Jankowska-Polańska Beata, Dudek Krzysztof, Szymanska-Chabowska Anna, Uchmanowicz Izabella
Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University.
Department of Logistic and Transport Systems, Faculty of Mechanical Engineering, Wroclaw University of Technology.
Clin Interv Aging. 2016 Dec 7;11:1781-1790. doi: 10.2147/CIA.S113994. eCollection 2016.
Hypertension affects about 80% of people older than 80 years; however, diagnosis and treatment are difficult because about 55% of them do not adhere to treatment recommendations due to low socioeconomic status, comorbidities, age, physical limitations, and frailty syndrome.
The purposes of this study were to evaluate the influence of frailty on medication adherence among elderly hypertensive patients and to assess whether other factors influence adherence in this group of patients.
The study included 296 patients (mean age 68.8±8.0) divided into frail (n=198) and non-frail (n=98) groups. The Polish versions of the Tilburg Frailty Indicator (TFI) for frailty assessment and 8-item Morisky Medication Adherence Scale for adherence assessment were used. The frail patients had lower medication adherence in comparison to the non-frail subjects (6.60±1.89 vs 7.11±1.42; =0.028). Spearman's rank correlation coefficients showed that significant determinants with negative influence on the level of adherence were physical (rho =-0.117), psychological (rho =-0.183), and social domain (rho =-0.163) of TFI as well as the total score of the questionnaire (rho =-0.183). However, multiple regression analysis revealed that only knowledge about complications of untreated hypertension (=0.395) and satisfaction with the home environment (=0.897) were found to be independent stimulants of adherence level.
Frailty is highly prevalent among elderly hypertensive patients. Higher level of frailty among elderly patients can be considered as a determinant of lower adherence. However, social support and knowledge about complications of untreated hypertension are the most important independent determinants of adherence to pharmacological treatment.
高血压影响约80%的80岁以上人群；然而，诊断和治疗困难，因为其中约55%的人由于社会经济地位低、合并症、年龄、身体限制和衰弱综合征而不遵守治疗建议。
本研究的目的是评估衰弱对老年高血压患者药物依从性的影响，并评估其他因素是否影响该组患者的依从性。
该研究纳入了296例患者（平均年龄68.8±8.0岁），分为衰弱组（n=198）和非衰弱组（n=98）。使用波兰版的蒂尔堡衰弱指标（TFI）进行衰弱评估，以及8项的莫里西药物依从性量表进行依从性评估。与非衰弱受试者相比，衰弱患者的药物依从性较低（6.60±1.89对7.11±1.42；P=0.028）。斯皮尔曼等级相关系数显示，对依从性水平有负面影响的显著决定因素是TFI的身体领域（rho=-0.117）、心理领域（rho=-0.183）和社会领域（rho=-0.163）以及问卷总分（rho=-0.183）。然而，多元回归分析显示，仅发现对未治疗高血压并发症的了解（P=0.395）和对家庭环境的满意度（P=0.897）是依从性水平的独立促进因素。
衰弱在老年高血压患者中非常普遍。老年患者较高的衰弱水平可被视为依从性较低的决定因素。然而，社会支持和对未治疗高血压并发症 的了解是药物治疗依从性最重要的独立决定因素。
