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High Prevalence of Medication Non-Adherence in a Sample of Community-Dwelling Older Adults with Adult Protective Services-Validated Self-Neglect

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Abstract

Background

Medication non-adherence can exacerbate disease severity, leading to impairments that interfere with self-care activities in older adults, and, ultimately, death. Elder self-neglect is the most common report to Adult Protective Services (APS) across the USA and is a significant risk factor for early mortality. These individuals often suffer from multiple comorbid diseases that require careful management, but for various reasons they are unwilling or unable to provide themselves with the self-care resources necessary for maintaining health and safety. No studies have assessed whether medication adherence is associated with elder self-neglect.

Objective

The purpose of this study was to assess and describe medication adherence in this population, as well as evaluate associations between medication adherence and cognitive impairment, depression, physical function, and abilities to perform basic and instrumental activities of daily living (BADLs and IADLs).

Methods

A cross-sectional study of 100 community-dwelling adults 65 years of age and older with APS-substantiated elder self-neglect were assessed. In-home comprehensive geriatric assessments (CGAs) were completed and included medication reviews. Information on each medication, including the amount taken from the date dispensed, was collected and used to determine adherence. The criteria for non-adherence were taking <80 or >110 % of at least one medication. The sample was also split into groups of low adherence (≤29 %), moderate adherence (29–86 %) and high adherence (≥86 %). Scores on the CGA measures Mini-Mental State Examination, Geriatric Depression Scale, Physical Performance Test (PPT) and Kohlman Evaluation of Living Skills were assessed to determine whether cognitive impairment, depression, physical function, and/or ability to perform BADLs and IADLs were associated with non-adherence or low, moderate or high levels of adherence.

Results

Twenty-five per cent of the sample was taking more than seven medications daily. The average rate of adherence was 59 %. Only eight participants (10 %) were adherent to their entire medication regimen, and thus, 90 % were considered non-adherent to at least one medication. The mean number of medications to which individuals were non-adherent was 3.4. The cognitive impairment, depression, physical function and BADL/IADL measures were not statistically associated with medication non-adherence using the cut-points of <80 or >110 %. However, when split into tertiles, the lowest medication adherence level (≤29 %) was significantly associated with a greater number of medications being consumed and lower objective physical function levels as measured by the PPT.

Conclusions

Medication non-adherence is a very prevalent problem among older adults who are self-neglecting, and higher non-adherence levels were associated with the number of medications being consumed as well as lower physical function. Physicians who find high rates of medication non-adherence in their patients should consider barriers to adherence, including a large number of medications, lower physical function and the possibility of elder self-neglect. Future efforts should focus on studying the underlying reasons for medication non-adherence in larger samples of older adults who are self-neglecting. This would facilitate the development of interventions to reduce medication non-adherence in this population.

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References

  1. Sabete E, editor. Adherence to long-term therapies: evidence for action. Geneva: World Health Organization; 2003.

    Google Scholar 

  2. Brown MT, Bussell JK. Medication adherence: WHO cares? Mayo Clinic Proc. 2011;86:304–14.

    Article  Google Scholar 

  3. Munger M, Van Tassel BW, LaFleur J. Medication nonadherence. MedGenMed. 2007;9:58.

    PubMed  Google Scholar 

  4. Schlenk EA, Dunbar-Jacob J, Engberg S. Medication nonadherence among older adults: a review of strategies and interventions for improvement. J Gerontol Nurs. 2004;30:33–43.

    PubMed  Google Scholar 

  5. Hughes CM. Medication non-adherence in the elderly: how big is the problem? Drugs Aging. 2004;21:793–811.

    Article  PubMed  Google Scholar 

  6. Col N, Fanale JE, Kronholm P. The role of medication noncompliance and adverse drug reactions in hospitalizations of the elderly. Arch Intern Med. 1990;150(4):841–5.

    Article  PubMed  CAS  Google Scholar 

  7. Sullivan S, Kreling D, Hazlet T. Noncompliance with medication regiments and subsequent hospitalizations: a literature analysis and cost of hospitalization estimate. J Res Pharm Econ. 1990;2:19–33.

