Adherence to Depression Treatment in Older Adults

National VA Serious Mental Illness Treatment, Research & Evaluation Center (SMITREC), Ann Arbor, Michigan 48109, USA.
Drugs & Aging (Impact Factor: 2.84). 02/2008; 25(7):559-71. DOI: 10.2165/00002512-200825070-00003
Source: PubMed


Depression in older adults has been detected, diagnosed and treated more frequently in recent years. However, substantial gaps in effective treatment remain. Adherence to depression treatment can be viewed as the 'next frontier' in the treatment of late-life depression. Using the Theory of Reasoned Action, a model of health behaviours, this paper conceptualizes and reviews the current evidence for key patient-level factors associated with depression treatment adherence among older adults. We categorize these factors according to how their impact on adherence might be affected by specialized treatment approaches or interventions as: (i) modifiable; (ii) potentially modifiable; and (iii) non-modifiable. Based on current evidence, modifiable factors associated with depression treatment adherence include patient attitudes, beliefs and social norms. Patient attitudes include perceptions of the effectiveness of depression treatment, preferences for the type of depression treatment and concepts regarding the aetiology of depression (e.g. resistance to viewing depression as a medical illness). There is also evidence from the literature that spiritual and religious beliefs may be important determinants of adherence to depression care. Social norms such as the impact of caregiver agreement with treatment recommendations and stigma may also affect adherence to depression treatment. Other factors may be less modifiable per se, but they may have an impact on adherence that is potentially modifiable by specialized interventions. Based upon a review of the current literature, potentially modifiable factors associated with adherence to depression treatment include co-morbid anxiety, substance use, cognitive status, polypharmacy and medical co-morbidity, social support and the cost of treatment. Finally, non-modifiable factors include patient gender and race. Importantly, non-modifiable factors may interact with modifiable factors to affect health behavioural intent (e.g. race and spiritual beliefs). Thus, adherence to depression treatment in older adults is associated with multiple factors. Strategies to improve patient adherence need to be multidimensional, including consideration of age-related cognitive and co-morbidity factors, environmental and social factors, functional status and belief systems. Evidence-based interventions involving greater patient, caregiver, provider and public health education should be developed to decrease stigma, negative attitudes and other modifiable barriers to detection, diagnosis, treatment and adherence to depression treatment. These interventions should also be tailored to the individual as well as to the treatment setting. While important progress has been made in increasing detection of depression in older adults, greater focus now needs to be placed on treatment engagement and continuation of improvements in quality of life, reducing suffering and achieving better outcomes.

