Skip to main content
SpringerLink
Log in

Adherence to Medicines in the Older-Aged with Chronic Conditions

Does Intervention by an Allied Health Professional Help?

  • Review Article
  • Published:
Drugs & Aging Aims and scope Submit manuscript

Abstract

Adherence to medicines is a major determinant of their effectiveness. However, estimates of non-adherence in the older-aged (defined as those aged ≥65 years) with chronic conditions vary from 40% to 75%. The problems caused by non-adherence in the older-aged include residential care and hospital admissions, progression of the disease and increased costs to society. The reasons for non-adherence in the older-aged include items related to the medicine (e.g. cost, number of medicines, adverse effects) and those related to the person (e.g. cognition, vision, depression). It is also known that there are many ways adherence can be increased (e.g. use of blister packs, cues).

Although it is assumed that interventions by allied health professionals (i.e. other than the prescriber/doctor), including a discussion of adherence, will improve adherence to medicines in the older-aged, the evidence for this has not been reviewed. There is some evidence that telephone counselling concerning adherence by a nurse or pharmacist improves short- and long-term adherence. However, face-to-face intervention counselling at the pharmacy or during a home visit by a pharmacist has shown variable results, with some studies showing improved adherence and some not. Broad-based education programmes during hospital stays have not been shown to improve medication adherence following discharge, whereas education programmes specifically for subjects with hypertension have been shown to improve adherence. In combination with an education programme, both counselling and a medicine review programme have been shown to improve short-term adherence in the older-aged.

Thus, there are many unanswered questions about the most effective interventions for promoting adherence. More studies are needed to determine the most appropriate interventions by allied health professionals, and such studies need to consider the disease state, demographics and socioeconomic status of the older-aged subject, and the intensity and duration of intervention required.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Table I
Table II

Similar content being viewed by others

References

  1. World Health Organization. Adherence to long-term therapies: evidence for action [online]. Available from URL: http://www.who.int/chp/knowledge/publications/adherence_report/en/index.html [Accessed 2009 Jul 7]

  2. Salzman C. Medicine compliance in the elderly. J Clin Psych 1995; 56Suppl. 1: 18–22

    Google Scholar 

  3. Mojtabai R, Olfson M. Medicine costs, adherence, and health outcomes among Medicare beneficiaries. Health Aff (Millwood) 2003; 22: 220–9

    Article  Google Scholar 

  4. Moher D, Liberati A, Tetzlaff J, et al., for the PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 2009; 339: b2535

    Article  PubMed  Google Scholar 

  5. National Pharmaceutical Council. Noncompliance with medicine regimens: an economic tragedy. Emerging issues in pharmaceutical cost containing. Washington, DC: National Pharmaceutical Council, 1992: 1–16

    Google Scholar 

  6. Soumerai SB, Ross-Degnan D, Avorn J, et al. Effects of Medicaid drug-payment limits on admission to hospitals and nursing homes. N Engl J Med 1991; 325: 1071–7

    Article  Google Scholar 

  7. Coll N, Fanale JE, Kronholm P. The role of medicine non-compliance and adverse drug reactions in hospitalizations of the elderly. Arch Intern Med 1990; 150: 841–5

    Article  Google Scholar 

  8. Chan M, Nicklason F, Vial JH. Adverse drug events as a cause of hospital admissions in the elderly. Intern Med J 2001; 31: 199–205

    Article  PubMed  CAS  Google Scholar 

  9. Malhotra S, Karan RS, Pandhi P, et al. Drug related medical emergencies in the elderly: role of adverse drug reactions and non-compliance. Postgrad Med J 2001; 77: 703–7

    Article  PubMed  CAS  Google Scholar 

  10. Tu W, Morris AB, Li J, et al. Association between adherence measurements of metoprolol and health care utilization in older patients with heart failure. Clin Pharmacol Ther 2005; 77: 189–201

