Academic journal article Research and Theory for Nursing Practice

Medication Adherence Interventions for Older Adults: Literature Review

Academic journal article Research and Theory for Nursing Practice

Medication Adherence Interventions for Older Adults: Literature Review

Article excerpt

This literature review explores the range and nature of medication adherence interventions tested with older adults. The unique needs of older adults require specifically designed and tailored interventions. Low medication adherence rates among some elderly contribute to inadequate pharmacological management of illnesses. Searches were conducted to identify randomized controlled trials of medication adherence; computerized databases, journal hand searches, and ancestry searches yielded 63 studies published between 1977 and 2005 where participants' mean age was > 60 years. Interventions were categorized by focus (patient, medication, and administration factors). Most were geared toward promoting knowledge and skills for medication-taking and adherence. Gaps were noted in addressing memory aids and self-monitoring strategies; further development of interventions addressing medication and administration factors influencing adherence are also needed. Identified interventions are geared toward self-medicating patients and fail to address caregivers administering medications. Finally, interventions do little to address variations in patterns of adherence among older adults.

Keywords: medication; medication adherence; compliance; the aged; literature review; nursing

The ability to take medications as prescribed is one important part of individuals' ability to address personal health needs. This is particularly true for older adults, who are far more likely to be taking medications to manage chronic illnesses. One epidemiologic study found that of persons aged 65 years or older, 91% of men and 94% of women had used at least one medication during the preceding week; 71% of men and 81% of women reported taking at least one prescription medication (Kaufman, Kelly, Rosenberg, Anderson, & Mitchell, 2002). These prescribed medicines are often the primary factors preventing older adults from developing serious complications from their chronic conditions. As such, the ability to regularly take medications as prescribed is an important health behavior for controlling chronic conditions and preventing the onset of more serious disease. Nurses typically conduct patient education and use other strategies to increase medication adherence. Despite the potential importance of these interventions for affecting health outcomes, few reviews have closely examined the nature of medication adherence interventions.

The World Health Organization defines adherence as "The extent to which a person's behaviour (taking medications, following a recommended diet and/or executing life-style changes) corresponds with the agreed recommendations of a health care provider" (Sabate, 2003, p. 13). Older adults have an increased risk for medication adherence problems due to cognitive and physical changes associated with aging (Maddigan, Farris, Keating, Wiens, & Johnson, 2003). Adherence to prescribed medications in older adults has been reported to range from 26% to 59% (Botelho & Dudrak, 1992; van Eijken, Tsang, Wensing, de Smet, & Grol, 2003). Medication nonadherence can lead to ineffective pharmacologic management of chronic conditions, and can also contribute to adverse drug events (Gurwitz et al., 2003). Adherent medication-taking behaviors include procuring the medication; administering the correct drug, dose, time, and route ; and persisting with taking the medication as long as the medication is necessary.

Despite an abundance of published research exploring predictors and correlates of medication adherence, we continue to lack enough effective, clinically useful interventions. This may be due in part to the fact that medication adherence, while central to the effective self-management of most chronic conditions, is a very individualized phenomenon. Medication-taking behavior may be heavily influenced by prior experiences, cultural factors, personal beliefs, side effects, patient-provider relationship, financial considerations, insurance coverage, and government regulation, among others (Balkrishnan, 1998; Pound et al. …

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