Assessing medication adherence in the elderly: which tools to use in clinical practice?

Area of Science:

• Geriatrics
• Pharmacology
• Health Literacy

Background:

• Medication adherence is challenging for all patients, especially the elderly.
• Nonadherence in older adults stems from diverse factors including demographics, health literacy, comorbidities, and medication side effects.
• Certain medications pose higher risks if adherence is poor, potentially leading to adverse events or disease exacerbation.

Purpose of the Study:

• To explore the multifaceted challenges of medication adherence in the elderly population.
• To identify risk factors and predictors associated with medication nonadherence in older adults.
• To evaluate traditional and novel methods for assessing medication adherence in geriatric patients.

Main Methods:

• Review of factors influencing medication adherence in the elderly.
• Discussion of demographic, health literacy, and clinical predictors of nonadherence.
• Evaluation of traditional assessment methods (e.g., direct questioning, refill records, pill counts) and their limitations.
• Introduction of patient-centered assessment tools (e.g., Drug Regimen Unassisted Grading Scale, MedTake test) and technological aids.
• Emphasis on open-ended, non-judgmental patient/caregiver interviews as a practical assessment approach.

Main Results:

• Nonadherence in the elderly is multifactorial, influenced by patient characteristics, health system factors, and medication properties.
• Traditional adherence assessment methods are often unreliable and may overestimate adherence rates.
• Patient-reported methods and open-ended interviews show promise for accurately identifying adherence issues in a non-threatening manner.
• Decline in functional abilities and specific conditions like cardiovascular disease and depression are potential indicators of nonadherence.

Conclusions:

• Effective medication adherence in the elderly requires a collaborative patient-prescriber relationship with open communication.
• Assessing health literacy and considering comorbidities, sensory impairments, and medication costs/side effects are vital.
• Non-judgmental, patient-centered interview techniques are the most practical and reliable methods for assessing medication adherence in older adults.
• Technological aids show potential but are currently limited in widespread application.