Medication adherence and its influencing factors in community-dwelling older adults with chronic illnesses in a rural area
,
Abstract
Background & Aim: Older adults with chronic diseases are usually required to manage multiple medications and complex medication regimens. Medication adherence is crucial in older adults which is increasingly being recognized due to its potential to impact healthcare utilization and treatment efficacy. The current study aimed to assess medication adherence and its influencing factors in community-dwelling older adults with chronic illnesses in rural areas.
Methods & Materials: A cross-sectional study design was used to achieve the study aim. The study sample was composed of 310 older patients from a rural area in Sharkia Governorate, Egypt. Medication adherence was assessed by the Arabic version of the General Medication Adherence Scale. Association between medication adherence and older patients' characteristics was identified through the Chi-square test, Pearson's correlation coefficient, and Logistic regression.
Results: Among 310 older patients, 84.8% of them were non-adherent to their medications. Significant relationships were found between medication adherence and age, gender, educational level, marital status, and monthly income. Aging less than 70 years, female gender, sufficient income, fewer illnesses, and medication number were significant predictors for medication adherence.
Conclusion: The current study findings revealed that most rural older adults with chronic illnesses were non-adherent to their medications, with many influencing factors such as age, gender, educational level, monthly income, and illnesses and medication number. So, the study recommends the importance of developing strategies to improve medication adherence in community-dwelling older adults in rural areas.
1. United Nations, Department of Economic and Social Affairs. World population ageing 2020: highlights. Available at: https://www.un.org/development/desa/pd/sites/www.un.org.development.desa.pd/files/files/documents/2020/Sep/un_pop_2020_pf_ageing_10_key_messages.pdf Accessed July 22, 2022.
2. Zhang C, Xiao S, Shi L, Xue Y, Zheng X, Dong F, Zhang J, Xue B, Lin H, Ouyang P.Urban–Rural Differences in Patterns and Associated Factors of Multimorbidity Among Older Adults in China: A Cross-Sectional Study Based on Apriori Algorithm and Multinomial Logistic Regression. Frontiers in Public Health. 2021 Aug 30;9:707062.
3. González-Bueno J, Sevilla-Sánchez D, Puigoriol-Juvanteny E, Molist-Brunet N, Codina-Jané C, Espaulella-Panicot J. Factors associated with medication non-adherence among patients with multimorbidity and polypharmacy admitted to an intermediate care center. International Journal of Environmental Research and Public Health. 2021 Sep 12;18(18):9606.
4. World Health Organization (WHO). Adherence to long-term therapies: evidence for action. 2003. Available at: https://www.who.int/chp/knowledge/publications/adherence_Section1.pdf?ua=1 Accessed July 24, 2022.
5. Alhabib MY, Alhazmi TS, Alsaad SM, AlQahtani AS, Alnafisah AA. Medication adherence among geriatric patients with chronic diseases in Riyadh, Saudi Arabia. Patient Preference and Adherence. 2022 Jan 1:2021-30.
6. Baryakova TH, Pogostin BH, Langer R, McHugh KJ. Overcoming barriers to patient adherence: the case for developing innovative drug delivery systems. Nature Reviews Drug Discovery. 2023 May;22(5):387-409.
7. Al Qasem A, Smith F, Clifford S. Adherence to medication among chronic patients in Middle Eastern countries: A review of studies. EMHJ-Eastern Mediterranean Health Journal. 2011;17(4):356-363.
8. Balkhi B, Alwhaibi M, Alqahtani N, Alhawassi T, Alshammari TM, Mahmoud M, Almetwazi M, Ata S, Kamal KM. Oral antidiabetic medication adherence and glycaemic control among patients with type 2 diabetes mellitus: a cross-sectional retrospective study in a tertiary hospital in Saudi Arabia. BMJ Open. 2019 Jul 1;9(7):e029280.
9. Neiman AB, Ruppar T, Ho M, Garber L, Weidle PJ, Hong Y, George MG, Thorpe PG. CDC grand rounds: Improving medication adherence for chronic disease management—innovations and opportunities. Morbidity and Mortality Weekly Report. 2017 Nov 11;66(45):1248.
10. Chew SM, Lee JH, Lim SF, Liew MJ, Xu Y, Towle RM. Prevalence and predictors of medication non‐adherence among older community‐dwelling people with chronic disease in Singapore. Journal of Advanced Nursing. 2021 Oct;77(10):4069-80.
11. Smaje A, Weston‐Clark M, Raj R, Orlu M, Davis D, Rawle M. Factors associated with medication adherence in older patients: A systematic review. Aging Medicine. 2018 Dec;1(3):254-66.
