Department of Psychiatry, Weill Cornell Medical College, White Plains, NY 10605, USA.
Clin Ther. 2013 Feb;35(2):153-60. doi: 10.1016/j.clinthera.2013.01.001. Epub 2013 Jan 26.
Nonadherence to medications among older adults can compromise quality care. Among older adults with chronic diseases, nonadherence rates can reach 50%. Individual-level obstacles to full adherence may come from psychological, illness (and disability due to aging or other impairments), and tangible barriers. In this study, we examine the barriers associated with nonadherence among community-dwelling older persons participating in Aging Service Network nutrition programs.
The goal of this study was to examine the relation of psychological, illness, and tangible barriers to reported medication adherence among older adults in a community, nonmedical setting.
Older adults (N = 299) receiving congregate meals participated in a study of factors associated with medication-taking behaviors and adherence. Self-reported medication nonadherence was measured by using the Morisky Medication Adherence Scale. Psychological barriers were assessed by using a risk/benefit score (perceived concerns vs necessity of medications). Illness barriers reviewed included overall cognitive functioning, disability, medical burden, and depression. Tangible barriers included number of medications, difficulty handling medication, and perceived cost.
Most participants took multiple medications (mean, 4.8) each day, and 4 of 10 older adults (41% [122 of 299]) reported at least 1 nonadherent behavior. The psychological barrier of a low risk/benefit score (odds ratio = 0.73 [95% CI, 0.6-0.94]) and the tangible barrier of difficulty opening the medication bottle (odds ratio = 2.16 [95% CI, 1.3-3.6]) were independently associated with nonadherence.
In a community-dwelling sample of older adults, nonadherence to medication was associated with both tangible and psychological barriers. Beliefs about medication can be powerful barriers to a successful adherence strategy. Adherence interventions should address the multilevel barriers (psychological, illness, and tangible) to adherence among older adults.
老年人不遵医嘱会影响医疗质量。在患有慢性病的老年人中，不遵医嘱的比例可能高达 50%。个人层面上完全遵医嘱的障碍可能来自心理、疾病（以及因衰老或其他损伤导致的残疾）和实际障碍。在这项研究中，我们研究了参与老年服务网络营养计划的社区居住老年人不遵医嘱的相关障碍。
本研究旨在研究在社区非医疗环境中，与老年人报告的药物依从性相关的心理、疾病和实际障碍。
接受集中供餐的老年人（N=299）参与了一项与药物服用行为和依从性相关因素的研究。通过 Morisky 药物依从量表来衡量自我报告的药物不依从性。通过风险/获益评分（感知顾虑与药物必要性）评估心理障碍。评估的疾病障碍包括整体认知功能、残疾、医疗负担和抑郁。实际障碍包括服用药物的种类、服药困难和感知费用。
大多数参与者每天服用多种药物（平均 4.8 种），每 10 名老年人中就有 4 人（41%[299 名中的 122 人]）报告至少有一种不依从行为。低风险/获益评分的心理障碍（比值比=0.73[95%CI，0.6-0.94]）和难以打开药瓶的实际障碍（比值比=2.16[95%CI，1.3-3.6]）与不依从相关。
在社区居住的老年人样本中，药物不依从与实际和心理障碍都有关。对药物的信念可能是成功的依从策略的一个强大障碍。针对老年人的依从性干预措施应解决多层次的依从性障碍（心理、疾病和实际障碍）。