    Article  PubMed  CAS  Google Scholar 

  11. Ho PM, Rumsfeld JS, Masoudi FA, et al. Effect of medicine nonadherence on hospitalization and mortality among patients with diabetes mellitus. Arch Intern Med 2006; 166: 1836–41

    Article  PubMed  Google Scholar 

  12. McCombs JS, Thiebaud P, McLaughlin-Miley C, et al. Compliance with drug therapies for the treatment and prevention of osteoporosis. Maturitas 2004; 48: 271–87

    Article  PubMed  CAS  Google Scholar 

  13. Balkrishnan R, Rajagopalan R, Camacho FT, et al. Predictors of medicine adherence and associated health care costs in an older population with type 2 diabetes mellitus: a longitudinal cohort study. Clin Ther 2003; 25: 2958–71

    Article  PubMed  Google Scholar 

  14. Horwitz RI, Viscoli CM, Berkman L, et al. Treatment adherence and risk of death after a myocardial infarction. Lancet 1990; 336: 542–5

    Article  PubMed  CAS  Google Scholar 

  15. Ho PM, Spertus JA, Masoudi FA, et al. Impact of medicine therapy discontinuation on mortality after myocardial infarction. Arch Intern Med 2006; 166: 1842–7

    Article  PubMed  Google Scholar 

  16. Geni AK, Sadia A, Na B, et al. Self-reported medicine adherence and cardiovascular events in patients with stable coronary heart disease: the Heart and Soul Study. Arch Intern Med 2007; 167: 1798–803

    Article  Google Scholar 

  17. Caro JJ, Ishak KJ, Huybrechts KF, et al. The impact of compliance with osteoporosis therapy on fracture rates in actual practice. Osteoporosis Int 2004; 15: 1003–8

    Article  Google Scholar 

  18. MacLauglin EJ, Raehl CL, Treadway AK, et al. Assessing medicine adherence in the elderly: which tools to use in clinical practice? Drugs Aging 2005; 22: 231–356

    Article  Google Scholar 

  19. Heisler M, Langa KM, Eby EL, et al. The health effects of restricting prescription medicine use because of cost. Med Care 2004; 42: 626–34

    Article  PubMed  Google Scholar 

  20. Irvine J, Baker B, Smith J, et al. Poor adherence to placebo or amiodarone therapy predicts mortality: results for the CAMIAT study. Psychosomatic Med 1999; 61: 566–75

    CAS  Google Scholar 

  21. Influence of adherence to treatment and response of cholesterol on mortality in the Coronary Drug Project. N Engl J Med 1980; 303: 1038–41

  22. Glynn RJ, Buring JE, Manson JE, et al. Adherence to aspirin in the prevention of myocardial infarction: the Physicians’ Health Study. Arch Int Med 1994; 154: 2649–57

    Article  CAS  Google Scholar 

  23. Simpson SH, Eurich DT, Majumdar SR, et al. A meta-analysis of the association between adherence to drug therapy and mortality. BMJ 2006; 333: 15

    Article  PubMed  Google Scholar 

  24. Balkrishnan R, Bhosle MJ, Camacho FT, et al. Predictors of medicine adherence and associated health care costs in an older population with overactive bladder syndrome: a longitudinal cohort study. J Urol 2006; 175: 1067–71

    Article  PubMed  Google Scholar 

  25. Isacson D, Olofsson C. Drugs up in smoke: a study of caseated drugs in Sweden. Pharm World Sci 1999; 21: 96–9

    Article  PubMed  CAS  Google Scholar 

  26. Morgan TM. The economic impact of wasted prescription medicine in an outpatient population of older adults. J Fam Pract 2001; 50: 779–81

    PubMed  CAS  Google Scholar 

  27. Avorn J, Monette J, Lacour A, et al. Persistence of use of lipid-lowering medications: a cross-national study. JAMA 1998; 279: 1458–62

