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Predictors of decline in medication adherence: results from the cohort study of medication adherence among older adults.

ABSTRACT: Few data are available on the predictors of decline in antihypertensive medication adherence and the association of decline in adherence with subsequent blood pressure (BP) control. The current analysis included 1965 adults from the Cohort Study of Medication Adherence Among Older Adults recruited between August 2006 and September 2007. Decline in antihypertensive medication adherence was defined as a ?2-point decrease on the 8-item Morisky Medication Adherence Scale assessed during telephone surveys 1 and 2 years after baseline. Risk factors for decline in adherence were collected using telephone surveys and administrative databases. BP was abstracted from outpatient records. The annual rate for a decline in adherence was 4.3% (159 participants experienced a decline). After multivariable adjustment, a decline in adherence was associated with an odds ratio (OR) for uncontrolled BP (?140/90 mm Hg) at follow-up of 1.68 (95% CI: 1.01-2.80). Depressive symptoms (OR: 1.84 [95% CI: 1.20-2.82]) and a high stressful life events score (OR: 1.68 [95% CI: 1.19-2.38]) were associated with higher ORs for a decline in adherence. Female sex (OR: 0.61 [95% CI: 0.42-0.88]), being married (OR: 0.68 [95% CI: 0.47-0.98]), and calcium channel blocker use (OR: 0.68 [95% CI: 0.48-0.97]) were associated with lower ORs for decline. In summary, a decline in antihypertensive medication adherence was associated with uncontrolled BP. Modifiable factors associated with decline were identified. Further research is warranted to determine whether interventions can prevent the decline in antihypertensive medication adherence and improve BP control.

SUBMITTER: Krousel-Wood M

PROVIDER: S-EPMC3220657 | biostudies-literature | 2011 Nov

REPOSITORIES: biostudies-literature

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Predictors of decline in medication adherence: results from the cohort study of medication adherence among older adults.

Krousel-Wood Marie M Joyce Cara C Holt Elizabeth E Muntner Paul P Webber Larry S LS Morisky Donald E DE Frohlich Edward D ED Re Richard N RN

Hypertension (Dallas, Tex. : 1979) 20111003 5

Few data are available on the predictors of decline in antihypertensive medication adherence and the association of decline in adherence with subsequent blood pressure (BP) control. The current analysis included 1965 adults from the Cohort Study of Medication Adherence Among Older Adults recruited between August 2006 and September 2007. Decline in antihypertensive medication adherence was defined as a ≥2-point decrease on the 8-item Morisky Medication Adherence Scale assessed during telephone su ...[more]

PMID: 21968751

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Project description:OBJECTIVE:Growing evidence suggests that older adults are at an increased risk of injurious falls when initiating antihypertensive medication, while the evidence regarding long-term use of antihypertensive medication and the risk of falling is mixed. However, long-term users who stop and start these medications may have a similar risk of falling to initial users of antihypertensive medication. Our aim was to evaluate the association between gaps in antihypertensive medication adherence and injurious falls in older (≥65 years) community-dwelling, long-term (≥≥1 year) antihypertensive users. DESIGN:Prospective cohort study. SETTING:Irish Community Pharmacy. PARTICIPANTS:Consecutive participants presenting a prescription for antihypertensive medication to 106 community pharmacies nationwide, community-dwelling, ≥65 years, with no evidence of cognitive impairment, taking antihypertensive medication for ≥1 year (n=938). MEASURES:Gaps in antihypertensive medication adherence were evaluated from linked dispensing records as the number of 5-day gaps between sequential supplies over the 12-month period prior to baseline. Injurious falls during follow-up were recorded via questionnaire during structured telephone interviews at 12 months. RESULTS:At 12 months, 8.1% (n=76) of participants reported an injurious fall requiring medical attention. The mean number of 5-day gaps in medication refill behaviour was 1.47 (SD 1.58). In adjusted, modified Poisson models, 5-day medication refill gaps at baseline were associated with a higher risk of an injurious fall during follow-up (aRR 1.18, 95% CI 1.02 to 1.37, p=0.024). CONCLUSION:Each 5-day gap in antihypertensive refill adherence increased the risk of self-reported injurious falls by 18%. Gaps in antihypertensive adherence may be a marker for increased risk of injurious falls. It is unknown whether adherence-interventions will reduce subsequent risk. This finding is hypothesis generating and should be replicated in similar populations.

