Medication Nonadherence and Subsequent Risk of Hospitalisation and Mortality among Older Adults

BackgroundDespite a higher risk for medication nonadherence among older adults residing in the community, few prospective studies have investigated the health outcomes associated with nonadherence in this population or the possible variations in risk in urban versus rural residents.ObjectivesThe primary objective of this study was to examine, in a prospective manner, the risk for hospitalisation (including an emergency department visit) and/or mortality associated with medication nonadherence in older, at-risk adults residing in the community. A secondary objective was to examine differences in the prevalence, determinants and consequences of medication nonadherence between rural and urban home care clients.MethodsData were derived from a 1-year prospective study of home care clients aged ≥65 years (n = 319) randomly selected from urban and rural settings in southern Alberta, Canada. Trained nurses conducted in-home assessments including a comprehensive medication review, self-report measures of adherence and the Minimum Data Set for Home Care (MDS-HC) tool. Hospitalisation and mortality data during 12-month follow-up were obtained via linkages with regional administrative and vital statistics databases.ResultsNonadherent clients showed an increased but nonsignificant risk for an adverse health outcome (hospitalisation, emergency department visit or death) during follow-up (hazard ratio [adjusted for relevant covariates] = 1.24, 95% CI 0.93, 1.65). Subgroup analyses suggested this risk may be higher for unintentional nonadherence (unadjusted hazard ratio = 1.55, 95% CI 0.97, 2.48). The prevalence of nonadherence was similar among rural (38.2%) and urban (38.9%) clients and was associated with the presence of vision problems, a history of smoking, depressive symptoms, a high drug regimen complexity score, residence in a private home (vs assisted-living setting) and absence of assistance with medication administration. In both settings, approximately 20% of clients received one or more inappropriate medications.ConclusionsAlthough not associated with rural/urban residence, medication nonadherence was common in our study population, particularly among those with depressive symptoms and complex medication regimens. The absence of a significant association between overall medication nonadherence and health outcomes may reflect study limitations and/or the need to differentiate among types of nonadherent behaviours.

[1]  J. Earle,et al.  Sociodemographic and clinical predictors of participation in two randomized trials: findings from the Collaborative Ocular Melanoma Study COMS report no. 7. , 2001, Controlled clinical trials.

[2]  John P Hirdes,et al.  The MDS‐CHESS Scale: A New Measure to Predict Mortality in Institutionalized Older People , 2003, Journal of the American Geriatrics Society.

[3]  R. Carney,et al.  Major Depression and Medication Adherence in Elderly Patients With Coronary Artery Disease , 1995 .

[4]  M. Beers,et al.  Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts. , 2003, Archives of internal medicine.

[5]  S. Jain,et al.  Drug related medical emergencies in the elderly: role of adverse drug reactions and non-compliance , 2001, Postgraduate medical journal.

[6]  S. Coons,et al.  Predictors of medication noncompliance in a sample of older adults. , 1994, Clinical therapeutics.

[7]  L. Green,et al.  Concurrent and Predictive Validity of a Self-reported Measure of Medication Adherence , 1986, Medical care.

[8]  H. Cohen,et al.  A method for assessing drug therapy appropriateness. , 1992, Journal of clinical epidemiology.

[9]  J. Cargill,et al.  Medication compliance in elderly people: influencing variables and interventions. , 1992, Journal of advanced nursing.

[10]  M. Rich,et al.  Effect of a multidisciplinary intervention on medication compliance in elderly patients with congestive heart failure. , 1996, The American journal of medicine.

[11]  N. Col,et al.  The role of medication noncompliance and adverse drug reactions in hospitalizations of the elderly. , 1990, Archives of internal medicine.

[12]  H. S. Lau,et al.  Validation of pharmacy records in drug exposure assessment. , 1997, Journal of clinical epidemiology.

[13]  H. Llewellyn-Thomas,et al.  Patients' willingness to enter clinical trials: measuring the association with perceived benefit and preference for decision participation. , 1991, Social science & medicine.

[14]  H. Ramachandran,et al.  Movement for medical treatment. A study in contact patterns of a rural population. , 1983, Social science & medicine.

[15]  J. Avorn,et al.  The effects of initial drug choice and comorbidity on antihypertensive therapy compliance: results from a population-based study in the elderly. , 1997, American journal of hypertension.

[16]  D. Bates,et al.  Incidence and preventability of adverse drug events among older persons in the ambulatory setting. , 2003, JAMA.

[17]  P. Montgomery,et al.  Pill Count, Self-Report, and Pharmacy Claims Data to Measure Medication Adherence in the Elderly , 1998, The Annals of pharmacotherapy.