    Article  PubMed  CAS  Google Scholar 

  28. Federman AD, Adams AS, Ross-Degnan D, et al. Supplemental insurance and use of effect cardiovascular drugs among elderly Medicare beneficiaries with coronary artery disease. JAMA 2001; 10: 1732–9

    Article  Google Scholar 

  29. Piette JD, Heisler M, Wagner TH. Problems paying out-of-pocket medicine costs among older adults with diabetes. Diabetes Care 2004; 27: 384–91

    Article  PubMed  Google Scholar 

  30. Safran DG, Neuman P, Schoen C, et al. Prescription drug coverage and seniors: how well are States closing the gap? Health Aff (Millwood) 2002 Jul–Dec; Suppl Web Exclusives: W253–68

    Google Scholar 

  31. Piette JD, Heisler M, Krein S, et al. The role of patient-physician trust in moderating medicine nonadherence due to cost pressures. Arch Intern Med 2005; 165: 1749–55

    Article  PubMed  Google Scholar 

  32. Schneeweiss S, Patrick AR, Maclure M, et al. Adherence to β-blocker therapy under drug cost-sharing in patients with and without acute myocardial infarction. Am J Manag Care 2007; 13:445–52

    PubMed  Google Scholar 

  33. Tosteson AN, Grove MR. Early discontinuation of treatment for osteoporosis. Am J Med 2003; 115: 209–16

    Article  PubMed  Google Scholar 

  34. Hughes CM. Medicine non-adherence in the elderly: how big is the problem? Drugs Aging 2004; 21: 793–811

    Article  PubMed  Google Scholar 

  35. Park DC, Hertzog G, Leventhal H, et al. Medicine adherence in rheumatoid arthritis patients: older is wiser. J Am Geriatric Soc 1999; 47: 172–83

    CAS  Google Scholar 

  36. Monane M, Bohn RL, Gurwitz JH, et al. Compliance with antihypertensive therapy among elderly Medicaid enrolees: the roles of age, gender, and race. Am J Public Health 1996; 86: 1805–8

    Article  PubMed  CAS  Google Scholar 

  37. Benner JS, Glynn RJ, Mogun H, et al. Long-term persistence in use of statin therapy in elderly patients. JAMA 2002; 288: 455–61

    Article  PubMed  Google Scholar 

  38. Monane M, Bohn RL, Gurwitz JH, et al. Noncompliance with congestive heart failure therapy in the elderly. Arch Intern Med 1994; 154: 433–7

    Article  PubMed  CAS  Google Scholar 

  39. Barat I, Andreasen F, Damsgaard EMS. Drug therapy in the elderly: what doctors believe and patients actually do. Br J Clin Pharmacol 2001; 51: 615–22

    Article  PubMed  CAS  Google Scholar 

  40. Monane M, Bohm RL, Gurwitz JH, et al. The effects of initial drug choice and comorbidity on antihypertensive therapy compliance: results from a population-based study in the elderly. Am J Hypertens 1997; 10: 697–704

    Article  PubMed  CAS  Google Scholar 

  41. Rizzo JA, Simons WR. Variations in compliance among hypertensive patients by drug class: implications for health care costs. Clin Ther 1997; 19: 1466–7

    Article  Google Scholar 

  42. Bhosle MJ, Reardon G, Camacho FT, et al. Medication adherence and health care costs with the introduction of latanoprost therapy for glaucoma in a Medicare managed care population. Am J Geriatr Pharmacother 2007; 5: 100–11

    Article  PubMed  Google Scholar 

  43. Chapman RH, Benner JS, Petrilla AA, et al. Predictors of adherence with antihypertensive and lipid-lowering therapy. Arch Intern Med 2005; 165: 1147–52

