Background Treatment adherence is a very important issue in ensuring the correct effectiveness of treatments, and it is often compromised in older patients. To assess and improve patients’ treatment adherence is an important role of clinical pharmacists, and knowing which factors are usually associated with a lack of adherence could help to enhance this task.
Purpose To estimate the prevalence of a lack of treatment adherence in older adults admitted to an acute geriatric unit, and to assess associated factors.
Material and methods Cross-sectional observational study of over 75 years’ old patients consecutively admitted to an acute geriatric unit in a third-level hospital. A clinical pharmacist performed a semi-structured clinical interview with the patients and their families, including the 4-items Morisky–Green test. Socio-demographic and clinical characteristics of included participants were registered from medical records and patient interview. Multivariate logistic regression was used to identify predictors of a lack of adherence. The following factors were included in the analysis: age, sex, polypharmacy (≥5 chronic medications), comorbidities (age-adjusted Charlson Comorbidity Index), functional and cognitive impairment (Barthel Index and degree of impairment: none, mild, moderate, severe), dependence for taking medications, use of weekly pillbox, multi-compartment compliance aid (MCA), visual and hearing deficiency, and changes in treatment in the past 3 months.
Results Two-hundred and fifty patients were included, 150 were females (60.0%) and mean age was 87.6 years (SD 4.6). An important lack of adherence was detected in 55 patients (22.0%, 95% CI: 16.83 to 27.17). Forty-eight patients (19.2%) used a weekly pillbox to organise their medications and 32 (12.8%) used a MCA; 52 (20.8%) changed their medications recently; 168 (67.2%) were dependent for taking their medications; 39 (15.6%) had visual deficiency; and 71 (28.4%) hearing deficiency. Only two factors were (inversely) associated with a lack of adherence: female sex (OR 0.50, 95% CI: 0.255 to 0.974) and dependence for taking medications (OR 0.26, 95% CI: 0.109 to 0.630).
Conclusion Between older adults admitted to an acute geriatric unit, males and patients that can handle their own medications are more likely to present worse adherence to their medications. Hospital pharmacists in this setting should pay special attention to this population to focus their interventions, addressing the lack of adherence in very old adults.
References and/or acknowledgements No conflict of interest.