Article

A Systematic Review of Barriers to Medication Adherence in the Elderly: Looking Beyond Cost and Regimen Complexity

RAND Health, Pittsburgh, Pennsylvania 15213, USA.
The American journal of geriatric pharmacotherapy 02/2011; 9(1):11-23. DOI: 10.1016/j.amjopharm.2011.02.004
Source: PubMed

ABSTRACT Medication nonadherence is a common problem among the elderly.
To conduct a systematic review of the published literature describing potential nonfinancial barriers to medication adherence among the elderly.
The PubMed and PsychINFO databases were searched for articles published in English between January 1998 and January 2010 that (1) described "predictors," "facilitators," or "determinants" of medication adherence or that (2) examined the "relationship" between a specific barrier and adherence for elderly patients (ie, ≥65 years of age) in the United States. A manual search of the reference lists of identified articles and the authors' files and recent review articles was conducted. The search included articles that (1) reviewed specific barriers to medication adherence and did not solely describe nonmodifiable predictors of adherence (eg, demographics, marital status), (2) were not interventions designed to address adherence, (3) defined adherence or compliance and specified its method of measurement, and (4) involved US participants only. Nonsystematic reviews were excluded, as were studies that focused specifically on people who were homeless or substance abusers, or patients with psychotic disorders, tuberculosis, or HIV infection, because of the unique circumstances that surround medication adherence for each of these populations.
Nine studies met inclusion criteria for this review. Four studies used pharmacy records or claims data to assess adherence, 2 studies used pill count or electronic monitoring, and 3 studies used other methods to assess adherence. Substantial heterogeneity existed among the populations studied as well as among the measures of adherence, barriers addressed, and significant findings. Some potential barriers (ie, factors associated with nonadherence) were identified from the studies, including patient-related factors such as disease-related knowledge, health literacy, and cognitive function; drug-related factors such as adverse effects and polypharmacy; and other factors including the patient-provider relationship and various logistical barriers to obtaining medications. None of the reviewed studies examined primary nonadherence or nonpersistence.
Medication nonadherence in the elderly is not well described in the literature, despite being a major cause of morbidity, and thus it is difficult to draw a systematic conclusion on potential barriers based on the current literature. Future research should focus on standardizing medication adherence measurements among the elderly to gain a better understanding of this important issue.

Download full-text

Full-text

Available from: Zachary Adam Marcum, Jul 06, 2015
0 Followers
 · 
262 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND: Low adherence to prescribed medications leads to serious negative health consequences in older adults. Effective interventions that improve adherence are often labor-intensive and complex. However, most studies do not analyze the separate effects of the components. OBJECTIVE: Persuasive System Design (PSD) is framework that analyzes the motivations that change behavior. In this paper, we aim to apply the model to changing the pill-taking behaviors of the aging population and determine which persuasive elements in interventions drive improvement in medication adherence. METHODS: Systematic review using the databases Medline (1977 to February 2012), Cochrane library (2000 to June 2013); Cinahl (1975 to June 2013), and Psycinfo (2002 to June 2012). Inclusion criteria were experimental trials with participants' mean age >= 60 years and had medication adherence as a primary or secondary measure. RESULTS: Meta-analysis (40 studies) demonstrated a significant association of tailoring, or one-on-one counseling, with medication adherence. Interventions with simulation (showing the causal relationship between non-adherence and negative effects) and rehearsal (miming medication-taking behavior) also showed evidence for improved adherence. CONCLUSIONS: Future medication adherence interventions might be more effective if they were based on persuasive technology.
    Technology and health care: official journal of the European Society for Engineering and Medicine 05/2014; 22(2). DOI:10.3233/THC-140812 · 0.64 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: A method that allows accurate control of the coverage error in Monte Carlo approximation of quantiles of the bootstrap distribution is discussed. The method is based on nonparametric tolerance internonparametric tolerance intervals and hence is applicable regardless of the underlying distribution. The results are useful for quantile estimation as well as for construction of robust confidence intervals and interval estimates. The minimum number of bootstrap replicates needed to estimate quantiles to a prescribed conditional coverage accuracy is determined. The results allow the user to perform bootstrap inference without being subject to intolerable fluctuations from Monte Carlo error.
    Signals, Systems and Computers, 2002. Conference Record of the Thirty-Sixth Asilomar Conference on; 12/2002
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Polypharmacy and medication non-adherence are common in older adults, potentially leading to medication-related problems and increased healthcare expenditures. Medication Delivery Units (MDUs) may improve adherence, but their interfaces may present usability challenges for older adults with age-related impairments. We used a combination of three inspection methods - heuristic evaluation, cognitive walkthrough, and simulated elderly interaction, to identify potential concerns with the usability of a commercially available telemedicine MDU. Each method revealed different problems, with repeated discoveries via different methods providing triangulated evidence. Despite the MDU's general usability, issues of varying severity were discovered. Significant usability issues associated with physical interactions with the MDU included loading and unloading the medication blister packs, and opening the delivered medication prior to administration. Less severe issues centered on small text sizes and poor user feedback. Further usability testing, involving older adults with a variety of impairments, is needed to validate findings.
    AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium 01/2011; 2011:795-804.