Adherence to Pharmacotherapy in the Elderly
Adherence is defined as accordance between prescribed therapy and patient behavior (Haynes 1979). This term covers not only pharmacotherapy but also other health-related advice from professional health workers. Despite the prominent significance of adhere
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General Aspects of Adherence Adherence is defined as accordance between prescribed therapy and patient behavior (Haynes 1979). This term covers not only pharmacotherapy but also other health-related advice from professional health workers. Despite the prominent significance of adherence for treatment, prevention, and rehabilitation success, rather little scientific work is done on this topic. This may be due in part to methodological problems such as how exactly to measure adherence. Second, although different categories of nonadherence are defined, their delineation seems to be rather arbitrary (e.g., intended vs. unintended nonadherence). Therefore, prevalence data of nonadherence are difficult to obtain even in well-controlled scientific studies (e.g., randomized controlled trials [RCTs]) (Kruse 1995; Spilker 1991). This explains why conflicting data concerning nonadherence exist in the literature, with prevalence rates for nonadherence ranging from 15% to 93%. For example, nonadherence to prescribed medications may be reported to be as high as 50% in arterial hypertension; in general, it will be higher in asymptomatic (such as arterial hypertension) than symptomatic diseases. Despite these large ranges concerning
H. Burkhardt (*) IVth Department of Medicine, Geriatrics, University Medical Centre Mannheim, Theodor-Kutzer-Ufer 1-3, Mannheim 68167, Germany e-mail: [email protected]
prevalence data, there is evidence for a consistently increasing rate of nonadherence with increasing number of drugs prescribed (Spagnoli et al. 1989). Simultaneous prescription of five and more drugs is considered critical in this context (McElnay and McCallion 1998). Nonadherence increases with an increasing number of simultaneously prescribed drugs. As multimorbidity and polypharmacy are more frequent in the elderly, this population is commonly thought to show an increased rate of nonadherence compared to younger adults. However, this could not be confirmed in most studies done on this topic (Fincham 1988; Balkrishnan 1998). Hughes (2004) provided an overview of studies concerning adherence especially in the elderly. In one of those studies, Mallion et al. (1998) showed that neither age nor gender proved as strong predictors of nonadherence in antihypertensive treatment. Nonadherence is influenced by several factors that represent not only aspects of the therapeutic schedule (e.g., complexity) but also – Patient-related aspects (e.g., personality) – Patient-physician interaction (e.g., shared decision making) – Sociocultural aspects (e.g., education, access to health system) – The patient’s health belief. A systematic overview of these factors was given in the review by Hughes (2004). Their influence may differ for different age classes and change with time in the same individual. The negative impact of some factors on adherence
M. Wehling (ed.), Drug Therapy for the Elderly, DOI 10.1007/978-3-7091-0912-0_25, # Springer-Verlag Wien 2013
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Table 1 Overview of significant factors influencing adherenc
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