    Article  PubMed  Google Scholar 

  44. Botelho RJ, Dudrak R. Home assessment of adherence to long-term medicines in the elderly. J Fam Pract 1992; 35: 61–5

    PubMed  CAS  Google Scholar 

  45. Paes AHP, Bakker A, Soe-Agnie CJ. Impact of dosage frequency on patient compliance. Diabetes Care 1997; 20: 1512–7

    Article  PubMed  CAS  Google Scholar 

  46. Cooper C, Carpenter I, Katona C, et al. The AdHOC study of older adults’ adherence to medication in 11 countries. Am J Geriatr Psychiatry 2005; 13: 1067–76

    PubMed  Google Scholar 

  47. Goeman DP, Douglass JA. Optimal management of asthma in elderly patients: strategies to improve adherence to recommended interventions. Drugs Aging 2007; 24: 381–94

    Article  PubMed  Google Scholar 

  48. Insel K, Morrow D, Brewer B, et al. Executive function, working memory, and medication adherence among old adults. J Gerontol Series B 2006; 61B: P102–7 [online]. Available from URL: http://psychsoc.gerontologyjournals.org/cgi/reprint/61/2/P102 [Accessed 2009 Dec 23]

    Article  Google Scholar 

  49. Gazmararian JA, Kripalani S, Miller MJ, et al. Factors associated with medication refill adherence in cardiovascular-related diseases: a focus on health literacy. J Gen Intern Med 2006; 21: 1215–21

    Article  PubMed  Google Scholar 

  50. DiMatteo MR, Lepper HS, Croghan TW. Depression is a risk factor for noncompliance with medical treatment: meta-analysis of the effects of anxiety and depression on patient adherence. Arch Intern Med 2000; 160: 2101–7

    Article  PubMed  CAS  Google Scholar 

  51. Carney RM, Freedland KE, Eisen SA, et al. Major depression and medicine adherence in elderly patients with coronary artery disease. Health Psychology 1995; 14: 88–90

    Article  PubMed  Google Scholar 

  52. Gehi A, Haas D, Pipkin S, et al. Depression and medicine adherence in outpatients with coronary heart disease: findings from the Heart and Soul Study. Arch Intern Med 2005; 165: 2508–13

    Article  PubMed  Google Scholar 

  53. Katon W, Cantrell CR, Sokol MC, et al. Impact of antidepressant drug adherence on comorbid medicine use and resource utilization. Arch Intern Med 2005; 165: 2497–503

    Article  PubMed  Google Scholar 

  54. Moisan J, Gaudet M, Grégoire J-P, et al. Non-compliance with drug treatment and reading difficulties with regard to prescription labelling among seniors. Gerontology 2002; 48: 44–51

    Article  PubMed  Google Scholar 

  55. Kruse W, Koch-Gwinner P, Nikolaus T, et al. Measurement of drug compliance by continuous electronic monitoring: a pilot study in elderly patients discharged from hospital. J Am Geriatr Soc 1992; 40: 1151–5

    PubMed  CAS  Google Scholar 

  56. Gray SL, Mahoney JE, Blough DK. Medicine adherence in elderly patients receiving home health services following hospital discharge. Ann Pharmacotherapy 2001; 35: 539–45

    Article  CAS  Google Scholar 

  57. Ware GJ, Holford NH, Davison JG, et al. Unit dose calendar packaging and elderly patient compliance. N Z Med J 1991; 104:495–7

    PubMed  CAS  Google Scholar 

  58. Murray MD, Birt JA, Manatunga AK, et al. Medicine compliance in elderly outpatients using twice-daily dosing and unit-of-use packaging. Ann Pharmacotherapy 1993; 27: 616–21

    CAS  Google Scholar 

  59. Cramer JA. Enhancing patient compliance in the elderly: role of packaging aids and monitoring. Drugs Aging 1998; 12: 7–15

    Article  PubMed  CAS  Google Scholar 

  60. Owen SG, Friesen WT, Roberts MS, et al. Determinants of compliance in rheumatoid arthritic patients assessed in their home environment. Br J Rheumatol 1985; 24: 313–20

