1
|
Wang A, Wan J, Zhu L, Chang W, Wen L, Tao X, Jin Y. Frailty and medication adherence among older adult patients with hypertension: a moderated mediation model. Front Public Health 2023; 11:1283416. [PMID: 38115848 PMCID: PMC10728772 DOI: 10.3389/fpubh.2023.1283416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 11/20/2023] [Indexed: 12/21/2023] Open
Abstract
Objective Medication adherence has a critical impact on the well-being of older adult patients with hypertension. As such, the current study aimed to investigate the mediating role of health literacy between frailty and medication adherence and the moderating role of educational level. Methods This cross-sectional study included patients admitted to the geriatric unit of a hospital. Participants were interviewed using the four-item Morisky Medication Adherence Scale, the Frailty Phenotype Scale, and the Health Literacy Management Scale. Spearman's correlation coefficients were used to assess the association between variables. Mediation and moderated mediation analyses were performed using Process version 4.1 via Model 4 and 14, respectively. Results Data from 388 participants were analyzed. The median (IQR [P25-P75]) score for medication adherence was 4.00 (2.00-4.00). Results revealed that after controlling for age, sex, hypertension complication(s) and body mass index, frailty significantly contributed to medication adherence (βtotal -0.236 [95% confidence interval (CI) -0.333 to -0.140]). Medication adherence was influenced by frailty (βdirect -0.192 [95% CI -0.284 to -0.099]) both directly and indirectly through health literacy (βindirect -0.044 [95% CI -0.077 to -0.014]). Educational level moderated the pathway mediated by health literacy; more specifically, the conditional indirect effect between frailty and medication adherence was significant among older adult hypertensive patients with low, intermediate, and high educational levels (effect -0.052 [95% CI -0.092 to -0.106]; effect -0.041 [95% CI -0.071 to -0.012]; effect -0.026 [95% CI -0.051 to -0.006]). The relationship between frailty and medication adherence in older adult patients with hypertension was found to have mediating and moderating effects. Conclusion A moderated mediation model was proposed to investigate the effect of frailty on medication adherence. It was effective in strengthening medication adherence by improving health literacy and reducing frailty. More attention needs to be devoted to older adult patients with hypertension and low educational levels.
Collapse
Affiliation(s)
- Anshi Wang
- School of Public Health, Wannan Medical College, Wuhu, China
- Institutes of Brain Science, Wannan Medical College, Wuhu, China
| | - Jingjing Wan
- Department of Nursing, Anhui College of Traditional Chinese Medicine, Wuhu, China
| | - Lijun Zhu
- School of Public Health, Wannan Medical College, Wuhu, China
| | - Weiwei Chang
- School of Public Health, Wannan Medical College, Wuhu, China
| | - Liying Wen
- School of Public Health, Wannan Medical College, Wuhu, China
| | - Xiubin Tao
- Nursing Department, Yijishan Hospital of Wannan Medical College, Wuhu, China
| | - Yuelong Jin
- School of Public Health, Wannan Medical College, Wuhu, China
| |
Collapse
|
2
|
Association between health literacy and medication adherence in chronic diseases: a recent systematic review. Int J Clin Pharm 2023; 45:38-51. [PMID: 36369411 DOI: 10.1007/s11096-022-01470-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 08/04/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND Poor medication adherence is a serious barrier to successful chronic disease management. Previous reviews reported that low health literacy could be associated with medication non-adherence but conclusions were uncertain. AIM The aim of this systematic review was to clarify the relationship between health literacy and medication adherence in adults with chronic diseases. A secondary objective was to identify the factors that influence medication adherence. METHOD Publications analyzing the relationship between health literacy and adherence in adults with chronic diseases were identified through 6 databases between 2015 and 2020. A quality assessment was conducted in order to improve the interpretation of the relationship between health literacy and medication adherence. A narrative synthesis was then performed to describe the relationship between health literacy and medication adherence. The factors influencing medication adherence were then analyzed as a secondary outcome. RESULTS Among the 27 studies, 17 and 10 were considered to be of good and medium methodological quality, respectively. Concerning the relationship between health literacy and adherence, 14 reported a positive relationship, 1 study suggested a negative relationship, 3 found mixed results, and 9 reported not finding a relationship. Patient-related factors such as medication beliefs, self-efficacy, or medication knowledge, as well as demographic factors such as ethnic minority and incomes influence medication adherence. CONCLUSION The present review confirms an unclear relationship between health literacy and medication adherence. Although health literacy plays a substantial role in medication adherence, other factors must be taken into account when addressing non-adherence.