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Available from: Helen Kales, Mar 19, 2015
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    • "The highest adherence rates are estimated for patients with cancer at about 80.0% (Dittmer, 2011; Ma et al., 2008; O'Connor, 2006), with lower rates reported for cardiovascular disease (Ho, Bryson, & Rumsfield, 2009), hypertension (Fitzgerald & Powers, 2011; Lewis, 2012; Munger, Van Tassell, & LaFleur, 2007; Vrijens, 2008), infectious diseases (Cramer & Rosenheck, 1998), diabetes mellitus; (Asche, Lafleur, & Conner, 2011; Bailey & Kodack, 2011; Fitzgerald & Powers, 2011), osteoporosis (Ettinger, Gallagher , & MacCosbe, 2006; Reginster, Rabenda, & Neuprez , 2006), asthma, and chronic obstructive pulmonary disease (Cramer & Rosenheck, 1998). Some of the lowest adherence rates are reported for patients with psychiatric disorders, particularly elderly patients with depression and patients with cognitive disorders (Velligan et al., 2009; Zivin & Kales, 2008). Patients with multiple chronic diseases also are at significantly greater risk of medication nonadherence (Barber, Parsons, Clifford, Darracott , & Home, 2004; Katon et al., 2005; Lin et al., 2010; Vogeli et al., 2007) with adherence declining after the first 6 months of treatment (Brunton, 2011; Burnier, 2006; Caro, Salas, Speckman, Raggio, & Jackson, 1999; Osterberg & Blaschke, 2005). "
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    ABSTRACT: This is the first of a three-part series on medication adherence in which the authors describe the continuum of adherence to nonadherence of medication usage. Research articles through MEDLINE and PubMed. Understanding the magnitude and scope of the problem of medication nonadherence is the first step in reaching better adherence rates. The second step is to evaluate the risk factors for each patient for medication adherence/nonadherence. The third step is to assess for adherence. The process will continue with a consistent systematic process to evaluate continual adherence. The implications for nurse practitioners include using time with patients to assist them in adherence, building a trusting relationship with patients, and developing protocols for assessing and preventing nonadherence.
    Full-text · Article · Jan 2014 · Journal of the American Association of Nurse Practitioners
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    • "Attitudes include perceived effectiveness of treatment, preferences for types of treatment, and patient resistance to viewing depression as a medical disease [17] [18]. Social norms including stigma of the depression diagnosis and the impact of caregivers' agreement with treatment recommendations influence treatment compliance [16] [19] [20]. "
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    ABSTRACT: Objectives. Describe older patients' perceptions about depression and characteristics associated with acceptance of treatments. Design. Cross-sectional study. Setting. Three primary care clinics in Iowa. Participants. Consecutive sample of 529 primary care patients. Measurements. Depression screening tool (a 9-item patient health questionnaire [PHQ-9]) and questionnaire including sociodemographic data, patient attitudes about depression, and acceptability of different treatments. Results. Mean age was 71.9 years (range 60-93 years), 314 (59%) female. Among the 529 participants, 93 (17.5%) had history of depression and 60 (11.3%) had PHQ-9 scores of 10 or greater. Participants believed depression is a disease for which they would use medication and counseling. Accepting medications from primary physicians was strongly associated with a past history of depression (P < 0.01) and with agreeing that depression needs treatment (P < 0.01). Counseling was not acceptable for those believing that they can control depression on their own (P < 0.01). Older patients (P < 0.001) and those with higher education levels (P < 0.01) were less likely to accept herbs or supplements as treatment options. Willingness to discuss treatments with family was associated with not using alcohol as a treatment and acceptance of all other treatment options (P < 0.001). Conclusions. Attitude that depression is a disease and the willingness to discuss depression with family may enhance treatment acceptance.
    Full-text · Article · Oct 2013 · The Scientific World Journal
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    • "Reliance on patient reports of psychological symptoms, particularly amongst older patients, may be compromised by stigma related to depression [8]. Consequently it is unsurprising that depression is thought to be under-diagnosed and under-treated amongst older people in Western nations [9-11]. "
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    ABSTRACT: Objectives: Depression may be under-diag-nosed and under-treated amongst older adults with multiple chronic illnesses. The current study explores the prevalence of depression diagnosis and Geriatric Depression Scale (GDS) symptoms amongst older multimorbid outpa-tients, and agreement between GDS scores and doctor-diagnosed depression. Method: Deiden-tified data from the files of 452 patients aged over 64, with chronic conditions present in two or more organ domains, were extracted from the clinical database of a tertiary referral hospital multidisciplinary outpatient clinic in South Aus-tralia between 2005 and 2011. Frequency calcu-lations determined the prevalence of depression diagnosis and GDS categories. Logistic regres-sion, cross-tabulation, kappa and ROC graphs explored relationships between variables. Re-sults: A depression diagnosis had been re-corded for 71 (15.7%) patients. Using the recom-mended cut-off scores for the GDS, 225 (49.8%) patients met criteria for mild-severe depressive symptoms, and 96 (21.3%) met criteria for mod-erate-severe symptoms. Poor agreement was found between doctor diagnosis of depression and a positive screen for depression using a GDS cut-off score of either 5, k = 0.112 (p = 0.001), or 9, k = 0.189 (p < 0.001), although logis-tic regression found an association between severity of depression and depression diagno-sis, OR = 1.15, p < 0.001 (CI = 1.08 -1.22). Con-clusion: A much higher proportion of patients with multimorbidities reported threshold level depression symptoms than had a recorded di-agnosis of depression, suggesting that although likelihood of diagnosis increases with symptom severity, depression often goes undetected in this population. Depressions' negative impact on prognosis calls for further investigation of the barriers to screening and diagnosis of de-pression in multimorbid patients.
    Full-text · Article · Apr 2013 · Health
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