A Review of Literature on Medication Compliance in the Older Adult

1. A Review of Literature on Medication Compliance in the Older Adult Ashley Cox, Cassie Appleyard, Sarah Hefler, Courtney Yankson & Sam Madsen

2. Abstract • Background: Medication compliance is a significant problem in the older adult population. Medications are commonly prescribed to older adults. We define medication compliance as successfully taking prescribed medications as ordered by a health care provider. • Objective: The aim of our research is to examine the factors that affect medication compliance in the older adult population.

3. Abstract • Methods: To write this review of literature, we found our research articles on CINAHL, a nursing-related research database. We focused our review on nine articles, and together they completed a comprehensive literature review. • Results: It was found that medication compliance in the older adult can be affected by: clients’ perceptions, cognitive impairments, financial burdens, racial differences, caregiver neglect, and lack of education to the patient and their support system.

4. Abstract • Summary: Based on the findings of our literature review, we can conclude that medication compliance is different for every patient and situation. There is no single solution that will apply to everyone. Nurses can improve medication compliance by properly educating clients and getting the client’s support system involved in the medication regimen.

5. Research Question • In older adults taking medications, what are the factors that affect medication compliance?

6. Sample • There are nine research articles • Looked for similarities as well as differences among the articles, finding that • the older clients may have forgotten to take their medications due to decreased cognitive function • the clients were not educated on how to properly take their medications • the clients had too many medications to take • the clients’ cares were neglected • the clients were unable to pay for the medications due to lack of financial resources.

7. Methods • Topic began as “Medication Safety for the Older Adults” • Used a research database called CINAHL • Key words for search included; “medication safety”, “elderly”, and “medication compliance” • Narrowed topic to “Medication Compliance in the Older Adult” • After 12 articles were found narrowed down to 9 that best fit our topic • Criteria for the articles: year published and how closely they reflected our topic

8. Methods Continued • The time frame we used was the past eight years • Used both qualitative and quantitative studies • Wide variety of articles looking at race, incomes, and different medical conditions • All articles give reasons for the difficulties of medication compliance

9. Results- “The Health Effects of Restricting Prescription Medication Use Because of Cost” • Purpose- to test if restricting medication use in the older adult because of high cost would affect the health status of the individuals • Population- 17,991 participants above the age of 51 years old, and took Rx medication regularly • Method-Multivariable logistic and Poisson regression models were used to assess the data • Conclusion-cost-related restrictions of medications in the older adults are associated with an increase in worsening health status

10. Results- “Medication Safety in Older Adults: Home-Based Practice Patterns” • Purpose- “to identify the current state of medication-taking practices in community-dwelling older adults taking high-risk medications so as to identify potential targets for interventions” (Metlay et al., 2005, p. 976). • Population- 1,000 subjects that were interviewed by trained professionals • Methods-private phone interviews and were entered into an Oracle database • Conclusion- It was found that people need both written and verbal instructions to reduce the risk of medication related health problems (Metlay et al., 2005)

11. Results- “Evaluation of a Medication Education Program for Elderly Hospitals in Patients” • Purpose- to assess the impact that the nursing staff had in hospital medication education programs for older adults • Population- participants were eligible if they were 65 years or older, were admitted in the geriatric ward, spoke English, took one or more medications daily, lived at home, and managed all of their medications on their own • Methods-information was collected and recorded in Microsoft Access 2000 • Conclusion-there was improvement in medication knowledge of the names of the medications taken, doses and times to take each medication, and the purposes of each medication, however still difficulty with knowledge of the side effects

12. Results-“A model of medication-taking behavior in elderly individuals with chronic disease” • Purpose- develop a real model that describes medication-taking behavior in elderly cardiac patients • Population- 19 participants that were at least 65 years old, had been diagnosed with cardiovascular disease, and took medications chronically • Method-participants were interviewed in three different phases • Conclusion- four major themes that were found to describe readiness to adhere: perceived reality, interpersonal influences, perceived effectiveness, and perceived partnership

13. Results- “Medication Adherence Among Older Adults” • Purpose- examine barriers to medication adherence • Population- participants aged 60 and older in an Adult Protective Agency Service • Method- analyze various factors that could affect medication compliance: age, gender, literacy, beliefs, and behaviors about disease and medications • Conclusion- the primary issue that led to non-adherence in the older adult was due to intentional caregiver neglect

14. Results-“Continuity and Adherence to Long-term Drug Treatment by Geriatric Patients after Hospital Discharge: A Prospective Cohort Study” • Purpose-to research the occurrence of medication modification one month after discharge • Population- 198 participants • Method- researchers recorded clinical, demographic, and medication regimen data for all patients at an interview prior to discharge and after discharge for one month, the patient, caregiver, or general practitioner was interviewed regarding the extent and reasons for modifications to the medication regimen and adherence to treatment • Conclusion- 6% were non-compliant to all medications and 30% were non-compliant to at least one of their medications

