Shared Decision-Making and Strategies to Optimize Adherence in Older Asthmatics

  • Don Bukstein
  • Dennis K. Ledford


Poor adherence to asthma medication and inadequate communication are critical problems in asthma care in older adults. They contribute to morbidity and mortality through poor asthma control, frequent asthma exacerbations, acute care visits, and oral corticosteroid usage in this particularly vulnerable population. The objective of this chapter is to discuss evidence-based, time-efficient strategies that can be adopted by healthcare professionals (HCPs) to increase patient adherence and promote optimal asthma outcomes. Authors will use asthma management guidelines in older patients and other key publications to enhance discussion. Findings include that establishing patient-centered, collaborative care in older asthmatic adults facilitates effective patient–provider communication that likely will improve adherence, thus leading to improved asthma outcomes. One critical strategy is shared decision-making (SDM), in which the older adult patient and the HCP share relevant information, discuss risks versus benefits of various treatment options, express treatment preferences, deliberate the options, and agree on treatment. Asthma self-management education in older adults, which emphasizes self-efficacy, is also essential. Special attention must be paid to the health literacy of the individual as well as the cultural and social issues for each patient. In order to increase patient adherence in older asthmatic adult, clinicians need to consider a variety of factors and implement strategies directly targeting underlying issues that may be specific for older adults. Strategies may include customizing and simplifying learning and intervention regimes, identifying barriers to adherence and addressing them, ensuring patient support structures are in place, and improving self-efficacy and health literacy.


Elderly Asthma Adherence Communication Shared decision-making Asthma self-management education 



The authors sincerely thank Sally Sochessler for her assistance and advisement.

Financial Disclosures

Dr. Bukstein declares that he has received honoraria as a speaker for AstraZeneca, Circassia, Genentech, ALK, Merck, Novartis, and Teva.

Dr. Dennis Ledford provided consultation services for AstraZeneca and Genentech; received research support paid to institution from AstraZeneca and Genentech; served as a member of speaker bureau for AstraZeneca, Boehringer Ingelheim, Genentech/Roche, Novartis, and Teva; and participated in legal reviews for cases of sudden asthma death, immunotherapy and adverse reactions, drug allergy, and indoor fungal exposure.

Funder Statement

The work for this article was not funded.


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Don Bukstein
    • 1
  • Dennis K. Ledford
    • 2
  1. 1.Allergy Asthma Sinus Center, Fitchburg and MilwaukeeFitchburgUSA
  2. 2.Internal MedicineJames A. Haley VA Hospital, Tampa General Hospital, Moffitt Cancer Center, Advent HealthTampaUSA

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