Older people and adherence with medication: A review of the literature

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Abstract

Background

Older people represent a sizeable population of the UK. Many older people receive drug treatment for long-term conditions. Adherence with medication is therefore an important clinical, financial and resource intensive concern.

Objectives

This review aimed to examine patient's beliefs, perceptions and views in relation to adherence with medication.

Design

A comprehensive search of the literature was undertaken using numerous approaches. The search of revealed 30 research papers.

Findings

Articles were initially evaluated using Critical Appraisal Skills Programme principles to identify those relevant to the review. Relevant studies were then subjected to a narrative analysis to assist the development of relevant themes. Four themes were identified; experience of adherence; perceptions and attitudes to medication adherence and non-adherence; patients acceptance of their illness and impact on medication taking behaviour and shared decision making.

Conclusions

The findings of this review imply that there is a need for more emphasis on shared decision making between the older patient and the prescriber. Using this approach, adherence with medication may improve. There is also a need to develop a standardized measure of medication adherence.

Introduction

Medication taking behaviour relates to the manner in which an individual adheres to a medication regimen. In the older person, it is known that alterations in medication taking behaviour can happen and can lead to suboptimal clinical responses to medication and the onset of psychological and medical complications as a consequence of poor therapeutic control (McElnay, 2005, Pound et al., 2005a). Altered medication taking behaviour can reduce the patient's quality of life and create a financial burden due to the inappropriate use of valuable resources (Pound et al., 2005b). Findings from a recent meta-analysis of randomized controlled trials revealed that roughly 20–50% of patients mismanage their medicines (Kripalani et al., 2007).

Section snippets

The concept of adherence

The terminology used to describe medication taking behaviour has undergone many transitions during the last decade. Initially, the term compliance was used to illustrate the medication taking behaviour, which was then replaced by the term concordance. Concordance refers to the “anticipated outcome of the consultation between doctors and patients about medicine taking” (Pound et al., 2005a, p. 134). It is viewed as successful prescribing and medication taking based on the partnership with the

Medication taking behaviour research

The vast majority of research that has investigated medication taking behaviour has centred on clinical trials and quantitative approaches which includes a paucity of qualitative studies (Benson and Britten, 2002). Over the last three decades, more than 200 variables have been identified that are pertinent to the extent and determinants of compliance with medication, few studies since the 1980s have successfully illustrated the predictability of adherence (Vermiere et al., 2001). Reported

Method

This review was restricted to a review of the current literature and draws on established methods (CRD, 2001). This review of the literature provides an evaluation of the range of existing research relevant to adherence with medication in older people. However, the aim of this review is not to evaluate the quality of the studies reported but to provide a succinct account of the range of existing studies and literature relevant to the subject of medication adherence and older people (Mays et

Findings

Four themes emerged from the findings of the studies reviewed. These include: the experience of adherence, perceptions and attitudes to medication adherence and non-adherence, patients’ acceptance of their illness and impact on medication taking behaviour, and disease specific information.

Discussion

Adherence to medication is an important aspect of medication management of long-term conditions particularly in older people and is a growing area of research. In the research available, there is a tendency to propose that the older person should be passive and not question medical decisions and that health will improve if they adhere to prescribed medication regimen. This assumption is based on a paternalistic approach to medication management. Prescribers should adopt a consultation style

Conclusion

Medication taking behaviour in older people is a complex issue that can have significant financial and health related consequences. It is an area of research that has been investigated in relation to the use of nursing interventions and prevalence but future research needs to be more patient centered to elucidate the patient's perspective and possible impact of a shared approach to clinical decision making. Further, the generation of a measure to assess risk of non-adherence with medication

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