    Google Scholar 

  8. Ferrini A, Ferrini R. Health in the later years. 3rd ed. Boston: McGraw Hill; 2000.

    Google Scholar 

  9. Centers for Disease Control and Prevention and the Merck Company Foundation. The state of health and aging in America 2004. Whitehouse Station, NJ: The Merck Company Foundation; 2004.

  10. Centers for Disease Control. Healthy aging: preventing disease and improving quality of life among older Americans. Atlanta (GA): Department of Health and Human Services, Centers for Disease Control; 2003.

  11. Boyd CM, Darer J, Boult C, et al. Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases. JAMA. 2005;294:716–24.

    Article  PubMed  CAS  Google Scholar 

  12. Vermeire E, Hearnshaw H, Van Royen P, et al. Patient adherence to treatment: three decades of research: a comprehensive review. J Clin Pharm Ther. 2001;26:331–42.

    Article  PubMed  CAS  Google Scholar 

  13. McCarthy R. The price you pay for the drug not taken. Bus Health. 1998;16:27–33.

    PubMed  CAS  Google Scholar 

  14. Winkler A, Teuscher AU, Mueller B, et al. Monitoring adherence to prescribed medication in type 2 diabetic patients treated with sulfonylureas. Swiss Med Wkly. 2002;132:379–85.

    PubMed  Google Scholar 

  15. Baum A, Revenson TA, Singer JE, editors. Handbook of health psychology. Mahwah: Lawrence Erlbaum Associates; 2001.

    Google Scholar 

  16. Insel K, Morrow D, Brewer B, et al. Executive function, working memory, and medication adherence among older adults. J Gerontol. 2006;61B:102–7.

    Google Scholar 

  17. Salas M, Veld B, van der Linden P, et al. Impaired cognitive function and compliance with antihypertensive drugs in the elderly: the Rotterdam Study. Clin Pharmacol Ther. 2001;70:561–6.

    Article  PubMed  CAS  Google Scholar 

  18. Stilley CS, Bender CM, Dunbar-Jacob J, et al. The impact of cognitive function on medication management: three studies. Health Psychol. 2010;29:50–5.

    Article  PubMed  Google Scholar 

  19. Bozek A, Jarzab J. Adherence to asthma therapy in elderly patients. J Asthma. 2010;47:162–5.

    Article  PubMed  Google Scholar 

  20. Texas Human Resources Code—Section 48.002. Definitions. Onecle; 2007. Available at: http://law.onecle.com/texas/human-resources/48.002.00.html. Accessed 2011 June 19.

  21. Dong X, Simon M, Mendes de Leon C, et al. Elder self-neglect and abuse and mortality risk in a community-dwelling population. JAMA 2009;302:517–26.

    Google Scholar 

  22. Lachs MS, Williams CS, O’Brien S, et al. The mortality of elder mistreatment. JAMA. 1998;280:428–32.

    Article  PubMed  CAS  Google Scholar 

  23. Dyer CB, Goins AM. The role of interdisciplinary geriatric assessment in addressing self-neglect in the elderly. Generations. 2000;24:23–7.

    Google Scholar 

  24. Dyer CB, Goodwin JS, Pickens-Pace S, et al. Self-neglect among the elderly: a model based on more than 500 patients seen by a geriatric medicine team. Am J Public Health. 2007;97:1671–6.

    Article  PubMed  Google Scholar 

  25. Burnett J, Coverdale JH, Pickens S, et al. What is the association between self-neglect, depressive symptoms and untreated medical conditions? JEAN. 2006;18:25–34.

    Google Scholar 

  26. Grocki JH, Huffman KK. Medication adherence among older adults. J Evid Based Soc Work. 2007;4:97–120.

    Google Scholar 

  27. Lal LS, Hung F, Feng C, et al. Evaluation of medication compliance in patients on antidepressants at an outpatient tertiary cancer setting. J Oncol Pharm Prac. 2011;17:131–5.

    Article  Google Scholar 

  28. Jerant A, Chapman B, Duberstein P, et al. Personality and medication non-adherence among older adults enrolled in a six-year trial. Brit J Health Psych. 2011;16:151–69.

