Medication Adherence in Healthy Elders: Small Cognitive Changes Make a Big Difference Nih Public Access

Objectives—This was a cross-sectional study of the ability of independently living healthy elders to follow a medication regimen. Participants were divided into a group with High Cognitive Function (HCF) or Low Cognitive Function (LCF) based on their scores on the ADAS-Cog. Methods—Thirty-eight participants aged 65 or older and living independently in the community followed a twice-daily vitamin C regimen for five weeks. Adherence was measured using an electronic 7-day pill box. and there was a 4.1 relative risk of non-adherence in the LCF group as compared to the HCF group. Discussion—This study provides strong evidence that even very mild cognitive impairment in healthy elderly living independently in the community has a detrimental and significant impact on adherence to a medication regimen. This study has important implications for the conduct of clinical drug trials in this population. Correct medication use is an important part of healthy aging (Monane, Monane, & Semla, 1997). More than 75% of people aged 65 and older take prescription medication, and on average they take 3 or more medications a day (Helling et al. than 50% of these individuals are non-adherent to their medication regimen (Botelho & Dudrak, 1992; Kendrick & Bayne, 1982), which can have tremendous impact on their health. The financial cost of this medication mismanagement is also significant, since it leads to increased hospitalization and drug side-effects (Col, Fanale, & Kronholm, 1990). The importance of proper medication adherence is underscored by the fact that ability to manage medication is considered an instrumental activity of daily living (IADL), that is, a skill that is essential to maintaining independence in the elderly (Fillenbaum & Smyer, 1981). There are many reasons why the elderly may be non-increased sensitivity to side effects, the high cost of medications, and forgetting or confusion about dosage schedule. There is evidence that memory deficits can lead to a decrease in medication management abilities, reflecting the important role that memory may play in medication adherence. While most studies have looked at the correlation between medication adherence and MMSE scores, which is not a highly sensitive measure of small Insel and colleagues found that a composite of memory and executive function scores was predictive of poor medication adherence in community-dwelling adults (Insel, Morrow, Brewer, & Figueredo, 2006). These findings would suggest that many apparently healthy elders living independently in the community may be at risk for poor medication adherence and its concomitant health risks, …