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Toward appropriate criteria in medication adherence assessment in older persons: Position Paper

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Abstract

Nonadherence to medication regimens is a worldwide challenge; adherence rates range from 38 to 57 % in older populations with an average rate of less than 45 % and nonadherence contributes to adverse drug events, increased emergency visits and hospitalisations. Accurate measurement of medication adherence is important in terms of both research and clinical practice. However, the identification of an objective approach to measure nonadherence is still an ongoing challenge. The aim of this Position Paper is to describe the advantages and disadvantages of the known medication adherence tools (self-report, pill count, medication event monitoring system (MEMS) and electronic monitoring devices, therapeutic drug monitoring, pharmacy records based on pharmacy refill and pharmacy claims databases) to provide the appropriate criteria to assess medication adherence in older persons. To the best of our knowledge, no gold standard has been identified in adherence measurement and no single method is sufficiently reliable and accurate. A combination of methods appears to be the most suitable. Secondly, adherence assessment should always consider tools enabling polypharmacy adherence assessment. Moreover, it is increasingly evident that adherence, as a process, has to be assessed over time and not just at one evaluation time point (drug discontinuation). When cognitive deficits or functional impairments may impair reliability of adherence assessment, a comprehensive geriatric assessment should be performed and the caregiver involved. Finally, studies considering the possible implementation in clinical practice of adherence assessment tools validated in research are needed.

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Acknowledgments

We would like to thank the participants of the Collaborative Work on Adherence to medical plans of the Action Group A1 ofEIP-AHA: Elisio Costa (UCIBIO, REQUIMTE, Faculty of Pharmacy and AgeUP NetWork, University of Porto, Portugal), Cathy Harrison (Department of Health, Social Services and Public Safety; Northern Ireland), Olga Laosa Zafra (Sermas—Hospital Universitario de Getafe), Alexandra Prados-Torres (Aragón Health Sciences Institute (IACS), Sibilia Quilici (Sanofi Pasteur MSD), Salvatore Riegler (CIRFF), Sonia Ruiz Morán (CGCOF- General Pharmaceutical Council of Spain), Magda Savin (GIRP).

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Authors and Affiliations

  1. Psychology Unit, Scientific Institute of Montescano (PV), Salvatore Maugeri Foundation, IRCCS, 27040, Montescano, PV, Italy

    Anna Giardini

  2. Pharmacy Service, Hospital Clínic Barcelona, Catalonia, Spain

    Maria Teresa Martin

  3. Economic and Social Research Institute, Sir John Rogerson’s Quay, Dublin, Ireland

    Caitriona Cahir

  4. Department of Pharmacology and Therapeutics, St James’s Hospital, Dublin, Ireland

    Caitriona Cahir

  5. Catherine McAuley School of Nursing and Midwifery, Brookfield Health Sciences Complex, University College Cork, Cork, Ireland

    Elaine Lehane

  6. School of Pharmacy, CIRFF/Center of Pharmacoeconomics, University of Naples Federico II, Naples, Italy

    Enrica Menditto

  7. Medical Department, Daiichi-Sankyo, Rome, Italy

    Maria Strano

  8. Italian Medicines Agency - AIFA, Rome, Italy

    Sergio Pecorelli & Alessandro Monaco

  9. University of Brescia, Brescia, Italy

    Sergio Pecorelli

  10. Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy

    Alessandra Marengoni

  11. Geriatric Steering Committee, Italian Medicines Agency, Rome, Italy

    Alessandra Marengoni

Authors
  1. Anna Giardini
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  2. Maria Teresa Martin
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  3. Caitriona Cahir
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  4. Elaine Lehane
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  5. Enrica Menditto
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  6. Maria Strano
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  7. Sergio Pecorelli
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  9. Alessandra Marengoni
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Corresponding author

Correspondence to Anna Giardini.

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The authors declare that there is no conflict of interests regarding the publication of this paper.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Additional information

On behalf of the A1 Action Group ‘Prescription and Adherence to medical plans’, European Innovation Partnership on Active and Healthy Ageing.

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Giardini, A., Martin, M.T., Cahir, C. et al. Toward appropriate criteria in medication adherence assessment in older persons: Position Paper. Aging Clin Exp Res 28, 371–381 (2016). https://doi.org/10.1007/s40520-015-0435-z

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  • DOI: https://doi.org/10.1007/s40520-015-0435-z

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