Ownby R L, Hertzog C, Crocco E, Duara R
Department of Psychology, Georgia Institute of Technology, Atlanta, USA.
Aging Ment Health. 2006 Jul;10(4):378-85. doi: 10.1080/13607860500410011.
Medication adherence is a substantial problem in the elderly. It may be even more important among elderly persons with memory problems, since other factors that lead to non-adherence may be compounded with the memory problems themselves. The objective was to determine whether a model that integrates research on medication adherence from several research domains is useful in understanding adherence in elderly patients. The methodology involved a cross-sectional observational study using a convenience sample of 63 patients drawn from a university-affiliated outpatient memory disorders clinic. The primary measure of medication adherence was caregivers' reports of patients' medication adherence. Patients and their caregivers were asked questions assessing their beliefs about the seriousness of each condition for which a medication was prescribed and the likely outcome of that condition without treatment. Additional data collected included presence of side effects, total number of medications taken, and patients' mood and cognitive status. Multilevel path analysis confirmed several model-based predictions. Caregivers' reports of adherence were predicted by estimates of disease outcome, the presence of side effects, and patients' relying on themselves to remember to take medications. Results partially confirm the integrative model in understanding medication adherence in these patients. Patients' beliefs about the likely effect of medication treatment for their condition and the presence of side effects influence reported medication adherence. Results thus suggest that efforts to educate patients about the likely response of their medical condition to treatment and to assess and deal with medication side effects might improve patient adherence.
药物依从性在老年人中是一个严重的问题。在有记忆问题的老年人中，这一问题可能更为重要，因为导致不依从的其他因素可能与记忆问题本身相互叠加。目的是确定一个整合了多个研究领域药物依从性研究的模型是否有助于理解老年患者的依从性。该方法涉及一项横断面观察性研究，使用从一家大学附属医院门诊记忆障碍诊所抽取的63名患者的便利样本。药物依从性的主要衡量指标是护理人员对患者药物依从性的报告。向患者及其护理人员询问问题，评估他们对每种所开药物治疗疾病的严重性以及未经治疗该疾病可能后果的看法。收集的其他数据包括副作用的存在情况、所服用药物的总数以及患者的情绪和认知状态。多层次路径分析证实了几个基于模型的预测。护理人员对依从性的报告可通过疾病结果估计、副作用的存在情况以及患者依靠自身记忆服药的情况来预测。结果部分证实了该整合模型在理解这些患者药物依从性方面的作用。患者对药物治疗其病情可能效果的看法以及副作用的存在会影响报告的药物依从性。因此，结果表明，努力让患者了解其病情对治疗的可能反应，并评估和处理药物副作用，可能会提高患者的依从性。
