BACKGROUND: Compared with the resources expended developing, evaluating
and making clinical decisions about prescribing medication, we know little about
what determines whether people take it. Older adults are prescribed more
medication than any other group. Poor adherence is a common reason for nonresponse
to medication.
OBJECTIVES: To investigate cross-nationally the impact of demographic,
psychiatric (including cognitive), physical health, behavioural and medication factors
on adherence to medication in older adults.
METHODS: Researchers interviewed 3881 people over 65 who receive home
care services using a structured interview at participants’ places of residence in
eleven countries. The main outcome measure was the percentage participants not
adherent to medication.
RESULTS: 12.5% (n= 456) of people reported they were not fully adherent to
medication. Non-adherence was predicted by problem drinking (OR=3.6), not having
a doctor review medication (OR=3.3), dementia (OR=1.4 for every one point
increase in impairment), good physical health (OR=1.2), resisting care (OR=2.1)
being married (OR=2.3) and living in the Czech Republic (OR=4.7) or Germany
(OR=1.4).
CONCLUSION: People, who screen positive for problem drinking and with
dementia, often undiagnosed are less likely to adhere to medication. Therefore
doctors should consider dementia and problem drinking when prescribing for older
adults. Interventions to improve adherence in older adults might be more effective if
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targeted at these groups. It is possible that medication review enhances adherence,
by improving the patient-doctor relationship, or by emphasising the relevance of
medications