    Article  PubMed  CAS  Google Scholar 

  61. Dolce JJ, Crisp C, Manzella B, et al. Medicine adherence patterns in chronic obstructive pulmonary disease. Chest 1991; 99: 837–41

    Article  PubMed  CAS  Google Scholar 

  62. Jackevicius CA, Mamdani M, Tu JV. Adherence with statin therapy in elderly patients with and without acute coronary syndromes. JAMA 2002; 288: 462–7

    Article  PubMed  Google Scholar 

  63. Lorenc L, Branthwaite A. Are older adults less compliant with prescribed medication than younger adults? Br J Clin Psychol 1993; 32: 485–92

    Article  PubMed  Google Scholar 

  64. Fosu GB. Social support and compliance with hypertensive regiments among the elderly. J Mental Health Aging 1995; 1: 7–20

    Google Scholar 

  65. Siliman RA, Bhatti S, Khan A, et al. The care of older persons with diabetes mellitus: families and primary care physicians. J Am Geriatr Society 1996; 44: 1314–21

    Google Scholar 

  66. Ekman I, Andersson G, Boman K, et al. Adherence and perception of medication in patients with chronic heart failure during a five-year randomised trial. Patient Educ Couns 2006;61: 348–53

    Article  PubMed  Google Scholar 

  67. Chia L, Schlenk EA, Dunbar-Jacob J. Effect of personal and cultural beliefs on medication adherence in the elderly. Drugs Aging 2006; 23: 191–202

    Article  PubMed  Google Scholar 

  68. Balkrishnan R. Predictors of medicine adherence in the elderly. Clin Ther 1998; 20: 764–71

    Article  PubMed  CAS  Google Scholar 

  69. Wang PS, Avorn J, Brookhart A, et al. Effects of non-cardiovascular comorbidities on antihypertensive use in elderly hypertensives. Hypertension 2005; 46: 273–9

    Article  PubMed  Google Scholar 

  70. Cargill JM. Medicine compliance in elderly people: influencing variables and interventions. J Adv Nurs 1992; 17: 422–6

    Article  PubMed  CAS  Google Scholar 

  71. Clifford A, Barber N, Elliot R, et al. Patient-centred advice is effective in improving adherence to medicines. Pharm World Sci 2006; 28: 165–70

    Article  PubMed  Google Scholar 

  72. Fulmer TT, Feldman P, Kim TS, et al. An intervention study to enhance medicine compliance in community-dwelling elderly individuals. J Gerontol Nurs 1999; 25: 6–14

    PubMed  CAS  Google Scholar 

  73. Wu JYF, Leung WYS, Chang S, et al. Effectiveness of telephone counselling by a pharmacist in reducing mortality in patients receiving polypharmacy: randomised controlled trial. BMJ 2006; 333: 522

    Article  PubMed  Google Scholar 

  74. Márquez Contreras E, Vegazo García O, Claros NM, et al. Efficacy of telephone and mail intervention in patient compliance with antihypertensive drugs in hypertension: ETECUM-HTA study. Blood Pressure 2005; 14: 151–8

    Article  PubMed  Google Scholar 

  75. Schectman G, Hiatt J, Hartz A. Telephone contacts do not improve adherence to niacin or bile acid sequestrant therapy. Ann Pharmacother 1994; 28: 29–35

    PubMed  CAS  Google Scholar 

  76. Faulkner MA, Wadibia EC, Lucas D, et al. Impact of pharmacy counselling on compliance and effectiveness of combination lipid-lowering therapy in patients undergoing coronary artery revascularization: a randomized, controlled trial. Pharmacotherapy 2000; 20: 410–6

    Article  PubMed  CAS  Google Scholar 

  77. Lipton HL, Bird JA. The impact of clinical pharmacists’ consultations on geriatric patients’ compliance and medical care use: a randomized controlled trial. Gerontologist 1994; 34: 307–15

