Academic journal article Generations

A Myriad of Multiples: Many Problematic Factors Contribute to Medication Non-Adherence in Elders

Academic journal article Generations

A Myriad of Multiples: Many Problematic Factors Contribute to Medication Non-Adherence in Elders

Article excerpt

The problem of non-adherence is dangerous and costly, and more exploration is needed to find solutions.

Poor adherence to medications among elders is a common problem with myriad contributing factors. A report from the Institute of Medicine (Kohn, Corrigan, and Donaldson, 2000) has identified such non-adherence as a significant source of medical errors. When patients fail to accurately report medication use to their provider, a cascade of unfavorable actions, based on a patient's response, can occur: the provider may increase dosages, change medications, or even switch diagnoses, depending upon the information given by the patient.

Patients sometimes deceive providers, concealing their non-adherence to medications in order to escape being labeled as "bad" patients. Some interesting cover-ups have been described: asthma patients activating their inhalers more than 100 times the day before a visit during which their inhaler would be weighed (Simmons et al., 2000); patients fabricating glucose readings in a log so they more closely adhere to what was prescribed (Mazze et al., 1984); and adjustments being made to a recording pill box that would give physicians access to their actual blood pressure readings (Burnier et al., 2001). Careful attention to adherence may contribute to better outcomes for patients when both patient and provider agree on mutual goals for treatment, understand the nature of the problem, and are aware of barriers to adherence.

Adherence Is a Significant Problem

Medication adherence is defined as "the extent to which a person's behavior in taking medication corresponds with agreed recommendations from a healthcare provider" (Sabaté, 2003). For some individuals, not taking prescribed medications can be a matter of life or death, and it is a costly problem, resulting in at least $290 billion in unnecessary healthcare expenses each year (New England Healthcare Institute, 2009). Additional prescriptions, avoidable emergency room visits, additional visits to healthcare providers, and hospital admissions all contribute to the high costs of non-adherence (Patel and Taylor, 2002). For instance, more than 10 percent of all hospital admissions are related to medication non-adherence (Schlenk, Dunbar-Jacob, and Engberg, 2004).

Poor adherence to medication regimens is a common problem in healthcare, especially among older adults who, by age 65, take at least one medication and have three or four chronic diseases. Adherence rates among older adults also vary depending upon the type of medication. In a study of 34,501 sixty-five-year-old and older insurance enrollees taking statins, only 25 percent adhered to the regimen after five years. In a study of 21,011 patients with hypertension, the adherence rate at six months was 75 percent, and only one in three were adherent after six months while taking both antihypertensive and lipid-lowering drugs.

Evidence supports an association between poor adherence and poor outcomes. In a study of 6,486 patients with diabetes in a managed-care system where patients were prescribed statins, patients with poor adherence had a death rate double that of patients who were identified with high rates of adherence. In a trial of clopidogrel prescribed for patients with drug-eluting stents, after thirty days, the adherence was only 13.6 percent, and the death rate risk increased nine-fold in those who prematurely discontinued the drug (Spertus et al., 2006). Such dangerous outcomes associated with poor medication adherence warrant a search for contributing factors in patients not taking prescribed medications, and the development of a process that increases medication adherence.

Factors Contributing to Poor Medication Adherence

Much of the literature addressing reasons for medication non-adherence is organized around risks, barriers, cost, and disease burden. This article is instead organized around patient, provider, and system-a framework used by Dr. …

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