Medication adherence is a crucial component in the treatment of chronic diseases. In the elderly, clinicians are faced with a unique set of problems associated with adherence for which they may not be adequately trained. The different factors affecting medication adherence in the elderly are many: patient, medication, health care providers, healthcare system, and socioeconomic factors.
The term medication adherence is the extent to which a person's behavior agrees with the agreed medication regimen from a healthcare provider. An elderly person is defined as a person who is aged ≥ 65 years.
Why is medication adherence so important? Adherence to medications has always been a problem among patients. As the elderly are prone to multiple comorbidities, they are at higher risk of polypharmacy, and therefore may present with higher risk of nonadherence to medications compared to the younger population. This can result in decreased therapeutic benefits for the patient, frequent hospital and physician visits due to the deterioration of their medical condition, increased healthcare expenditure, and even overtreatment of a condition.
The reasons for nonadherence in the elderly are many. As adherence to medications very much depends on an individual, multiple studies have investigated the different patient factors that may affect an individual's willingness and ability to adhere to a medication schedule. These non-adherence factors are varied, such as mental state, physical health, demographics, past medical history, behavior/attitudes/habits, knowledge/beliefs, and others.
How can medication adherence be improved? To address the different non-adherence factors, a multilevel approach should be used:
- Assess the patient’s mental status. Is the patient capable of handling his own medications?
- Assess behavior, attitude and habits. Is patient willing to take his medications? Is he adherent to follow-ups?
- Assess patient’s knowledge and beliefs about his medications and disease. Is his knowledge about his medications and disease accurate?
- Assess patient’s physical status. Is the patient wheelchair bound and able to serve the medications himself or need a caregiver?
- Does the patient have disease such as chronic obstructive pulmonary disorder that may affect adherence?
- Was patient recently hospitalized? If so, more care needs to be given to ensure adherence.
- Medication factors -- drug and regimen. Is the packaging user-friendly for the patient? Has patient been counselled on the appropriate storage of the drug, if needed? Is it possible to reduce the number of medications and to simplify the regimen?
All of these factors, if addressed properly, can significantly improve medication adherence and reduce depression in elderly patients.
Source: Journal of Clinical Gerontology and Geriatrics -- Volume 7, Issue 2, June 2016.