[18]  J. Mckenney,et al.  Drug-related hospital admissions. , 1976, American journal of hospital pharmacy.

[19]  M. Olfson,et al.  Medication costs, adherence, and health outcomes among Medicare beneficiaries. , 2003, Health affairs.

[20]  LTC Kurt Kroenke,et al.  Reducing Polypharmacy in the Elderly , 1990, Journal of the American Geriatrics Society.

[21]  P. Sloane,et al.  Validation of the Minimum Data Set Cognitive Performance Scale: agreement with the Mini-Mental State Examination. , 1995, The journals of gerontology. Series A, Biological sciences and medical sciences.

[22]  E Monsó,et al.  Risk factors for hospitalization for a chronic obstructive pulmonary disease exacerbation. EFRAM study. , 2001, American journal of respiratory and critical care medicine.

[23]  C. Viscoli,et al.  Treatment adherence and risk of death after a myocardial infarction , 1990, The Lancet.

[24]  F Y Aoki,et al.  Drug‐Associated Hospital Admissions in Older Medical Patients , 1988, Journal of the American Geriatrics Society.

[25]  Edmonton Ab,et al.  ASSESSING MEDICATION ADHERENCE AMONG OLDER PERSONS IN COMMUNITY SETTINGS , 2005 .

[26]  D. Malone,et al.  The Relationship between Drug Therapy Noncompliance and Patient Characteristics, Health‐Related Quality of Life, and Health Care Costs , 2000, Pharmacotherapy.

[27]  V. Conn,et al.  Medication regimen complexity and adherence among older adults. , 1991, Image--the journal of nursing scholarship.

[28]  C. Maxwell,et al.  Measurement, Correlates, and Health Outcomes of Medication Adherence Among Seniors , 2004, The Annals of pharmacotherapy.

[29]  Rosenthal Tc,et al.  Access to health care in rural western New York State. , 1992 .

[30]  C. Regan,et al.  A systematic review of the effectiveness of interventions to help older people adhere to medication regimes. , 2004, Age and ageing.

[31]  L. R. Strandberg,et al.  Underutilization of Antihypertensive Drugs and Associated Hospitalization , 1989, Medical care.

[32]  David G. Kleinbaum,et al.  Survival Analysis: A Self-Learning Text , 1997 .

[33]  J. Avorn,et al.  Noncompliance with congestive heart failure therapy in the elderly. , 1994, Archives of internal medicine.

[34]  R. Verbrugge,et al.  Impact of Medication Adherence on Hospitalization Risk and Healthcare Cost , 2005, Medical care.

[35]  J. Cooper,et al.  Drug misuse in older people. , 1981, The Gerontologist.

[36]  B E Fries,et al.  Scaling ADLs within the MDS. , 1999, The journals of gerontology. Series A, Biological sciences and medical sciences.

[37]  R. Aparasu,et al.  Inappropriate prescribing for elderly outpatients. , 1999, American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists.

[38]  D. Kutzik,et al.  Self-reported memory of medication use by the elderly. , 1995, American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists.

[39]  K. Matuszewski,et al.  Noncompliance with drug therapy for chronic obstructive pulmonary disease: a risk factor for hospitalization? , 1999, Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research.

[40]  M. Abrahamowicz,et al.  Questionable prescribing for elderly patients in Quebec. , 1994, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[41]  W. Carter,et al.  Screening for noncompliance among patients with hypertension: is self-report the best available measure? , 1981, Medical care.

[42]  Ross Koppel,et al.  Medication Safety in Older Adults: Home‐Based Practice Patterns , 2005, Journal of the American Geriatrics Society.

[43]  N. Ikegami,et al.  Comprehensive Clinical Assessment in Community Setting: Applicability of the MDS‐HC , 1997, Journal of the American Geriatrics Society.

[44]  J N Morris,et al.  Development of a minimum data set-based depression rating scale for use in nursing homes. , 2000, Age and ageing.

[45]  P. Hawe,et al.  Can medication education improve the drug compliance of the elderly? Evaluation of an in hospital program. , 1990, Patient education and counseling.

[46]  H. Perry,et al.  Polypharmacy and hospitalization among older home care patients. , 2000, The journals of gerontology. Series A, Biological sciences and medical sciences.

[47]  G. Guyatt,et al.  Health-Related Quality of Life and Participation in Osteoporosis Clinical Trials , 1998, Calcified Tissue International.

[48]  Krista F Huybrechts,et al.  Assessment of compliance with osteoporosis treatment and its consequences in a managed care population. , 2006, Bone.