Medication Adherence in Elders - Research Proposal Example

? Contents Specific Aim 3 Literature Review 4 References 8 Medication Adherence in Elders Research Proposal Specific Aim Advanced health care facilities and improved amenities have led to remarkable rise in life expectancy, the gain being as high as 30 years in western European countries, USA, Canada, Australia, New Zealand; and even higher in Japan, Spain and Italy. Children born in 21st century are expected to live up to 100 years so that old age is now being demarcated in to young old and oldest old.. A rise in the proportion of ageing population (>65 years) also means increased susceptibility to diseases, better health care facilities, and higher economic burden to ensure that longer life also means better life (Christensen et al., 2009). Medical adherence has been defined by Osterberg & Blaschke, (2005) as “the extent to which patients take medications as prescribed by their health care providers”. It has been reported as a crucial factor determining the health and well being of elderly population by the World Health Organization (Chung et al., 2008). The issue has been reported to have high prevalence varying from 8-71%, 13-93% during various studies. It has been estimated to result in huge economic burden as well as high mortality (Unni, 2008). Recent evidences indicate that only 50% of the prescribed doses are actually taken by individuals diagnosed with chronic diseases. Of these patients approximately 22% take medication in quantities lesser than the amount recommended, 12% do not fill their prescription and 12% buy the medication but forego them entirely. Though race, ethnicity and age have not been reported to be a risk factor for medication non-adherence, the issue is rendered critical among elderly patients due to the high vulnerability of this age group to chronic illnesses (Kocureck, 2009). In the light of above discussion the importance of research investigating the various aspects of the medication adherence in elderly population is highlighted. The current research aims to examine the prevalence rates of medication adherence in elderly population. Literature Review High prevalence and large economic burden of medical non adherence has led to extensive studies and investigations enabling an understanding of the issue and devising adherence strategies. However despite the prolific research conducted during the last three decades an optimal strategy is lacking and hence the prevalence rates for non adherence are still on a rise. An estimated 100 billion dollar remains the annual cost of dealing with complications such as hospitalization, disability, disease aggravation mortality etc resulting as a consequence of non adherence (Wertheimer & Santella, 2003). On the basis of causes of non-adherence two types of medication non-adherence have been identified: intentional and unintentional. While the latter has been attributed to forgetfulness or incidental causes; the former is usually reported in patients who have been taking medications but discontinue upon feeling better or worse. However later research has shown that patient’s belief is an important contributor to forgetfulness in taking medication rendering ‘forgetting to take medication’ not a purely unintentional type of non-adherence (Unni, 2008). The major obstacles to medication resulting in non-adherence include forgetfulness, different priorities, deliberate omission of doses, information deficit and certain psychological factors. While the aforementioned factors are at least partially under the control of patients, certain factors such as cost, patient lifestyle inconsistent with medication timing and complex medication regime are important contributing factors attributed to the health care provider (Osterberg & Blaschke, 2005). Six patterns of medication adherence have been identified in patients with chronic diseases. First group adheres to the prescribed doses and timings fully, second is characterized by delays but with complete doses, third miss a single doses occasionally and also are inconsistent with respect to time. The fourth and fifth groups are characterized by monthly or more frequent drug holidays and complete omission of doses respectively. Each of these groups comprise approximately one-sixth of the population (Osterberg & Blaschke, 2005). Several predictors of medical adherence have been identified including patient dependent factors such as age and educational factors; economic status and medical expenses, lack of information or prejudices as well as the nature of disease. Psychological disorders such as depression and anxiety have lower probability of medication adherence compared to physical disorders. Psychological factors such as trust in the health care provider, belief in the medication, life style preferences, and personal or family experiences too are important determinants of medication adherence. Interestingly higher prevalence rates for non-adherence have been reported for medical professionals compared to general population (Unni, 2008). The major predictor for lack of adherence is medication schedule. A medication regime involving single dosage in a day has higher probability of being complied compared to the one with three or more doses during a day. It is very important for health care providers to consider these predictors while dealing with patients (Osterberg & Blaschke, 2005). Medical adherence rates are calculated as the proportion of prescribed doses that are used by the patient during a particular span of time. A more specific calculation involves the collection of data on dose taken along with the timing of dose administration (Osterberg & Blaschke, 2005). Several methods have been devised and improvised for the direct and indirect quantification of medication adherence. These include biological methods such as body fluid assay to measure drug concentration. The biological method have the advantage of accuracy bur are intrusive and expensive. Indirect methods such as interviews, electronic monitoring, pharmacy records etc on the other hand do facilitate quantification but do not provide an insight in to causes of non adherence. This problem can be overcome through indirect methods involving self reports (Unni, 2008). Morisky et al. (1986) have provided a structured four item measurement for quantifying adherence based on self report method of measurement. With high validity and an alpha reliability of 0.61, the test items facilitate health care provider to monitor and enhance adherence. The adverse impact of non-adherence on health and economy are enormous. Kocureck (2009) report that 33-69% of patients admitted in to hospitals due to medication related issues have problems arising as a consequence of non-adherence. This population forms 23% of nursing home admitted patients. Repeated visits to health care centres, failure of treatment regimes, and avoidable medication changes are also major negative outcomes of non-adherence. These factors leading to additional medical expenditures as a consequence of important specialized and expensive services and material can be avoided by adhering to medication regime. A colossal 100 billion dollar has been estimated to be the cost of handling complications resulting as a consequence of medication non-adherence. Strategies to improve medication adherence follow the principle of behaviour modification along with reinforcements. These interventions include a fourfold strategy. Patient education, along with convenient dosage as well as timing can help overcome patient non-compliance. Longer clinic hours reducing time in waiting rooms along with better patient doctor communication can help remove doubts and enhance belief of the patients. Encouraging and even insisting on frequent follow ups, and efficient scheduling of these visits can further ensure compliance. (Osterberg & Blaschke, 2005). It is important to state here that the interventions strategies devised and used till date have not been found to be effective A better understanding of the causes of poor adherence in individual patients followed by patient dependent strategies is required to be successful in improving adherence (Unni, 2008). Improper medication adherence has been a major global burden involving grave consequences. The problem acquires more significance in elderly patients due to chronic illnesses and high vulnerability to diseases during this age. A rise in life expectancy during the last few decades has led to a rise in proportion of elderly population which is expected to rise further during the coming decades. Hence it is of grave importance that a sound understanding of the various aspects of medical adherence and its lack be developed. Also specific identification and intervention strategies using modern technology and gadgets need to be devised for enhancing adherence. References 1. Christensen, K., Doblhammer, G., Rau, R., & Vaupel, J. (2009). Ageing population: the challanges ahead. Lancet , 1196-1208. 2. Chung, W., Kimel, J. C., & Needham, B. (2008). Understanding how prescription medication compliance is affected by out of home activities. Technology of aging , 27-34. 3. Kocureck, B. (2009). Promoting medical adherrence in older adults.....and the rest of us. Diabetes spectrum , 80-4. 4. Morisky, D. E., Green, L. W., & Levine, D. M. (1986). Concurrent and Predictive Validity of a Self-Reported Measure of Medication Adherence. Medical care , 67-74. 5. Osteberg, L., & Blaschke, T. (2005). Adherence to medication. The new England journal of medicine , 487-97. 6. Unni, E. J. (2008). Development of models to predict medication non-adherrence based on a new typology. Dissertation . University of Iowas. 7. Wertheimer, A. I., & Santella, T. M. (2003). Medication Compliance Research: Still So Far to Go . Journal of Applied Research in Clinical and Experimental Therapeutics , 254-61. Read More