Journal of General Internal Medicine

, Volume 29, Issue 11, pp 1506–1512

Strategies Used by Older Adults with Asthma for Adherence to Inhaled Corticosteroids

  • Taylor L. Brooks
  • Howard Leventhal
  • Michael S. Wolf
  • Rachel O’Conor
  • Jose Morillo
  • Melissa Martynenko
  • Juan P. Wisnivesky
  • Alex D. Federman
Original Research

ABSTRACT

BACKGROUND

Older adults with asthma have low levels of adherence to their prescribed inhaled corticosteroids (ICS). While prior research has identified demographic and cognitive factors associated with ICS adherence among elderly asthmatics, little is known about the strategies that older adults use to achieve daily use of their medications. Identifying such strategies could provide clinicians with useful advice for patients when counseling their patients about ICS adherence.

OBJECTIVE

To identify medication use strategies associated with good ICS adherence in older adults.

PARTICIPANTS

English-speaking and Spanish-speaking adults ages 60 years and older with moderate or severe asthma were recruited from primary care and pulmonary practices in New York City, NY, and Chicago, IL. Patients with chronic obstructive pulmonary disease, other chronic lung diseases or a smoking history of greater than 10 pack-years were excluded.

MAIN MEASURES

Medication adherence was assessed with the Medication Adherence Rating Scale (MARS). Medication use strategies were assessed via open-ended questioning. “Good adherence” was defined as a mean MARS score of 4.5 or greater.

KEY RESULTS

The rate of good adherence to ICS was 37 %. We identified six general categories of medication adherence strategies: keeping the medication in a usual location (44.2 %), integrating medication use with a daily routine (32.6 %), taking the medication at a specific time (21.7 %), taking the medication with other medications (13.4 %), using the medication only when needed (13.4 %), and using other reminders (11.9 %). The good adherence rate was greater among individuals who kept their ICS medication in the bathroom (adjusted odds ration [AOR] 3.05, 95 % CI 1.03–9.02, p = 0.04) or integrated its use into a daily routine (AOR 3.77, 95 % CI: 1.62–8.77, p = 0.002).

CONCLUSIONS

Keeping ICS medications in the bathroom and integrating them into daily routines are strategies associated with good ICS adherence. Clinicians concerned with adherence should consider recommending these strategies to their older asthmatic patients, although additional research is needed to determine whether such advice would improve adherence behaviors.

KEY WORDS

medication adherence asthma inhaled corticosteroids 

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Copyright information

© Society of General Internal Medicine 2014

Authors and Affiliations

  • Taylor L. Brooks
    • 1
  • Howard Leventhal
    • 2
  • Michael S. Wolf
    • 3
  • Rachel O’Conor
    • 3
  • Jose Morillo
    • 4
  • Melissa Martynenko
    • 4
  • Juan P. Wisnivesky
    • 4
    • 5
  • Alex D. Federman
    • 4
  1. 1.New York UniversityNew YorkUSA
  2. 2.Institute of Health, Health Care Policy and Aging ResearchRutgers UniversityNew BrunswickUSA
  3. 3.Division of General Internal Medicine, Feinberg School of MedicineNorthwestern UniversityChicagoUSA
  4. 4.Division of General Internal MedicineMount Sinai School of MedicineNew YorkUSA
  5. 5.Division of Pulmonary, Critical Care and Sleep MedicineMount Sinai School of MedicineNew YorkUSA

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