12. Ulley J, Harrop D, Ali A, Alton S, Fowler Davis S. Deprescribing interventions and their impact on medication adherence in community-dwelling older adults with polypharmacy: A systematic review. BMC Geriatrics. 2019 Dec;19(1):1-3.
13. Bolina AF, Gomes NC, Marchiori GF, Pegorari MS, Tavares DM. Potentially inappropriate medication use and frailty phenotype among community‐dwelling older adults: A population‐based study. Journal of Clinical Nursing. 2019 Nov;28(21-22):3914-22.
14. Yang C, Lee DT, Wang X, Chair SY. Effects of a nurse-led medication self-management intervention on medication adherence and health outcomes in older people with multimorbidity: A randomised controlled trial. International Journal of Nursing Studies. 2022 Oct 1;134:104314.
15. Angadi NB, Kavi A, Torgal SS. Therapeutic Adherence among Elderly with Chronic Diseases Residing in Urban Area of South India–A descriptive cross-sectional study. Biomedical and Pharmacology Journal. 2020 Dec 30;13(4):2109-16.
16. Abd Allah ES, Mahmoud SA, Serea MM. Factors Affecting Medication Adherence among Elderly in Rural Areas, Sharkia Governorate, Egypt. Annals of the Romanian Society for Cell Biology. 2021 Aug 5;25(6):18830-41.
17. Kharameh ZT, Khoshravesh S, Noori R, Abdolmalaki M, Bakhshi M. Determinants of medication adherence among Iranian elderly patients with chronic diseases. Jundishapur Journal of Chronic Disease Care. 2018 Jul 31;7(3):e68310. doi: 10.5812/jjcdc.68310.
18. Naqvi AA, Hassali MA, Rizvi M, Zehra A, Iffat W, Haseeb A, Jamshed S. Development and validation of a novel General Medication Adherence Scale (GMAS) for chronic illness patients in Pakistan. Frontiers in Pharmacology. 2018 Oct 9;9:1124.
19. Naqvi AA, Mahmoud MA, AlShayban DM, Alharbi FA, Alolayan SO, Althagfan S, Iqbal MS, Farooqui M, Ishaqui AA, Elrggal ME, Haseeb A. Translation and validation of the Arabic version of the General Medication Adherence Scale (GMAS) in Saudi patients with chronic illnesses. Saudi Pharmaceutical Journal. 2020 Sep 1;28(9):1055-61.
20. Menditto E, Cahir C, Aza-Pascual-Salcedo M, Bruzzese D, Poblador-Plou B, Malo S, Costa E, González-Rubio F, Gimeno-Miguel A, Orlando V, Kardas P. Adherence to chronic medication in older populations: Application of a common protocol among three European cohorts. Patient Preference and Adherence. 2018 Oct 5:1975-87. doi: 10.2147/PPA.S164819.
21. Jeon HO. Correlation of physical, psychological, and functional factors with independent medication adherence in Korean older adults with chronic illness: Using the 2017 national survey of older Koreans. Archives of Gerontology and Geriatrics. 2020 Sep 1;90:104130.
22. Liu J, Yu Y, Yan S, Zeng Y, Su S, He T, Wang Z, Ding Q, Zhang R, Li W, Wang X. Risk factors for self-reported medication adherence in community-dwelling older patients with multimorbidity and polypharmacy: A multicenter cross-sectional study. BMC Geriatrics. 2023 Dec;23(1):1-0.
23. Salama AA, Yasin AE, Elbarbary W. Medication knowledge as a determinant of medication adherence in geriatric patients, Serse Elian City, Menoufia Governorate, Egypt.
24. Menoufia Medical Journal. 2017 Jan 1;30(1):63.
25. Bosch-Lenders D, Maessen DW, Stoffers HE, Knottnerus JA, Winkens B, van den Akker M. Factors associated with appropriate knowledge of the indications for prescribed drugs among community-dwelling older patients with polypharmacy. Age and Ageing. 2016 May 1;45(3):402-8.
26. Tan YW, Suppiah S, Bautista MA, Malhotra R. Polypharmacy among community-dwelling elderly in Singapore: Prevalence, risk factors and association with medication non-adherence. Proceedings of Singapore Healthcare. 2019 Dec;28(4):224-31.
27. Lau Y, Htun TP, Chan KS, Klainin-Yobas P. Multidimensional factors affecting medication adherence among community-dwelling older adults: a structural-equation-modeling approach. Journal of Public Health. 2017 Feb;25:113-22.
28. Félix IB, Henriques A. Medication adherence and related determinants in older people with multimorbidity: A cross‐sectional study. InNursing Forum 2021. Oct 2021;56:834-43.
29. Park HY, Seo SA, Yoo H, Lee K. Medication adherence and beliefs about medication in elderly patients living alone with chronic diseases. Patient Preference and Adherence. 2018 Jan 24:175-81.
