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Medication adherence and old age

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Medication adherence is an essential aspect of patient care and is required for therapeutic goals to be met. The WHO, in its 2021 report on drug adherence, notes that “raising the effectiveness of adherence initiatives may have a considerably bigger influence on the health of the community than any improvement in specific medical treatment.” Non-adherence, on the other hand, leads to bad clinical outcomes, higher rates of illness and death, and wasteful spending on health care.

Poor medication adherence (filling a prescription for a drug at a pharmacy but then taking the medication erratically or completely stopping)  is a substantial public health issue among the elderly. Medication non-adherence  is estimated to occur in 50% of older adults, resulting in significant morbidity and health-care costs ranging from $100 billion to $300 billion in the United States. While older persons are no more likely than younger ones to struggle with medication adherence, they frequently have a higher comorbidity burden with a bigger number of prescribed drugs and, as a result, suffer more health-related concerns when non-adherence occurs.

Categories of Non-Adherence

Meanwhile, some research categorises non-adherence as primary or secondary. Primary non-adherence is defined as the frequency with which patients fail to fill prescriptions when starting new medications, and it is related to refilling and starting medication therapy. Secondary non-adherence is described as not taking medication as prescribed when prescriptions are filled. It has an impact not only on the clinical outcome but also on the financial outcome of the health system.

Factors that Contribute to Poor Medication Adherence

Poor medication adherence has complex factors that must be recognised before strategies to enhance medication adherence can be created. The WHO classifies the factors that contribute to poor drug adherence into five categories: socioeconomic factors, therapy-related factors, patient-related factors, condition-related factors, and health system/health care team (HCT)-related factors. Once it is determined whether the non-adherence is primary (the initiation of pharmacotherapy) or secondary (the implementation of the prescribed regime) and what variables contributed to it, a proper intervention can be customised individually to enhance each patient’s medication-taking behaviour.

Challenges Faced by the Older Population

Non-adherence is a big problem for older people, who often have multiple chronic conditions and need more than one treatment.

Maintaining a simple task, such as keeping track, is becoming increasingly difficult in today’s hectic world, particularly for our elderly population, who suffer from mild forgetfulness to symptomatic dementia (or Alzheimer’s). Older adults are often at higher risk for non-adherence, as they are more likely to be on multiple prescription medications.

Also because the old population tends to engage in polypharmacy, the cost of buying the drugs could be overwhelming. Therefore, it is important to look for various ways to reduce the cost of the drugs, which can include using the free coupon for Jardiance

Strategies to Enhance Medication Adherence

To date, no single intervention technique has been proven to be helpful in promoting adherence across all patients, conditions, and settings. Between September and October 2014, a group of experts in geriatrics, pharmacology, epidemiology, and public health used a modified RAND appropriateness technique to achieve agreement on the likely best strategies to promote adherence in older people.

Interventions were found and classified based on their target (patient, therapy, and public health/society):

  • comprehensive geriatric assessment
  • patient and caregiver education to increase patient empowerment
  • utilisation of adherence aids
  • physician and other healthcare professional education
  • adherence assessment

Photo by Ksenia Yakovleva on Unsplash

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