15. Results- ” Racial differences in medication adherence: A cross-sectional study of Medicare enrollees” • Purpose-determine whether racial differences in medication adherence between African Americans and whites persist after adjusting for demographic characteristics, health literacy, depression, and social support” (Gerber et al., 2010, p. 137). • Population- 489 participants at least 65 years old • Method- face-to-face interviews • Conclusion- race was not associated with low adherence from not refilling medications before running out or forgetting to take the medications, however race remained a factor in low adherence due to not following physician instructions on how to take the medications

16. Results-“Medication therapy: adherence, knowledge and difficulties of elderly people from bipolar disorder” • Purpose- attempt to discover the adherence, knowledge, and difficulties older adults experienced regarding their medication • Population- 17 older adults ages 60 and older from a Mental Health Center in Brazil • Method- use of the Morisky-Green test to conduct the interviews and tests in an attempt to find out the level of adherence and whether the possible non-adherence was intentional or unintentional • Conclusion- 2 participants were fully compliant, 11 participants were unintentionally non-compliant, 2 participants were intentionally non-compliant, and 2 participants were both intentionally and unintentionally compliance

17. Results- “Medication therapy: adherence, knowledge and difficulties of elderly people from bipolar disorder” Continued • Purpose- to know the level of knowledge that the participants had regarding their medication names, doses, and frequency of use • Method- researchers rated the participants’ levels of knowledge based on five intervals ranging from “without knowledge” to “good knowledge.” • Conclusion- over half of the participants presented 0% of knowledge, and only five participants were able to name more than 75% of the medications they were taking. Some reasons for patients not taking there medications are; struggling with the self administration of the numerous medications and felt as if they were unnecessarily taking too many of them, the negative side effects of the medications, also the article stated that cognitive impairments might play a role in the older adult forgetting to take the medications

18. Results- “Impact of Self-administration of Medication Program on Elderly Inpatients’ Competence to Manage Medications: A Pilot Study” • Purpose- assess how Self Administered Medication Programs (SAMP’S) impact patients in managing their own medication • Population- 24 patients • Method- assessment data in three phases • Conclusion- that 22 out of the 24 patients successfully completed all stages of the SAMP

19. Nursing Implications • This is why there are so many theories, and it is difficult to set a universal plan to improve medication adherence. There are general guidelines that we can follow, such as providing proper verbal and written education to the patient and their families. However, no single technique will work for all. (Shen et al., 2006). • Nurses are essential in the assessment of what will work best for the patient because they have frequent communication with their patients (Shen et al., 2006).

20. Conclusion • There are many reasons for noncompliance in the older adult population • Money, education, and cognitive impairment • No one technique works best for everyone • Should be based on an individual basis • More research needs to be done on individualized programs for medication compliance

21. References • Chen, C., Wu, J., Yen, M., & Chen, Z. (2007). A model of medication-taking behavior in elderly individuals with chronic disease. Journal Of Cardiovascular Nursing, 22(5), 359-365. • Gerber, B., Cho, Y., Arozullah, A., & Lee, S. (2010). Racial differences in medication adherence: A cross-sectional study of Medicare enrollees. American Journal Of Geriatric Pharmacotherapy, 8(2), 136-145. doi:10.1016/j.amjopharm.2010.03.002 • Grocki, J., & Huffman, K. (2007). Medication adherence among older adults. Journal Of Evidence-Based Social Work, 4(1-2), 97-120. • Heisler, M., Langa, K., Eby, E., Fendrick, A., Kabeto, M., & Piette, J. (2004). The health effects of restricting prescription medication use because of cost. Med Care, 42(7), 626-634. • Lam, P., Elliott, R., & George, J. (2011). Impact of a self-administration of medications programme on elderly inpatients' competence to manage medications: a pilot study. Journal Of Clinical Pharmacy & Therapeutics, 36(1), 80-86. doi:10.1111/j.1365-2710.2009.01157.x

22. References Continued • Mansur, N., Weiss, A., Hoffman, A., Gruenewald, T., & Beloosesky, Y. (2008). Continuity and adherence to long-term drug treatment by geriatric patients after hospital discharge: a prospective cohort study. Drugs & Aging, 25(10), 861-870. • Metlay, J., Cohen, A., Polsky, D., Kimmel, S., Koppel, R., & Hennessy, S. (2005). Medication safety in older adults: home-based practice patterns. Journal Of The American Geriatrics Society, 53(6), 976-982. doi:10.1111/j.1532-5415.2005.53308.x • Paula, Miranda, P., Giacchero, & Miasso, A. (2011). Medication therapy: adherence, knowledge and difficulties of elderly people from bipolar disorder. Revista Latino-Americana De Enfermagem (RLAE), 19(4), 944-952. doi:S0104-11692011000400013 • Shen, Q., Karr, M., Ko, A., Chan, D., Khan, R., & Duvall, D. (2006). Evaluation of a medication education program for elderly hospital in-patients. Geriatric Nursing, 27(3), 184-192.