Primary Care Research Unit, Sunnybrook Health Sciences Centre, Toronto, Canada.
Int J Geriatr Psychiatry. 2012 Dec;27(12):1275-82. doi: 10.1002/gps.3778. Epub 2012 Feb 15.
The aim of this study was to prospectively examine the influence of cognitive, medical, behavioral, and social risk factors on medication nonadherence in community-dwelling older adults with cognitive impairment.
A sample of 339 elderly participants with cognitive impairment, who lived alone and took at least one medication, underwent baseline assessment which included the five subscales of the Dementia Rating Scale (DRS), number of medications, retrospective medication nonadherence, amount of formal and informal assistance, functional impairment, depression, perception of social resources, comorbidity, and alcohol consumption. The outcome was medication nonadherence during the 12-month prospective period as reported by the participants' primary care physicians and caregivers at three-month intervals.
Fifty-nine participants (17.4%) had, at least, one report of medication nonadherence. Logistic regression analyses indicated for every point increase on the DRS Conceptualization subscale (OR = 1.14; 95% CI = 1.02-1.27), there was a 14% increase in the odds of nonadherence. For every point increase on the DRS Memory subscale (OR = 0.89; 95% CI = 0.81-0.97) and DRS Initiation/Perseveration subscale (OR = 0.93; 95% CI = 0.87-1.00), there was an 11% decrease and 7% decrease in the odds, respectively. Having at least one previous occurrence of medication nonadherence (OR = 2.61; 95% CI = 1.18-5.62) and taking at least four medications (OR = 2.58; 95% CI = 1.31-5.29), both increased the odds by over 2.5-fold.
Our unique finding that better conceptualization predicted nonadherence has important implications for healthcare providers' approaches to improve adherence in older adults with cognitive impairment. Replication in future studies is warranted.
本研究旨在前瞻性研究认知、医学、行为和社会风险因素对认知障碍的社区居住老年人药物治疗不依从的影响。
339 名认知障碍的老年参与者作为样本，他们独居并服用至少一种药物，接受了基线评估，其中包括痴呆评定量表（DRS）的五个分量表、药物数量、回顾性药物不依从、正式和非正式帮助的数量、功能障碍、抑郁、对社会资源的感知、合并症和酒精摄入。结果是参与者的初级保健医生和护理人员每三个月报告一次的 12 个月前瞻性期间的药物不依从情况。
59 名参与者（17.4%）至少有一次药物不依从的报告。逻辑回归分析表明，DRS 概念化分量表每增加一分（OR=1.14；95%CI=1.02-1.27），不依从的可能性增加 14%。DRS 记忆分量表（OR=0.89；95%CI=0.81-0.97）和 DRS 启动/坚持分量表（OR=0.93；95%CI=0.87-1.00）每增加一分，不依从的可能性分别降低 11%和 7%。至少有一次药物不依从的既往发作（OR=2.61；95%CI=1.18-5.62）和服用至少四种药物（OR=2.58；95%CI=1.31-5.29）都使可能性增加了两倍以上。
我们的一项独特发现是，更好的概念化预测了不依从，这对医疗保健提供者改善认知障碍老年人依从性的方法具有重要意义。未来的研究需要进一步验证。
