 75% of the elderly are unable to provide details of their prescriptions, and almost half misinterpret them.

These data are indicative of poor compliance in geriatrics. Compliance is defined as the degree of concordance between an individual's behavior and medical prescriptions or recommendations. The factors contributing to poor compliance in elderly patients have been studied in numerous studies. The following 4 categories of factors have been identified:

• The first category corresponds to the treatments themselves: unsuitable galenic form, difficult-to-obtain dosage, misunderstood mode of administration, similar packaging and tablets, handling of eye drops, liquids to be measured, blister pack openings, handling of pillbox, size of tablets to be handled (too small) or swallowed (too big), poor tolerance.
• The second category corresponds to patients' comorbidities, including cognitive and functional deficits (dexterity, vision), depressive or anxious state, as well as patients' level of literacy, defined as the ability to read, understand and use written information in daily life, and numeracy, defined as the fundamental mathematical knowledge enabling a person to function in society.
• The third category relates to the disease: the patient's own representations and perceptions of the disease, as well as his or her habits.
• The fourth category relates to the relationship between doctor and patient: clarity of repeated explanations given to the patient, empathy, partner relationship, patient not daring to express problems of understanding.

In addition to all these factors limiting compliance, the investigator hypothesized that poor understanding of prescriptions could lead to poor patient compliance and medication errors.

In fact, it's common to complain about doctors' handwriting and the resulting lack of understanding of prescriptions. But we believe that beyond the practitioner's handwriting, all the editorial and typographical elements of the prescription come into play in its comprehensibility.