Project description:BackgroundOlder adults with chronic kidney disease (CKD) typically use more than 5 medications and have multiple prescribing physicians. However, little is known about how they prioritize their medical conditions or decide which medications to take.MethodsSemistructured interviews (average length, 40 minutes) with 20 community-dwelling adults with CKD stages 3-5D receiving nephrology care at a tertiary referral center. Respondents were asked about medications, prescribing physicians, and medication-taking behaviors. We performed thematic analysis to explain patients' decisions regarding medication prioritization, understanding, and adherence decisions.ResultsParticipants (age range, 55-84 years; mean, 72 years) used 5-14 prescribed medications, had 2-9 physicians, and had 5-11 comorbid conditions. All had assigned implicit priorities to their medications. Although most expressed the intention to be adherent, many regularly skipped medications they considered less important. Most identified the prescribing physician and indication for each medication, but there often was substantial discordance between beliefs about medications and conventional medical opinion. Respondents prioritized medications based on the salience of the particular condition, perceived effects of the treatment, and barriers (physical, logistic, or financial) to using the prescribed drug. Side effects of medications were common and anxiety provoking, but discussions with the prescribing physician often were delayed or unfulfilling for the patient.ConclusionsPolypharmacy in patients with CKD leads to complex medication choices and adherence behaviors in this population. Most patients we interviewed had beliefs or priorities that were nonconcordant with conventional medical opinion; however, patients rarely discussed these beliefs and priorities or the resultant poor medication adherence with their physicians. Further study is needed to provide quantitative data about the magnitude of adherence barriers. It is likely that more effective communication about medication use could improve patients' health outcomes and reduce potential adverse drug events.

Project description:Diabetes is a chronic medical condition and adherence to medication in adults with diabetes is important. Identifying predictors to medication adherence in adults with diabetes would help identify vulnerable patients who are likely to benefit by improving their adherence levels.We conducted a cross-sectional study at the Dubai Police Health Centre between February 2015 and November 2015. Questionnaires were used to collect socio-demographic, clinical and disease related variables and the primary measure of outcome was adherence levels as measured by the Morisky Medication Adherence Scale (MMAS-8©). Multivariate logistic regression was carried out to identify predictors to adherence.Four hundred and forty six patients were interviewed. Mean age 61 year +/- 11. 48.4 % were male. The mean time since diagnosis of diabetes was 3.2 years (Range 1-15 years). Two hundred and eighty eight (64.6 %) patients were considered non-adherent (MMAS-8© adherence score < 6) while 118 (26.5 %) had moderate adherence (MMAS-8© adherence score 6 = <8) and 40 (9.0 %) high adherence (MMAS-8© adherence scores <8) to their medication respectively. The strongest predictor for adherence as predicted by the multi-logistic regression model was the patient's level of education. A technical diploma certificate as compared to a primary school level of education was the strongest predictor of adherence (OR = 66.1 CI: 6.93 to 630.43); p < 0.001). The patient's age was also a predictor of adherence with older patients reporting higher levels of adherence (OR = 1.113 (CI: 1.045 to 1.185; p = 0.001 for every year increase in age). The duration of diabetes was also a predictor of adherence (OR = 1.830 (CI: 1.270 to 2.636; p = 0.001 for every year increase in the duration of diabetes). Other predictors to medication adherence include Insulin use, ethnicity and certain cultural behaviours.A number of important predictors to medication adherence in diabetics were identified in this study. Such predictors could help develop policies for improving adherence in diabetics.

Project description:ObjectiveIn older adults, widespread pain (WP) is common, although its etiology is unclear. This study sought to identify factors associated with an increased risk of developing WP in adults age ?50 years.MethodsA population-based prospective study was conducted. A baseline questionnaire was administered to subjects to collect data on pain, psychological status, lifestyle and health behaviors, and sociodemographic and clinical factors. Participants free of WP (as defined by the American College of Rheumatology 1990 criteria for fibromyalgia) were followed up for 3 years, and those with new-onset WP at followup were identified. Logistic regression analyses were used to test the relationship between baseline factors and new-onset WP. Multiple imputation was used to test the results for sensitivity to missing data.ResultsIn this population-based study, 4,326 subjects (1,562 reporting no pain at baseline and 2,764 reporting some pain at baseline) participated at followup. Of these participants, 800 (18.5%) reported a status of new WP at followup (of whom, 121 [7.7%] had reported no pain at baseline and 679 [24.6%] had reported some pain at baseline). The majority of the study factors were associated with new-onset WP. However, only a few factors showed a persistent association with new-onset WP in the multivariate analysis, including age (odds ratio [OR] 0.97, 95% confidence interval [95% CI] 0.96-0.99), baseline pain status (OR 1.1, 95% CI 1.08-1.2), anxiety (OR 1.5, 95% CI 1.01-2.1), physical health-related quality of life (OR 1.3, 95% CI 1.1-1.5), cognitive complaint (OR 1.3, 95% CI 1.04-1.6), and nonrestorative sleep (OR 1.9, 95% CI 1.2-2.8). These associations persisted after adjustment for the presence of diffuse osteoarthritis (OA), which led to a modest increase in model fit (C-statistic 0.738, compared with 0.731 in the model excluding diffuse OA). The results were not sensitive to missing data.ConclusionOf the factors measured in this study, nonrestorative sleep was the strongest independent predictor of new-onset WP.

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Predictors of decline in medication adherence: results from the cohort study of medication adherence among older adults.

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Predictors of decline in medication adherence: results from the cohort study of medication adherence among older adults.

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