Poor adherence may have a major impact on clinical outcome, contributing to substantial worsening of disease, increased health care costs and even death. With increasing numbers of medications, low adherence is a growing concern, seriously undermining the benefits of current medical care. Little is known about medication adherence among older adults living at home and requiring complex medication regimens.
The aim of this study was to describe adherence to drug prescriptions in a cohort of elderly patients receiving polypharmacy, discharged from an internal medicine ward.
A sample of elderly patients (65 years of age or older) discharged from an internal medicine ward in Italy throughout 2012 were enrolled. They were followed for 3 months after discharge with a structured telephone interview to collect information on drug regimens and medication adherence 15–30 days (first follow-up) and 3 months (second follow-up) after discharge. Demographic variables including age, sex, marital status and caregiver were collected.
Among 100 patients recruited, information on medication adherence was available for, respectively, 89 and 79 patients at the first and second follow-ups. Non-adherence was reported for 49 patients (55.1 %) at the first follow-up and for 55 (69.6 %) 3 months from discharge. Voluntary withdrawal of a drug and change of dosage without medical consultation were the main reasons for non-adherence at both follow-ups. The number of drugs prescribed at discharge was related to medication non-adherence at both follow-up interviews. No association was found between age and non-adherence. Only 25 patients (28.1 %) at the first follow-up and 20 (25.3 %) at the second understood the reasons for their medications.
Low medication adherence is a real, complex problem for older patients receiving polypharmacy. We found that the increasing number of drugs prescribed at hospital discharge is correlated to non-adherence and a high percentage of patients did not understand the purpose of their medications. Simplification of drug regimens and reduction of pill burdens as well as better explanations of the reason for the medications should be targets for intervention.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
Osterberg L, Blaschke T. Adherence to medication. N Engl J Med. 2005;353(5):487–97.
Claxton AJ, Cramer J, Pierce C. A systematic review of the associations between dose regimens and medication compliance. Clin Ther. 2001;23(8):1296–310.
Coleman CI, Limone B, Sobieraj DM, et al. Dosing frequency and medication adherence in chronic disease. J Manag Care Pharm. 2012;18(7):527–39.
Slejko JF, Ho M, Anderson HD, Nair KV, et al. Adherence to statins in primary prevention: yearly adherence changes and outcomes. J Manag Care Pharm. 2014;20(1):51–7.
Cramer J, Rosenheck R, Kirk G, et al. Medication compliance feedback and monitoring in a clinical trial: predictors and outcomes. Value Health. 2003;6:566–73.
Haynes RB, McDonald HP, Garg AX. Helping patients follow prescribed treatment: clinical applications. JAMA. 2002;288:2880–3.
Cramer JA, Scheyer RD, Mattson RH. Compliance declines between clinic visits. Arch Intern Med. 1990;150:1509–10.
Andrade SE, Kahler KH, Frech F, et al. Methods for evaluation of medication adherence and persistence using automated databases. Pharmacoepidemiol Drug Saf. 2006;15(8):565–74.
Donovan JL, Blake DR. Patient non-compliance: deviance or reasoned decision-making? Soc Sci Med. 1992;34(5):507–13.
Vermeire E, Hearnshaw H, Van Royen P, et al. Patient adherence to treatment: three decades of research. A comprehensive review. J Clin Pharm Ther. 2001;26(5):331–42.
Budnitz DS, Lovegrove MC, Shehab N, et al. Emergency hospitalizations for adverse drug events in older Americans. N Engl J Med. 2011;365(21):2002–12.
Hilmer SN, Gnjidic D. The effects of polypharmacy in older adults. Clin Pharmacol Ther. 2009;85:86–98.
Steinman MA, Landefeld CS, Rosenthal GE, et al. Polypharmacy and prescribing quality in older people. J Am Geriatr Soc. 2006;54:1516–23.
Koh Y, Kutty FBM, Li SC. Drug-related problems in hospitalized patients on polypharmacy: the influence of age and gender. Ther Clin Risk Manag. 2005;1:39–48.
Lund BC, Carnahan RM, Egge JA, et al. Inappropriate prescribing predicts adverse drug events in older adults. Ann Pharmacother. 2010;44(6):957–63.
Nobili A, Licata G, Salerno F, et al. Polypharmacy, length of hospital stay, and in-hospital mortality among elderly patients in internal medicine wards. The REPOSI study. Eur J Clin Pharmacol. 2011;67(5):507–19.
Viktil KK, Blix HS, Moger TA, et al. Polypharmacy as commonly defined is an indicator of limited value in the assessment of drug-related problems. Br J Clin Pharmacol. 2006;63:187–95.
Milton JC, Hill-Smith I, Jackson SHD. Prescribing for older people. BMJ. 2008;336:606–9.
Simonson W, Feinberg JL. Medication-related problems in the elderly. Defining the issues and identifying solutions. Drug Aging. 2005;22:559–69.
Stewart MA. The validity of an interview to assess patients’ drug taking. Am J Prev Med. 1987;3:95–100.
Nazareth I, Burton A, Shulman S, et al. A pharmacy discharge plan for hospitalized elderly patients—a randomized controlled trial. Age Ageing. 2001;30(1):33–40.
Volume CI, Farris KB, Kassam R, et al. Pharmaceutical care research and education project: patient outcomes. J Am Pharm Assoc (Wash). 2001;41(3):411–20.
George J, Vuong T, Bailey MJ, et al. Medication regimen complexity and adherence in patients at risk of medication misadventure. J Pharm Pract Res. 2006;36:99–102.
Cherubini A, Ruggiero C, Gasperini B, et al. The prevention of adverse drug reactions in older subjects. Curr Drug Metab. 2011;12:652–7.
Boyd CM, Darer J, Boult C, et al. Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases: implications for pay for performance. JAMA. 2005;294:716–24.
Giovannetti ER, Wolff JL, Xue QL, et al. Difficulty assisting with health care tasks among caregivers of multimorbid older adults. J Gen Intern Med. 2012;27:37–44.
American Geriatrics Society Expert Panel on the Care of Older Adults with Multimorbidity. Patient-centered care for older adults with multiple chronic conditions: a stepwise approach from the American Geriatrics Society: American Geriatrics Society Expert Panel on the Care of Older Adults with Multimorbidity. J Am Geriatr Soc. 2012;60(10):1957–68.
Weiss M, Britten N. What is concordance? Pharm J. 2003;271:493.
Moen J, Norrgard S, Antonov K, et al. GPs’ perceptions of multiple-medicine use in older patients. J Eval Clin Pract. 2010;16:69–75.
Sanson-Fisher RW, Campbell EM, Redman S, et al. Patient–provider interactions and patient outcomes. Diabetes Educ. 1989;15:134–8.
Roter DL, Hall JA, Merisca R, et al. Effectiveness of interventions to improve patient compliance: a meta-analysis. Med Care. 1998;36:1138–61.
The Anatomical Therapeutic Chemical Classification System with Defined Daily Doses (ATC/DDD). http://www.who.int/classifications/atcddd/en/?”.
This study was supported by grants from the Region Health Ministry of the Lombardy Region.
About this article
Cite this article
Pasina, L., Brucato, A.L., Falcone, C. et al. Medication Non-Adherence Among Elderly Patients Newly Discharged and Receiving Polypharmacy. Drugs Aging 31, 283–289 (2014). https://doi.org/10.1007/s40266-014-0163-7
- Medication Adherence
- Adverse Drug Event
- Pill Count
- Increase Health Care Cost
- Internal Medicine Ward