Intelligent noncompliance with special emphasis on the elderly.

Intelligently noncompliant patients alter their prescribed therapy on a rational basis that often represents advanced therapeutic principles. The literature contains many examples of patients who alter their medication but still have good treatment outcome. Doses are altered to avoid adverse effects or because the dose was excessive or inconvenient. When compliance studies are done in a large heterogeneous group, the rates for different age groups are almost always similar. Health professionals have devised compliance-ensuring strategies such as educational programs and modification of the regimen. Use of compliance-ensuring strategies, however, opposes the current trend which advocates a more direct, active patient participation in treatment decisions.