Previous studies of medication adherence have contributed important findings about the health behaviors of older adults. We know that medication adherence is more likely if the medication regimen fits with individual beliefs about illness and health goals, and that specific beliefs about specific medicines appear to be better predictors of adherence than general views about medication use. Because older adults are more likely to be on multiple medications and to experience more rapid changes in health status than the general population, older adults are theoretically more predisposed to changing attitudes about the medications they are prescribed. Unfortunately, almost all studies of medication adherence by older adults have been cross-sectional (which means that data consist of observations made at one point in time) in design, which has made it impossible to examine the influence of changes in attitude.
An article in the Journal of Psychosomatic Research discusses perhaps the first large study of older adult medication adherence to employ a longitudinal design, which enabled the researchers to examine the influence of changes in belief. Recruiting older adults with multiple health conditions from the large-scale German Ageing Survey, the authors measured medication adherence and attitudes across different time points. Interestingly, a higher number of illnesses predicted a higher degree of noncompliance, but a greater number of medications predicted a higher degree of compliance. Further, the findings support the theory that intentional and unintentional noncompliance have different causes and correlates. At the same time, changes in individual perceptions about medication use predicted changes in unintentional, as well as intentional, noncompliance.
The article reports many other findings about the relationships between different types of beliefs on medication adherence that may be useful for clinicians, patients, and policymakers. The authors raise an important point: medication nonadherence, in specific cases, “might be an adaptive choice of behavior, since polypharmacy in older multimorbid individuals in itself might pose a health risk, due to potentially dangerous interactions resulting from multiple medications.” It is not only patients who benefit from education and strong doctor-patient communication. As these findings suggest, patient-doctor miscommunication and “health care fragmentation” (the fact that individuals with multiple health conditions typically interact with multiple health care professionals in multiple settings) complicates health education as well as individual adherence.
Schüz B, Marx C, Wurm S, Warner L, Ziegelmann J, Schwarzer R, Tesch-Römer C (2011). “Medication beliefs predict medication adherence in older adults with multiple illnesses.” Journal of Psychosomatic Research 70: 179-187
German Ageing Survey (in English): http://www.dza.de/en/research/deas.html