Collapse
|
3
|
Olesen K, Willaing I, Maindal HT, Andersen GS. Does health literacy predict cardiometabolic marker trajectories among people with diabetes? A longitudinal mixed-effect analysis. J Diabetes Complications 2023; 37:108358. [PMID: 36462458 DOI: 10.1016/j.jdiacomp.2022.108358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 10/17/2022] [Accepted: 11/05/2022] [Indexed: 11/13/2022]
Abstract
AIMS To assess trajectories in cardiometabolic markers among people with type 1 and type 2 diabetes with varying health literacy levels. METHODS Survey data assessing self-reported health literacy among 1401 people with type 1 diabetes and 910 people with type 2 diabetes were linked to prospective clinical data. Mixed effects modelling was used to identify the impact of three health literacy domains on trajectories of systolic blood pressure (SBP), low-density lipoprotein cholesterol (LDL-C), and glycated hemoglobin (HbA1c). RESULTS High health literacy scores in some domains were associated with attenuated HbA1c trajectories, while associations with LDL-C and SBP were weak or absent, particularly among participants with type 2 diabetes. The domain "Ability to Actively Manage Health" had the strongest association with HbA1c (P < 0.001). Exponential changes over time were not observed. Differences in the estimated progression of cardiometabolic markers by health literacy levels did not reach statistical significance. CONCLUSION Low health literacy was associated with suboptimal glycaemic levels in type 1 and type 2 diabetes. There was inconclusive evidence of associations between health literacy, BP, and LDL-C. Development in cardiometabolic markers did not indicate faster diabetes progression among people with low health literacy.
Collapse
Affiliation(s)
- Kasper Olesen
- Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, 2730 Herlev, Denmark.
| | - Ingrid Willaing
- Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, 2730 Herlev, Denmark
| | - Helle Terkildsen Maindal
- Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, 2730 Herlev, Denmark; Department of Public Health, Section for Health Promotion and Health Services, Aarhus University, Bartholins Alle 2, DK 8000 Aarhus C, Denmark
| | | |
Collapse
|
4
|
Skerry L, Kervin E, Freeze TA, Brillant A, Woodland J, Hanson N. "It's a lonely battle": A qualitative study of older adult Canadians' experiences with chronic obstructive pulmonary disease medication adherence and support. Can Pharm J (Ott) 2022; 156:32-41. [PMID: 36686315 PMCID: PMC9849920 DOI: 10.1177/17151635221140412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background Medication adherence is critical for optimal management of chronic obstructive pulmonary disease (COPD) and is influenced by patient, treatment and societal factors. Currently, little is known about the patient perspectives of older adult Canadians with COPD regarding medication adherence. Therefore, the purpose of this study was to explore the lived experiences of older Canadian adults with COPD regarding medication adherence and management. Methods Semi-structured interviews were conducted with 20 community-dwelling older adults with COPD, and iterative thematic analysis was performed. Results Six themes emerged from these data: (1) continuity of care, (2) importance of pharmacy for information and care, (3) medication self-management, (4) "there needs to be more information," (5) drug costs a concern and (6) "it's a lonely battle." Conclusion Findings suggested a need for improved continuity of care, disease-related information provision and means of addressing psychosocial needs. Holistic approaches to patient education and self-management, with consideration for varying health literacy, are needed.