    Article  PubMed  CAS  Google Scholar 

  78. Bernsten C, Björkman I, Caramona M, et al. Improving the well-being of elderly patients via community pharmacy-based provision of pharmaceutical care: a multicentre study in seven European countries. Drugs Aging 2001; 18: 63–77

    Article  PubMed  CAS  Google Scholar 

  79. Bouvy ML, Heerdink ER, Urquart J, et al. Effect of a pharmacist-led intervention on diuretic compliance in heart failure patients: a randomized controlled study. J Card Fail 2003; 9: 404–11

    Article  PubMed  Google Scholar 

  80. Murray MD, Young J, Hoke S, et al. Pharmacist intervention to improve medicine adherence in heart failure: a randomized trial. Ann Intern Med 2007; 146: 714–5

    PubMed  Google Scholar 

  81. Nazareth I, Burton A, Shulman S, et al. A pharmacy discharge plan for hospitalized elderly patients: a randomized controlled trial. Age Ageing 2001; 30: 33–40

    Article  PubMed  CAS  Google Scholar 

  82. Goodyer LI, Miskelly F, Miskelly F. Does encouraging good compliance improve patients’ clinical condition in heart failure. Br J Clinic Pract 1995; 10: 173–6

    Google Scholar 

  83. Hawe P, Higgins G. Can medicine education improve the drug compliance of the elderly? Evaluation of an in hospital program. Patient Educ Counsel 1990; 16: 151–60

    Article  CAS  Google Scholar 

  84. Taylor CT, Byrd DC, Krueger K. Improving primary care in rural Alabama with a pharmacy initiative. Am J Health Syst Pharm 2003; 60: 1123–9

    PubMed  Google Scholar 

  85. Nessman DG, Carnahan JE, Nugent CA. Increasing compliance: patient-operated hypertension groups. Arch Intern Med 1980; 140: 1427–30

    Article  PubMed  CAS  Google Scholar 

  86. Sclar DS, Chin A, Skaer TL, et al. Effect of health education in promoting prescription refill compliance among patients with hypertension. Clin Ther 1991; 13: 489–95

    PubMed  CAS  Google Scholar 

  87. Herschorn S, Becker D, Miller E, et al. Impact of a health education intervention in overactive bladder patients. Can J Urol 2004; 11:2430–7

    PubMed  Google Scholar 

  88. Poston J, Loh E, Durham W. The Medication Use Study: a large-scale controlled evaluation of the effects of the Vital Interests™ program on adherence to medication regimens. Can Pharmaceut J 1999; 131: 31–8

    Google Scholar 

  89. Lee JK, Grace KA, Taylor AJ. Effect of a pharmacy care program on medicine adherence and persistence, blood pressure, and low-density lipoprotein cholesterol: a randomized controlled trial. JAMA 2006; 296: 2563–71

    Article  PubMed  CAS  Google Scholar 

  90. Rich HW, Gray DB, Beckham V, et al. Effect of a multi-disciplinary intervention on medicine compliance in elderly patients with congestive heart failure. Am J Med 1996; 101: 270–6

    Article  PubMed  CAS  Google Scholar 

  91. Lowe CJ, Raynor DK, Purvis J, et al. Effect of medicine review and education programme for older people in general practice. Br J Clin Pharmacol 2000; 50: 172–5

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgements

No sources of funding were used to assist in the preparation of this review. The author has no conflicts of interest that are directly relevant to the content of this review.

Author information

Authors and Affiliations

  1. School of Life Sciences, Queensland University of Technology, GPO Box 2334, Brisbane, Queensland, 4001, Australia

    Sheila A. Doggrell

Authors
  1. Sheila A. Doggrell
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sheila A. Doggrell.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Doggrell, S.A. Adherence to Medicines in the Older-Aged with Chronic Conditions. Drugs Aging 27, 239–254 (2010). https://doi.org/10.2165/11532870-000000000-00000

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/11532870-000000000-00000

Keywords

Search

Navigation