30. Liquori G, De Leo A, Di Simone E, Dionisi S, Giannetta N, Ganci E, Trainito SP, Orsi GB, Di Muzio M, Napoli C. Medication Adherence in Chronic Older Patients: An Italian Observational Study Using Medication Adherence Report Scale (MARS-5I). International Journal of Environmental Research and Public Health. 2022 Apr 25;19(9):5190.
31. Abdul-Sattar AB, Abou El Magd SA. Determinants of medication non-adherence in Egyptian patients with systemic lupus erythematosus: Sharkia Governorate. Rheumatology International. 2015 Jun;35:1045-51.
2. Zhang C, Xiao S, Shi L, Xue Y, Zheng X, Dong F, Zhang J, Xue B, Lin H, Ouyang P.Urban–Rural Differences in Patterns and Associated Factors of Multimorbidity Among Older Adults in China: A Cross-Sectional Study Based on Apriori Algorithm and Multinomial Logistic Regression. Frontiers in Public Health. 2021 Aug 30;9:707062.
3. González-Bueno J, Sevilla-Sánchez D, Puigoriol-Juvanteny E, Molist-Brunet N, Codina-Jané C, Espaulella-Panicot J. Factors associated with medication non-adherence among patients with multimorbidity and polypharmacy admitted to an intermediate care center. International Journal of Environmental Research and Public Health. 2021 Sep 12;18(18):9606.
4. World Health Organization (WHO). Adherence to long-term therapies: evidence for action. 2003. Available at: https://www.who.int/chp/knowledge/publications/adherence_Section1.pdf?ua=1 Accessed July 24, 2022.
5. Alhabib MY, Alhazmi TS, Alsaad SM, AlQahtani AS, Alnafisah AA. Medication adherence among geriatric patients with chronic diseases in Riyadh, Saudi Arabia. Patient Preference and Adherence. 2022 Jan 1:2021-30.
6. Baryakova TH, Pogostin BH, Langer R, McHugh KJ. Overcoming barriers to patient adherence: the case for developing innovative drug delivery systems. Nature Reviews Drug Discovery. 2023 May;22(5):387-409.
7. Al Qasem A, Smith F, Clifford S. Adherence to medication among chronic patients in Middle Eastern countries: A review of studies. EMHJ-Eastern Mediterranean Health Journal. 2011;17(4):356-363.
8. Balkhi B, Alwhaibi M, Alqahtani N, Alhawassi T, Alshammari TM, Mahmoud M, Almetwazi M, Ata S, Kamal KM. Oral antidiabetic medication adherence and glycaemic control among patients with type 2 diabetes mellitus: a cross-sectional retrospective study in a tertiary hospital in Saudi Arabia. BMJ Open. 2019 Jul 1;9(7):e029280.
9. Neiman AB, Ruppar T, Ho M, Garber L, Weidle PJ, Hong Y, George MG, Thorpe PG. CDC grand rounds: Improving medication adherence for chronic disease management—innovations and opportunities. Morbidity and Mortality Weekly Report. 2017 Nov 11;66(45):1248.
10. Chew SM, Lee JH, Lim SF, Liew MJ, Xu Y, Towle RM. Prevalence and predictors of medication non‐adherence among older community‐dwelling people with chronic disease in Singapore. Journal of Advanced Nursing. 2021 Oct;77(10):4069-80.
11. Smaje A, Weston‐Clark M, Raj R, Orlu M, Davis D, Rawle M. Factors associated with medication adherence in older patients: A systematic review. Aging Medicine. 2018 Dec;1(3):254-66.
12. Ulley J, Harrop D, Ali A, Alton S, Fowler Davis S. Deprescribing interventions and their impact on medication adherence in community-dwelling older adults with polypharmacy: A systematic review. BMC Geriatrics. 2019 Dec;19(1):1-3.
13. Bolina AF, Gomes NC, Marchiori GF, Pegorari MS, Tavares DM. Potentially inappropriate medication use and frailty phenotype among community‐dwelling older adults: A population‐based study. Journal of Clinical Nursing. 2019 Nov;28(21-22):3914-22.
14. Yang C, Lee DT, Wang X, Chair SY. Effects of a nurse-led medication self-management intervention on medication adherence and health outcomes in older people with multimorbidity: A randomised controlled trial. International Journal of Nursing Studies. 2022 Oct 1;134:104314.
15. Angadi NB, Kavi A, Torgal SS. Therapeutic Adherence among Elderly with Chronic Diseases Residing in Urban Area of South India–A descriptive cross-sectional study. Biomedical and Pharmacology Journal. 2020 Dec 30;13(4):2109-16.