Collapse
Affiliation(s)
- Leanne Skerry
- Horizon Health Network, Research Services,
Saint Joseph’s Hospital, Saint John, New Brunswick
| | - Emily Kervin
- Horizon Health Network, Research Services,
Saint Joseph’s Hospital, Saint John, New Brunswick
| | - Tracy A. Freeze
- Horizon Health Network, Research Services,
Saint Joseph’s Hospital, Saint John, New Brunswick
| | - Andrew Brillant
- Pharmacy Services, Saint Joseph’s Hospital,
Saint John, New Brunswick
| | - Jennifer Woodland
- Horizon Health Network, Research Services,
Saint Joseph’s Hospital, Saint John, New Brunswick
| | | |
Collapse
|
5
|
Khatiwada B, Rajbhandari B, Mistry SK, Parsekar S, Yadav UN. Prevalence of and factors associated with health literacy among people with Noncommunicable diseases (NCDs) in South Asian countries: A systematic review. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2022. [DOI: 10.1016/j.cegh.2022.101174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
|
6
|
Vandraas KF, Reinertsen KV, Kiserud CE, Bøhn SK, Lie HC. Health literacy among long-term survivors of breast cancer; exploring associated factors in a nationwide sample. Support Care Cancer 2022; 30:7587-7596. [PMID: 35674792 PMCID: PMC9385742 DOI: 10.1007/s00520-022-07183-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 04/21/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND Poor health literacy may hamper health management and long-term outcomes in breast cancer survivorship. Knowledge of factors associated with poor health literacy is needed to identify survivors in need of additional support and to improve the quality of health care, but is currently scant. Here, we explore health literacy and associated factors in a nationwide sample of long-term survivors of breast cancer. MATERIAL AND METHODS All survivors aged 20-65 years when diagnosed with stage I-III breast cancer in 2011 or 2012 were identified through the Norwegian Cancer Registry, and invited to participate in the Survivorship, Work and Sexual Health (SWEET) study. Health literacy was measured using The European Health Literacy Survey Questionnaire-12 (HLS-EU-Q12) and analyzed as a continuous and categorical variable. Associations between health literacy and socioeconomic, physical, and mental health variables, including the most common late effects after cancer treatment, were explored in uni- and multivariable linear regression models. RESULTS The final sample consisted of 1355 survivors (48%) with a mean age of 60 years at survey (SD 8.7). Eight years had passed since diagnosis (SD.0.7), and the majority of survivors had high socioeconomic status. Advanced judgment calls concerning treatment and health risks were reported to be the most difficult for survivors to handle. Mean health literacy sum score was 36.2 (range 12-48, SD 5.4). Thirty-nine percent had intermediate, while 19.3% reported marginal or inadequate health literacy. Education, income, age at diagnosis, the personality trait neuroticism, and fear of cancer recurrence were significantly associated with health literacy in the multivariate model, explaining 12% of the variance in health literacy scores. CONCLUSION Low levels of health literacy were prevalent in this population-based sample of long-term survivors of breast cancer, despite high socioeconomic status. Communicating and interpreting risks seem to be especially challenging. Attention to health literacy at a societal and individual level is necessary in order to provide survivorship care of high quality.
Collapse
Affiliation(s)
- Kathrine F Vandraas
- National Advisory Unit for Late Effects After Cancer Treatment, Department of Oncology, Oslo University Hospital, Radium Hospital, Oslo, Norway.
| | - Kristin V Reinertsen
- National Advisory Unit for Late Effects After Cancer Treatment, Department of Oncology, Oslo University Hospital, Radium Hospital, Oslo, Norway
| | - Cecilie E Kiserud
- National Advisory Unit for Late Effects After Cancer Treatment, Department of Oncology, Oslo University Hospital, Radium Hospital, Oslo, Norway
| | - Synne K Bøhn
- National Advisory Unit for Late Effects After Cancer Treatment, Department of Oncology, Oslo University Hospital, Radium Hospital, Oslo, Norway
| | - Hanne C Lie
- National Advisory Unit for Late Effects After Cancer Treatment, Department of Oncology, Oslo University Hospital, Radium Hospital, Oslo, Norway
- Department of Behavioral Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
| |
Collapse
|
7
|
Trela KC, Zajac P, Zhu M, Press VG. Health literacy and type of education intervention predicting post-education metered-dose inhaler misuse. Respir Med 2022; 200:106930. [PMID: 35870435 DOI: 10.1016/j.rmed.2022.106930] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/23/2022] [Accepted: 07/05/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Asthma and chronic obstructive pulmonary disease (COPD) guidelines recommend self-management assessment and inhaler education at all care-visits. Assessment is vital for identifying inhaler misuse. Whether age-related factors impede the efficacy of educational interventions for inhaler technique among older patients is unknown. We aimed to study factors associated with metered-dose inhaler (MDI) misuse pre/post-inhaler education among younger (< 65) and older inpatient populations (≥ 65). METHODS Adult inpatients with asthma or COPD enrolled across five studies between 2007 and 2017, who were eligible for, consented, and assigned to one of three education interventions (Brief Intervention [BI], Teach-to-Goal [TTG], Virtual Teach-to-Goal [V-TTG]) were included. Participants' visual acuity, health literacy, and MDI technique pre/post education were assessed using validated assessments. Binary logistic regression was used to investigate factors that increased odds of inhaler misuse. RESULTS Across the five studies, 394 unique participants were enrolled with a mean age of 51.9 years (SD±15). There was no significant difference in baseline MDI misuse by age, vision, or health literacy levels. Post-education misuse use was lower among patients with better baseline MDI technique, those who received TTG or V-TTG education, and those with high health literacy. Neither age nor visual acuity were significantly associated with increased rates of misuse, although age was correlated with low health literacy. CONCLUSION MDI education with teach-to-goal modalities is more effective than brief intervention; however, patients with low health literacy (disproportionately affecting older patients) may benefit less from these interventions. Further investigation into tailored inhaler education is needed.
