Regimen complexity and medication nonadherence in elderly patients

Istituto Nazionale di Ricovero e Cura per Anziani (INRCA), Cosenza
Therapeutics and Clinical Risk Management (Impact Factor: 1.47). 03/2009; 5(1):209-16.
Source: PubMed


To assess whether the number of daily administrations of individual drugs, as a measure of regimen complexity, contributes to the profile of an elderly patient who adheres poorly to the prescribed therapy.
Six hundred ninety patients over 64 years who were consecutively admitted to 11 acute medical care and three long term/rehabilitation wards in Italy.
Self-reported adherence to drugs taken at home before admission was measured by a single question assessment for each listed drug supplemented with a latter question about the circumstances of the missed administration. For cognitively impaired patients the question was put to patients' relatives or caregivers.
A structured multidimensional assessment was performed to identify nonadherence and its potential correlates. Correlates of nonadherence were identified by multivariable logistic regression.
We recorded 44 cases (6.4%) of nonadherence to at least one drug. Being assisted by foreign caregivers (OR 2.17; 95% CI 1.02-4.63) and the use of at least one multiple daily dosing drug (OR 2.99; 95% CI 1.24-7.17) were significant independent correlates of medication nonadherence, while age, selected indexes of frailty and the cumulative number of prescribed drugs were not.
Regimen complexity and type of assistance are independent correlates of medication nonadherence.

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    • "Moreover, also movement disorders such as extrapyramidal diseases might cause further difficulty in coordination and properly sequencing the puffing and the breath holding in affected patients [113]. Furthermore, the number of daily dosings has been shown to be inversely associated with adherence in both a Parkinson population [114] and in a broad elderly population [115]. Finally, COPD-related and age-related lung volume and inhaled flows decrease may result in ineffective effort and poor drug inhalation [116]. "
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    • "In general, an increase in the number of daily doses of a drug may increase complexity, consistent with previous measures [14] [15] [16] [17] [18]. This is not guaranteed, however, as adding a second dose that is to be taken with another medication already in the regimen would not increase complexity as defined here. "
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