16. Abd Allah ES, Mahmoud SA, Serea MM. Factors Affecting Medication Adherence among Elderly in Rural Areas, Sharkia Governorate, Egypt. Annals of the Romanian Society for Cell Biology. 2021 Aug 5;25(6):18830-41.
17. Kharameh ZT, Khoshravesh S, Noori R, Abdolmalaki M, Bakhshi M. Determinants of medication adherence among Iranian elderly patients with chronic diseases. Jundishapur Journal of Chronic Disease Care. 2018 Jul 31;7(3):e68310. doi: 10.5812/jjcdc.68310.
18. Naqvi AA, Hassali MA, Rizvi M, Zehra A, Iffat W, Haseeb A, Jamshed S. Development and validation of a novel General Medication Adherence Scale (GMAS) for chronic illness patients in Pakistan. Frontiers in Pharmacology. 2018 Oct 9;9:1124.
19. Naqvi AA, Mahmoud MA, AlShayban DM, Alharbi FA, Alolayan SO, Althagfan S, Iqbal MS, Farooqui M, Ishaqui AA, Elrggal ME, Haseeb A. Translation and validation of the Arabic version of the General Medication Adherence Scale (GMAS) in Saudi patients with chronic illnesses. Saudi Pharmaceutical Journal. 2020 Sep 1;28(9):1055-61.
20. Menditto E, Cahir C, Aza-Pascual-Salcedo M, Bruzzese D, Poblador-Plou B, Malo S, Costa E, González-Rubio F, Gimeno-Miguel A, Orlando V, Kardas P. Adherence to chronic medication in older populations: Application of a common protocol among three European cohorts. Patient Preference and Adherence. 2018 Oct 5:1975-87. doi: 10.2147/PPA.S164819.
21. Jeon HO. Correlation of physical, psychological, and functional factors with independent medication adherence in Korean older adults with chronic illness: Using the 2017 national survey of older Koreans. Archives of Gerontology and Geriatrics. 2020 Sep 1;90:104130.
22. Liu J, Yu Y, Yan S, Zeng Y, Su S, He T, Wang Z, Ding Q, Zhang R, Li W, Wang X. Risk factors for self-reported medication adherence in community-dwelling older patients with multimorbidity and polypharmacy: A multicenter cross-sectional study. BMC Geriatrics. 2023 Dec;23(1):1-0.
23. Salama AA, Yasin AE, Elbarbary W. Medication knowledge as a determinant of medication adherence in geriatric patients, Serse Elian City, Menoufia Governorate, Egypt.
24. Menoufia Medical Journal. 2017 Jan 1;30(1):63.
25. Bosch-Lenders D, Maessen DW, Stoffers HE, Knottnerus JA, Winkens B, van den Akker M. Factors associated with appropriate knowledge of the indications for prescribed drugs among community-dwelling older patients with polypharmacy. Age and Ageing. 2016 May 1;45(3):402-8.
26. Tan YW, Suppiah S, Bautista MA, Malhotra R. Polypharmacy among community-dwelling elderly in Singapore: Prevalence, risk factors and association with medication non-adherence. Proceedings of Singapore Healthcare. 2019 Dec;28(4):224-31.
27. Lau Y, Htun TP, Chan KS, Klainin-Yobas P. Multidimensional factors affecting medication adherence among community-dwelling older adults: a structural-equation-modeling approach. Journal of Public Health. 2017 Feb;25:113-22.
28. Félix IB, Henriques A. Medication adherence and related determinants in older people with multimorbidity: A cross‐sectional study. InNursing Forum 2021. Oct 2021;56:834-43.
29. Park HY, Seo SA, Yoo H, Lee K. Medication adherence and beliefs about medication in elderly patients living alone with chronic diseases. Patient Preference and Adherence. 2018 Jan 24:175-81.
30. Liquori G, De Leo A, Di Simone E, Dionisi S, Giannetta N, Ganci E, Trainito SP, Orsi GB, Di Muzio M, Napoli C. Medication Adherence in Chronic Older Patients: An Italian Observational Study Using Medication Adherence Report Scale (MARS-5I). International Journal of Environmental Research and Public Health. 2022 Apr 25;19(9):5190.
31. Abdul-Sattar AB, Abou El Magd SA. Determinants of medication non-adherence in Egyptian patients with systemic lupus erythematosus: Sharkia Governorate. Rheumatology International. 2015 Jun;35:1045-51.
| Files | ||
| Issue | Vol 10 No 3 (2023): Summer | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/npt.v10i3.13434 | |
| Keywords | ||
| medication adherence; community-dwelling older adults; chronic illnesses; rural area | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Ahmed E, Abdel-Aziz H, Ahmed S. Medication adherence and its influencing factors in community-dwelling older adults with chronic illnesses in a rural area. NPT. 2023;10(3):250-260.