Collapse
Affiliation(s)
- Kristin C Trela
- University of Chicago Medicine, Department of Anesthesiology and Critical Care, USA
| | - Paulina Zajac
- University of Chicago, Harris School of Public Policy, USA
| | - Mengqi Zhu
- University of Chicago Medicine, Section of General Internal Medicine, USA
| | - Valerie G Press
- University of Chicago Medicine, Section of General Internal Medicine, USA.
| |
Collapse
|
8
|
Lima RIM, Parente MA, Ferreira TISP, Coelho AAS, Loureiro EVSD, Barbosa TM, Lustosa SB, Damasceno OC, Teixeira FB. Letramento funcional em saúde de usuários da atenção primária de Altamira, Pará. REVISTA BRASILEIRA DE MEDICINA DE FAMÍLIA E COMUNIDADE 2022. [DOI: 10.5712/rbmfc17(44)2763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introdução: O Letramento Funcional em Saúde (LFS) está associado à capacidade dos pacientes em compreender e utilizar seus conhecimentos em saúde no âmbito do autocuidado e na promoção a saúde. Por isso, torna-se essencial reconhecer o nível de LFS e identificar os fatores que o influenciam. Objetivo: Analisar o nível de letramento funcional em saúde (LFS) de usuários de Unidades de Saúde da Família (USF) na área urbana de Altamira (PA). Métodos: Estudo transversal no qual a coleta de dados ocorreu entre agosto de 2018 e dezembro de 2019 em 12 USF da área urbana. O cálculo amostral foi realizado com base na população urbana de Altamira registrada pelo Censo de 2010. Utilizou-se intervalo de confiança de 95% com margem de erro de 5% e prevalência de achados de 50% em uma população semelhante, encontrando-se assim o valor de 382. Os participantes foram entrevistados a fim de se coletarem informações sobre dados sociodemográficos, e posteriormente foi aplicado um questionário baseado na versão brasileira do Short Test of Functional Health Literacy (S-TOFHLA), instrumento utilizado para a mensuração do LFS. O coeficiente de correlação de Pearson, o teste qui-quadrado, o teste G e a odds ratio foram utilizados para verificar a relação entre a pontuação do S-TOFHLA e os dados sociodemográficos. Além disso, uma análise de regressão múltipla foi realizada para predizer os fatores que interferem no LFS. Por fim, o teste ANOVA buscou diferenças entre os níveis de LFS dos usuários nas USF analisadas. Resultados: Foram incluídos no estudo 400 participantes, dos quais 59% apresentaram LFS adequado, 16,5% limítrofe e 24,5% inadequado. As variáveis, grau de escolaridade, idade e renda foram associadas ao LFS na população estudada, predizendo, respectivamente, em 46, 26 e 17% o desempenho no teste S-TOFHLA. Baixa escolaridade e baixa renda aumentam o risco de indivíduos possuírem LFS insatisfatório em cinco e quatro vezes, nessa ordem. Por fim, foram encontradas diferenças entre os níveis de LFS dos usuários das USF analisadas. Conclusões: A população da área urbana de Altamira apresentou alta prevalência de LFS insatisfatório. Sendo assim, no intuito de aumentar os resultados satisfatórios em saúde, os profissionais da região devem adequar as suas formas de comunicação e linguagem às necessidades dos usuários das USF, observando que a adequação da equipe pode trazer melhorias para o entendimento das informações e oportunizar melhores condições de recuperação e autocuidado em saúde.
