To identify the determinants of antihypertensive medication adherence in community-living elderly adults.
Longitudinal observational study.
Population-based health survey in the province of Quebec, Canada.
Data from a representative sample (N = 2,811) of community-dwelling adults in Quebec aged 65 and older participating in the Étude sur la Santé des Aînés study. The final study sample analyzed consisted of 926 participants taking antihypertensive drugs during the 2 years of the study.
Adherence to antihypertensive medication was measured using days of supply obtained during a specified time period. Depression and anxiety disorders were assessed using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria, and physical health status was measured using the Charlson Comorbidity Index. Other factors considered were age, education, marital status, annual family income, and number of antihypertensive drugs that participants used.
Mean antihypertensive proportion (percentage) of days supplied in was 92.5% in Year 1 and 59.4% in Year 2. The presence of depression and anxiety disorders and the number of antihypertensive medications significantly predicted medication adherence. The sex by depression and anxiety disorders interaction term was significant.
Adherence to antihypertensive medication was significantly associated with depression and anxiety disorders in men but not women. The treatment of depression and anxiety disorders in individuals with hypertension may be helpful in improving medication adherence rates and healthcare outcomes.
"In patients with hypertension, psychological distress may serve as a barrier against adequate medication adherence . Prior findings have shown an independent association between poor medication adherence in elderly patients with hypertension and depression and anxiety [10, 11]. "
[Show abstract][Hide abstract] ABSTRACT: Recent guidelines on cardiovascular disease prevention advocate the importance of psychological risk factors, as they contribute to the risk of developing cardiovascular disease. However, most previous research on psychological distress and cardiovascular factors has focused on selected populations with cardiovascular disease.
The primary aim was to determine the prevalence of depression, anxiety, and Type D personality in elderly primary care patients with hypertension. Secondary aim was to examine the relation between elevated systolic blood pressure and depression, anxiety, and Type D personality.
A cross-sectional study in primary care practices located in the south of the Netherlands.
Primary care hypertension patients (N = 605), between 60 and 85 years (45 % men, mean age = 70 ± 6.6), were recruited for this study. All patients underwent a structured interview including validated self-report questionnaires to assess depression (PHQ-9), anxiety (GAD-7), and Type D personality (DS14) as well as blood pressure assessment.
Depression was prevalent in 5 %, anxiety in 5 %, and Type D personality in 8 %. None of the distress measures were associated with elevated systolic blood pressure of >160 mmHg (all p-values >0.05). This study showed no relation between psychological distress and elevated systolic blood pressure in elderly primary care patients with hypertension.
Netherlands heart journal: monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation 12/2013; 22(2). DOI:10.1007/s12471-013-0502-z · 1.84 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The purpose of this study is to identify factors predictive of treatment interruptions during radiation therapy (RT) for head and neck cancer.
The medical records of 280 consecutive patients who completed a 6- or 7-week course of RT for squamous cell carcinoma of the head and neck were reviewed. The number of missed treatment days, excluding those due to holidays or machine downtime, was determined for each patient. All patients were treated to a median dose of 63 Gy (range, 60 to 70 Gy).
The proportion of patients who missed 0, 3-5, 6-10, and greater than 10 days was 25, 59, 12, and 5 %, respectively. The percentage of patients who missed greater than 5 days was 62 % among the 39 patients with Karnofsky Performance Status (KPS) score of 70 or less compared to 10 % among those with a KPS score of greater than 70 (p < 0.01). Among the 33 patients identified with a preexisting psychiatric condition, the percentage that subsequently missed greater than 5 days of treatment was 48 % compared to 13 % among those without a psychiatric condition. When missed RT days were analyzed as a continuous variable, the correlations with both KPS and preexisting psychiatric condition remained highly significant (p < 0.01, for both).
Poor performance status and preexisting psychiatric condition predicted for treatment interruptions during RT for head and neck cancer. In view of the possible detrimental effect on treatment outcome, appropriate social programs should be initiated to overcome potential barriers to RT for these particular populations.
Supportive Care in Cancer 07/2013; 21(12). DOI:10.1007/s00520-013-1907-3 · 2.36 Impact Factor
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