Medication non-adherence in the elderly: how big is the problem?

Area of Science:

• Geriatric Medicine
• Pharmacology
• Patient Adherence Research

Background:

• Medication adherence is a complex behavior influencing patient outcomes, particularly in elderly populations with multiple comorbidities.
• Non-adherence risks are amplified in older adults due to polypharmacy, but age alone is not a definitive predictor of poor adherence.
• Existing adherence studies lack standardization in measurement, patient definition, and disease scope, hindering comparative analysis.

Purpose of the Study:

• To explore the multifaceted nature of medication adherence in patients, with a focus on the elderly population.
• To review current strategies for improving medication adherence and discuss the critical role of patient-provider communication.
• To emphasize the importance of patient-centered approaches in optimizing therapeutic results.

Main Methods:

• Literature review and synthesis of existing research on medication adherence in various patient groups.
• Analysis of factors influencing adherence, including patient age, comorbidities, polypharmacy, and access to medications.
• Examination of interventions aimed at improving adherence, such as forgiving drug designs, drug holidays, and simplified dosing.

Main Results:

• Older patients may intentionally non-adhere to manage adverse effects, and age is not consistently linked to poorer adherence.
• Medication access, formulary restrictions, and insurance programs can impact adherence.
• Interventions like once-daily scheduling, compliance aids, and 'forgiving drugs' show potential for improving adherence.

Conclusions:

• Patient-centered decision-making and strong patient-healthcare professional communication (concordance) are crucial for effective medication management.
• Multifaceted interventions, incorporating practical approaches and the patient's perspective, are necessary for successful adherence strategies.
• The ultimate goal of adherence interventions should be to achieve satisfactory therapeutic outcomes, not adherence for its own sake.