Collapse
|
9
|
Prosser TR, Bollmeier SG. Concordance between reported medication taking behavior and prescription instructions for patients with chronic obstructive pulmonary disease visiting community pharmacies. J Am Pharm Assoc (2003) 2022; 62:1280-1286. [DOI: 10.1016/j.japh.2022.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 02/11/2022] [Accepted: 02/14/2022] [Indexed: 11/16/2022]
|
10
|
van Beers M, Mount SW, Houben K, Gosker HR, Schuurman L, Franssen FM, Janssen DJ, Schols AM. Working memory training efficacy in COPD: the randomised, double-blind, placebo-controlled Cogtrain trial. ERJ Open Res 2021; 7:00475-2021. [PMID: 34853784 PMCID: PMC8628195 DOI: 10.1183/23120541.00475-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 09/13/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Cognitive impairment is highly prevalent in COPD and is associated with a sedentary lifestyle, unhealthy diet and increased cognitive stress susceptibility. Enhancement of cognitive performance by working memory training (WMT) may reverse these effects. Therefore, this study aimed to investigate the efficacy of WMT in COPD on cognitive performance, healthy lifestyle behaviours and cognitive stress susceptibility. METHODS The double-blind randomised, placebo-controlled Cogtrain trial consisted of a 12-week training phase comprising 30 active or sham WMT sessions, followed by a second 12-week maintenance phase with 12 sessions. Measurements took place at baseline and after the first and second phases. The primary outcome was cognitive performance. Secondary outcomes were the recall of prespecified healthy lifestyle goals, physical capacity and activity, dietary quality and cognitive stress susceptibility. Motivation towards exercising and healthy eating and psychological wellbeing were exploratory outcomes. RESULTS Sixty-four patients with moderate COPD (45% male, aged 66.2±7.2 years, median forced expiratory volume in 1 s 60.6% predicted) were randomised. WMT significantly increased patients' performance on the trained tasks in the first phase, which remained stable in the second phase. Of the 17 cognitive outcome measures, only one measure of memory improved after the first phase and one measure of reaction time after the second phase. This intervention did not influence physical capacity and activity, recall of prespecified healthy lifestyle goals, psychological wellbeing or cognitive stress susceptibility. CONCLUSION WMT improved performance on the trained tasks but not overall cognitive performance, healthy lifestyle behaviours or cognitive stress susceptibility in patients with COPD.
Collapse
Affiliation(s)
- Martijn van Beers
- Dept of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Sarah W. Mount
- Dept of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Katrijn Houben
- Dept of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Harry R. Gosker
- Dept of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Lisanne Schuurman
- Dept of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Frits M.E. Franssen
- Dept of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands
- Dept of Research and Education, CIRO, Horn, The Netherlands
| | - Daisy J.A. Janssen
- Dept of Research and Education, CIRO, Horn, The Netherlands
- Dept of Health Services Research, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Annemie M.W.J. Schols
- Dept of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands
| |
Collapse
|
11
|
Owsiany MT, Hawley CE, Paik JM. Differential Diagnoses and Clinical Implications of Medication Nonadherence in Older Patients with Chronic Kidney Disease: A Review. Drugs Aging 2020; 37:875-884. [PMID: 33030671 DOI: 10.1007/s40266-020-00804-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2020] [Indexed: 12/16/2022]
Abstract
Older adults with chronic kidney disease (CKD) often have many comorbidities, which requires them to take multiple medications. As the number of daily medications prescribed increases, the risk for polypharmacy increases. Understanding and improving medication adherence in this patient population is vital to avoiding the drug-related adverse events of polypharmacy. The primary objective of this review is to summarize the existing literature and to understand the factors leading to medication nonadherence in older patients with CKD. In this review, we discuss the prevalence of polypharmacy, the current lack of consensus on the incidence of medication nonadherence, the heterogeneity of assessing medication adherence, and the most common differential diagnoses for medication nonadherence in this population. Specifically, the most common differential diagnoses for medication nonadherence in older adults with CKD are (1) medication complexity; (2) cognitive impairment; (3) low health literacy; and (4) systems-based barriers. We provide tailored strategies to address these differential diagnoses and subsequently improve medication adherence. The clinical implications include deprescribing to decrease medication complexity and polypharmacy, utilizing a team-based approach to identify and support patients with cognitive impairment, enriching communication between health providers and patients with low health literacy, and improving health care access to address systems-based barriers. Further research is needed to determine the effects of addressing these differential diagnoses and medication adherence in older adults with CKD.
Collapse
Affiliation(s)
- Montgomery T Owsiany
- New England Geriatric Research, Education and Clinical Center, VA Boston Healthcare System, 150 South Huntington Avenue, Boston, MA, 12D-94, USA
| | - Chelsea E Hawley
- New England Geriatric Research, Education and Clinical Center, VA Boston Healthcare System, 150 South Huntington Avenue, Boston, MA, 12D-94, USA
| | - Julie M Paik
- New England Geriatric Research, Education and Clinical Center, VA Boston Healthcare System, 150 South Huntington Avenue, Boston, MA, 12D-94, USA. .,Renal Section, VA Boston Healthcare System, Boston, MA, USA. .,Renal Division and Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA. .,Harvard Medical School, Boston, MA, USA.
| |
Collapse
|