MacLaughlin Eric J, Raehl Cynthia L, Treadway Angela K, Sterling Teresa L, Zoller Dennis P, Bond Chester A
Department of Pharmacy Practice at Texas Tech University Health Sciences Center School of Pharmacy, Amarillo, Texas 79106-1712, USA.
Drugs Aging. 2005;22(3):231-55. doi: 10.2165/00002512-200522030-00005.
Adherence to prescribed medication regimens is difficult for all patients and particularly challenging for the elderly. Medication adherence demands a working relationship between a patient or caregiver and prescriber that values open, honest discussion about medications, i.e. the administration schedule, intended benefits, adverse effects and costs. Although nonadherence to medications may be common among the elderly, fundamental reasons leading to nonadherence vary among patients. Demographic characteristics may help to identify elderly patients who are at risk for nonadherence. Inadequate or marginal health literacy among the elderly is common and warrants assessment. The number of co-morbid conditions and presence of cognitive, vision and/or hearing impairment may predispose the elderly to nonadherence. Similarly, medications themselves may contribute to nonadherence secondary to adverse effects or costs. Especially worrisome is nonadherence to 'less forgiving' drugs that, when missed, may lead to an adverse event (e.g. withdrawal symptoms) or disease exacerbation. Traditional methods for assessing medication adherence are unreliable. Direct questioning at the patient interview may not provide accurate assessments, especially if closed-ended, judgmental questions are posed. Prescription refill records and pill counts often overestimate true adherence rates. However, if elders are asked to describe how they take their medicines (using the Drug Regimen Unassisted Grading Scale or MedTake test tools), adherence problems can be identified in a non-threatening manner. Medication nonadherence should be suspected in elders who experience a decline in functional abilities. Predictors of medication nonadherence include specific disease states, such as cardiovascular diseases and depression. Technological aids to assessing medication adherence are available, but their utility is, thus far, primarily limited to a few research studies. These computerised devices, which assess adherence to oral and inhaled medications, may offer insight into difficult medication management problems. The most practical method of medication adherence assessment for most elderly patients may be through patient or caregiver interview using open-ended, non-threatening and non-judgmental questions.
对所有患者来说，坚持规定的药物治疗方案都很困难，而对老年人而言尤其具有挑战性。药物治疗的依从性要求患者或护理人员与开处方者之间建立一种有效的关系，这种关系重视关于药物的开放、坦诚的讨论，即给药时间表、预期益处、不良反应和费用。尽管老年人中不坚持用药的情况可能很常见，但导致不坚持用药的根本原因在患者中各不相同。人口统计学特征可能有助于识别有不坚持用药风险的老年患者。老年人健康素养不足或有限的情况很常见，值得进行评估。并存疾病的数量以及认知、视力和/或听力障碍的存在可能使老年人更容易出现不坚持用药的情况。同样，药物本身可能因不良反应或费用而导致不坚持用药。特别令人担忧的是不坚持服用“容错性较低”的药物，一旦漏服，可能会导致不良事件（如戒断症状）或疾病恶化。评估药物治疗依从性的传统方法并不可靠。在患者访谈中直接提问可能无法提供准确的评估，尤其是如果提出封闭式、批判性问题的话。处方 refill 记录和药片计数往往会高估实际的依从率。然而，如果要求老年人描述他们如何服药（使用药物治疗方案无辅助分级量表或 MedTake 测试工具），就可以以一种无威胁的方式识别出依从性问题。对于功能能力下降的老年人，应怀疑其存在药物治疗不依从的情况。药物治疗不依从的预测因素包括特定的疾病状态，如心血管疾病和抑郁症。有评估药物治疗依从性的技术辅助手段，但到目前为止，其效用主要限于少数研究。这些评估口服和吸入药物依从性的计算机化设备可能有助于深入了解药物管理方面的难题。对大多数老年患者来说，评估药物治疗依从性最实用的方法可能是通过患者或护理人员访谈，使用开放式、无威胁性和非批判性的问题。
