Academic journal article Research and Theory for Nursing Practice

Improper Intake of Medication by Elders-Insights on Contributing Factors: A Review of the Literature

Academic journal article Research and Theory for Nursing Practice

Improper Intake of Medication by Elders-Insights on Contributing Factors: A Review of the Literature

Article excerpt

Elders represent 6.4% of the world's populations, and 60% of them take medication. In one of six hospital admissions of elders, failures in medication intake are involved. Most of these admissions (88%) could be prevented if elders at risk can be identified (Beijer & Blaey, 2002). This review was conducted to identify and gain insight into which factors influence medication intake in elders. The factors are grouped into six categories: physiological factors, cognitive factors, polypharmacy and medication frequency, patient consent to the treatment and motivation for taking the medication, demographic variables, and family caregivers and social support. In order to identify elders at risk in an early stage, it is recommended that a risk-assessment instrument be developed.

Keywords: medication intake; adherence; aged; predisposing factors

Elders worldwide have become the fastest growing segment of the population. In developed countries, they represent 12-18% of the population and consume approximately 50% of all prescription medicines (Sabate, 2003). Taking medication is not always as easy and obvious as it seems. A recent study of the World Health Organization on adherence to long-term therapies estimates that 50% of all patients do not adhere to their medication regime (Sabate, 2003).

The improper intake of medication does not always lead to serious consequences for the patient. In 60% of the hospital admissions of elders, however, failure of medication intake plays a significant role (Mannesse, Derkx, de Ridder, Man in 't Veld, & van der Cammen, 2000). Eighty-eight percent of these admissions can be avoided by enhancing patient adherence in medication intake. In The Netherlands (with more than 16 million inhabitants), this means that 77,000 elderly people incurring hospital admissions are costing between 200 and 400 million a year that could be prevented (Beijer & Blaey, 2002; Mannesse et al, 2000).

Hospital admissions can have serious consequences for elders. From 30% to 60% of elderly people admitted to hospital became less independent after discharge (Fortinsky, Covinsky, Palmer, & Landefeld, 1999). Hospital admission creates much personal suffering and has tremendous economic consequences, and it must be prevented when possible. District nurses and nurse practitioners are in an ideal position to signal patients' failures with medication intake early in the process.

Improper intake of medication is often described as nonadherence. Adherence is defined as the extent to which a person's behavior (taking medication, following a diet, or executing lifestyle changes) corresponds with recommendations from a health care provider and agreed to by the patient (Sabate, 2003). In this review, we restrict ourselves to medication nonadherence. We conducted a literature review to gain insight into factors influencing medication nonadherence with focus on community-dwelling elders. The aim of this review is to identify the factors that contribute to medication nonadherence as the first step in the development of a risk-assessment instrument for elders. We have concentrated on elderly patients, because problems related to medication intake and adherence are great in this group (Fulmer, Kirn, Montgomery, & Lyder, 2001 ; Pesznecker, Patsdaughter, Moody, & Albert, 1990; Ryan, 1999; Wade & Bowling, 1986).

METHOD

IDENTIFICATION OF RELEVANT LITERATURE

We searched for studies related to improper intake of medication by elders in which adherence plays an important role. Studies published from 1990 until the present were identified by searching the following databases: Cinahl, PubMed, Invert (Dutch database), E-psyche, and PsycINFO. The full text databases of the Nursing and Allied Health Collection and the Psychology and Behavioral Science Collection were searched from 1995, the date of availability of those databases. Searches were performed using different combinations of the following keywords: "aged," "elderly," "adherence," "compliance," and "medication. …

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