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.
To identify medication use strategies associated with good ICS adherence in older adults.
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.
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.
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).
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.
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Bateman ED, Hurd SS, Barnes PJ, et al. Global strategy for asthma management and prevention: GINA executive summary. Eur Respir J. 2008;31(1):143–78.
National Asthma Council Australia. Asthma Management Handbook, 2006. Available at http://www.nationalasthma.org.au/handbook. Accessed May 5, 2014.
Apter A, Boston R, George M, et al. Modifiable barriers to adherence to inhaled steroids among adults with asthma: It’s not just black and white. J Allergy Clin Immunol. 2003;111(6):1219–26.
van Eijken M, Tsang S, Wensing M, et al. Interventions to improve medication compliance in older patients living in the community: A systematic review of the literature. Drugs Aging. 2003;20(3):229–40.
Sofianou A, Martynenko M, Wolf MS, et al. Asthma beliefs are associated with medication adherence in older asthmatics. J Gen Intern Med. 2013;28(1):67–73.
Moorman JE, Rudd RA, Johnson CA, et al. National surveillance for asthma—United States, 1980–2004. MMWR Surveill Summ. 2007;56(8):1–54.
Moorman JE, Zahran H, Truman BI, Molla MT. Current asthma prevalence—United States, 2006–2008. MMWR Surveill Summ. 2011;60(Suppl):84–86.
Moorman JE, Mannino DM. Increasing U.S. asthma mortality rates: who is really dying? J Asthma. 2001;38(1):65–71.
Goeman D, Jenkins C, Crane M, Paul E, Douglass J. Educational intervention for older people with asthma: A randomised controlled trial. Patient Educ Couns. 2013;93(3):586–95.
Hartert TV, Togias A, Mellen BG, Mitchel EF, Snowden MS, Griffin MR. Underutilization of controller and rescue medications among older adults with asthma requiring hospital care. J Am Geriatr Soc. 2000;48(6):651–7.
Hartert TV, Windom HH, Peebles RS Jr, Freidhoff LR, Togias A. Inadequate outpatient medical therapy for patients with asthma admitted to two urban hospitals. Am J Med. 1996;100(4):386–94.
Legorreta AP, Christian-Herman J, O’Connor RD, Hasan MM, Evans R, Leung KM. Compliance with national asthma management guidelines and specialty care: a health maintenance organization experience. Arch Intern Med. 1998;158(5):457–64.
Meng YY, Leung KM, Berkbigler D, Halbert RJ, Legorreta AP. Compliance with US asthma management guidelines and specialty care: a regional variation or national concern? J Eval Clin Pract. 1999;5(2):213–221.
Veehof L, Meyboom-de Jong B, Haaijer-Ruskamp FM. Polypharmacy in the elderly: a literature review. Informa Healthcare. 2000;6(3):98–106.
Wagner GJ, Ryan GW. Relationship between routinization of daily behaviors and medication adherence in HIV-positive drug users. AIDS Patient Care and STDs. 2004;18(7):385–93.
Ryan GW, Wagner GJ. Pill taking ‘routinization’: a critical factor to understanding episodic medication adherence. AIDS Care. 2003;15(6):795–806.
Masood D, Cheriyan S, Patterson R. Management of Asthma in the geriatric population. Gerontology. 1996;42:183–9.
Phillips AL, Leventhal H, Leventhal EA. Assessing theoretical predictors of long-term medication adherence: patients’ treatment-related beliefs, experiential feedback and habit development. Psychol Health. 2013;28(10):1135–51.
Cohen JL, Mann DM, Wisnivesky JP, Horne R, Leventhal H, Musumeci-Szabó TJ, Halm EA. Assessing the validity of self-reported medication adherence among inner-city asthmatic adults: the medication adherence report scale for asthma. Annals of Allergy, Asthma & Immunology. 2009;103(4):325–31.
Leventhal H, Leventhal EA, Breland JY. Cognitive science speaks to the “common-sense” of chronic illness management. Annals of Behavioral Medicine. 2011;41(2):152–63.
Ponieman D, Wisnivesky JP, Leventhal H, Musumeci-Szabó TJ, Halm EA. Impact of positive and negative beliefs about inhaled corticosteroids on adherence in inner-city asthmatic patients. Annals of Allergy, Asthma & Immunology. 2009;103(1):38–42.
Federman AD, Wolf M, Sofianou A, et al. The association of health literacy with illness and medication beliefs among older adults with asthma. Patient Educ Couns. 2013;92(2):273–8.
Halm EA, Mora P, Leventhal H. No symptoms, no asthma: the acute episodic disease belief is associated with poor self-management among inner-city adults with persistent asthma. Chest. 2006;129(3):573–80.
Horne R, Weinman J, Hankins M. The beliefs about medicines questionnaire: the development and evaluation of a new method for assessing the cognitive representation of medication. Psychol Health. 1999;14:1–24.
Spitzer RL, Kroenke K, Williams JBW, Williams J, Lowe B, Lowe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166(10):1092–7.
Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606–13.
Federman AD, Wisnivesky JP, Wolf MS, Leventhal H, Halm EA. Inadequate health literacy is associated with suboptimal health beliefs in older asthmatics. J Asthma. 2010;47(6):620–626.
Baker DW, Williams MV, Parker RM, Gazmararian JA, Nurss J. Development of a brief test to measure functional health literacy. Patient Educ Couns. 1999;38(1):33–4.
The ABLE study was supported by a grant from the National Heart, Lung and Blood Institute (R01HL096612). Ms. Brooks was supported through Project Learn of the Robert Wood Johnson Foundation.
Conflict of Interest
The authors declare that they do not have any conflicts of interest.
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Brooks, T.L., Leventhal, H., Wolf, M.S. et al. Strategies Used by Older Adults with Asthma for Adherence to Inhaled Corticosteroids. J GEN INTERN MED 29, 1506–1512 (2014). https://doi.org/10.1007/s11606-014-2940-8
- medication adherence
- inhaled corticosteroids