    Article  Google Scholar 

  29. Simoni JM, Kurth AE, Pearson CR, et al. Self-report measures of antiretroviral therapy adherence: a review with recommendations for HIV research and clinical management. AIDS Behav. 2006;10:227–45.

    Article  PubMed  Google Scholar 

  30. Folstein MF, Folstein S, McHugh PR. Mini-mental state: a practical method of grading the cognitive state of patients for the clinician. J Psychiatric Res. 1975;12:189–98.

    Article  CAS  Google Scholar 

  31. Tombaugh TN, McIntyre NJ. The Mini-Mental State Examination: a comprehensive review. JAGS. 1992;40:922–35.

    CAS  Google Scholar 

  32. Yesavage JA, Brinck TL, Rose TL, et al. Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatric Res. 1983;17:37–9.

    Article  CAS  Google Scholar 

  33. Almeida OP, Almeida SA. Short versions of the Geriatric Depression Scale: a study of their validity for the diagnosis of major depressive episode according to ICD-10 and DSM-IV. Int J Geriat Psychiatry. 1999;14:858–65.

    Article  CAS  Google Scholar 

  34. Marc LG, Raue PJ, Bruce ML. Screening performance of the 15-item Geriatric Depression Scale in a diverse elderly home care population. Am J Geriatr Psychiatry. 2008;16:914–21.

    Article  PubMed  Google Scholar 

  35. Kohlman L. Kohlman evaluation of living skills. 2nd ed. Bethesda: American Occupational Therapy Association; 1992.

    Google Scholar 

  36. Zimnavoda T, Weinblatt N, Katz N. Validity of the Kohlman Evaluation of Living Skills (KELS) with Israeli elderly individuals living in the community. Occup Ther Int. 2002;9:312–25.

    Article  PubMed  Google Scholar 

  37. Reuben DB, Siu AL. An objective measure of physical function of elderly outpatients: the Physical Performance Test. J Am Geriatr Soc. 1990;38:1105–12.

    PubMed  CAS  Google Scholar 

  38. Salzman C. Medication compliance in the elderly. J Clin Psychiatry. 1995;56:18–22.

    PubMed  Google Scholar 

  39. Spiers MV, Kutzik DM, Lamar M. Variation in medication understanding in the elderly. Am J Health Syst Pharm. 2004;61:373–80.

    PubMed  Google Scholar 

  40. Dunbar-Jacob J, Mortimer-Stephens MK. Treatment adherence in chronic disease. Clin Epidemiol. 2001;54:S57–60.

    Article  Google Scholar 

  41. Yiannakopoulou E, Papadopulos JS, Cokkinos DV, et al. Adherence to antihypertensive treatment: a critical factor for blood pressure control. Eur J Cardiovasc Prev Rehabil. 2005;12:243–9.

    Article  PubMed  Google Scholar 

  42. Ho PM. Effect of medication nonadherence on hospitalization and mortality among patients with diabetes mellitus. Arch Intern Med. 2006;166:1836–41.

    Article  PubMed  Google Scholar 

  43. McDonald H, Garq A, Haynes R. Interventions to enhance patient adherence to medication prescriptions: scientific review. JAMA. 2003;289:2868–79.

    Article  Google Scholar 

Download references

Acknowledgments

The research reported in this manuscript was funded by the Agency for Healthcare Research and Quality # 1R01HS017440-01A1. The investigators retained full independence in the conduct of this research. The authors have no conflicts of interest to report.

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Authors and Affiliations

  1. The University of Texas Southwestern Medical School, Dallas, TX, USA

    Anisha Turner

  2. Division of Geriatrics and Palliative Medicine, Department of Internal Medicine, UTHealth, 3601 N. MacGregor Way, CREST Office, Houston, TX, 77004, USA

    Ann Hochschild, Jason Burnett, Amber Zulfiqar & Carmel B. Dyer

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Correspondence to Jason Burnett.

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Turner, A., Hochschild, A., Burnett, J. et al. High Prevalence of Medication Non-Adherence in a Sample of Community-Dwelling Older Adults with Adult Protective Services-Validated Self-Neglect. Drugs Aging 29, 741–749 (2012). https://doi.org/10.1007/s40266-012-0007-2

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