Factors associated with low adherence to medication in older adults

Tavares, Noemia Urruth Leão; Bertoldi, Andréa Dâmaso; Thumé, Elaine; Facchini, Luiz Augusto; França, Giovanny Vinícius Araújo de; Mengue, Sotero Serrate

doi:10.1590/S0034-8910.2013047004834

Acessibilidade / Reportar erro

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Original Articles • Rev. Saúde Pública 47 (6) • Dec 2013 • https://doi.org/10.1590/S0034-8910.2013047004834 copy

Factors associated with low adherence to medication in older adults

Authorship SCIMAGO INSTITUTIONS RANKINGS

OBJECTIVE

: To assess factors associated with low adherence to pharmacotherapy in older adults.

METHODS

: Cross-sectional population-based study, with a representative sample of 1,593 individuals aged 60 or older, living in the urban area of Bagé, RS, Southern Brazil, in 2008. A multiple stage sampling model was used. The data were collected through individual household interviews. The analyses of the association between low adherence regarding pharmacotherapy, measured using the Brief Medication Questionnaire (BMQ), and demographic, socioeconomic, behavioral, health, assistance and prescription factors were carried out applying Poisson regression model to assess crude and adjusted prevalence ratios, their respective 95% confidence intervals and p-value (Wald test).

RESULTS

: Around 78.0% of individuals reported have taken at least one medication in the seven days prior to the interview. Of these, approximately one third (28.7%) were considered to have low adherence to the treatment. The factors significantly associated to low adherence to treatment were: age (65 to 74 years old), not having health insurance, having to purchase (totally or partially) their own medicines, having three or more morbidities, having functional disabilities and using three or more medicines.

CONCLUSIONS

: The increased use of medicines by older adults, because of the high prevalence of non-communicable diseases in this group, and the access to the treatment need to be considered by health care professionals regarding fostering adherence to treatment, which increases therapeutic solutions and quality of life among older people.

Aged; Patient Dropouts; Medication Adherence; Health Services Accessibility; Socioeconomic Factors; Primary Health Care; Family Health Program; Cross-Sectional Studies

Variable	n	%
Sex (N = 1,242)
Male	468	37.7
Female	774	62.3
Age (years) (N = 1,242)
60 to 64	307	24.7
65 to 74	562	45.3
75 or more	373	30.0
Skin color (N = 1,242)
White	981	79.0
Non-white	261	21.0
Schooling (completed years of study) (N = 1,241)
0	293	23.6
1 to 7	686	55.3
8 to 20	262	21.1
Socioeconomic level (N = 1,232)^a
A/B	408	33.1
C	487	39.5
D/E	337	27.4
Marital status (N = 1,242)
Single/Divorced	195	15.7
Married or cohabiting	629	50.6
Widowed	418	33.7
Private health insurance (N = 1,236)
No	792	64.1
Yes	444	35.9
Model of primary health care (N = 1,242)
Traditional	568	45.7
Family Health Care Strategy	674	54.3
Source of medication (N = 1,241)
Health center	465	37.5
Paid for	558	45.0
Partly from the health care center, partly paid for	218	17.5
Doctor’s appointment in the last 3 months (N = 1,240)
No	551	44.4
Yes	689	55.6
Self-perceived health (N = 1,206)
Very good/Good	716	59.4
Regular/Bad/Very bad	490	40.6
Number of reported morbidities (N = 1,242)^b
0	226	18.2
1	305	24.6
2	333	26.8
3 or +	378	30.4
IADL Incapacity (N = 1,238)^c
No	810	65.4
Yes	428	34.6
Depression (N = 1,184)
No	1,007	85.1
Yes	177	14.9
Cognitive deficit (N = 1,184)
No	1,025	86.6
Yes	159	13.4
Total medications used (N = 1,241)
1	300	24.2
2	291	23.4
3 or +	650	52.4

Questions	%
Regime domain
Reported missing a day of treatment	59.8
Reported missing doses of treatment	37.6
Beliefs domain
Reported that some medications “do not work properly”	5.2
Recall domain
Receive a schematic of multiple doses of medications	65.3
Reported difficulty in reading what was written on the packet	20.8
Reported difficulty in remembering to take medications	16.0
Reported difficulty in obtaining the medications	12.0
Reported difficulties in taking various medicines at the same time	13.5

Variable	n	% Low adherence	Unadjusted RP	95%CI	p^c
Level 1^b

Sex (N = 1,242)					0.273
Male	468	26.9	1	1
Female	774	29.8	1.11	0.92;1.33
Age (N = 1,242)					0.048
60 to 64	307	26.4	1	1
65 to 74	562	32.2	1.22	0.98;1.52
75 and over	373	25.5	0.97	0.75;1.25
Skin color (N = 1,242)					0.537
White	981	28.3	1	1
Non-white	261	30.3	1.07	0.87;1.32
Schooling (years of study) (N = 1,241)					0.306
0	293	31.1	1	1
1 to 7	686	29.2	0.94	0.76;1.15
8 to 20	262	25.2	0.81	0.62;1.06
Socioeconomic level (N = 1,232)^d					0.807
Classes A/B	408	29.9	1	1
Class C	487	27.9	0.93	0.76;1.15
Classes D/E	337	29.1	0.97	0.78;1.22
Marital status (N = 1,242)					0.877
Single/Divorced	195	28.2	1	1
Married	629	28.3	1.00	0.78;1.30
Widowed	418	29.7	1.05	0.80;1.38
Private health insurance (N = 1,236)					0.027
No	792	31.1	1	1
Yes	444	25.0	0.80	0.66;0.97

Level 2^b

Primary Health Care Model (N = 1,242)					0.973
Traditional	568	28.7	1	1
ESF	674	28.8	1.00	0.84;1.20
Source of medication (N = 1,241)					< 0.001
Health care center	465	24.1	1	1
Pay for	558	25.3	1.05	0.85;1.30
Partly at the health care center and partly paid for	218	47.7	1.98	1.60;2.45
Doctor’s appointment in the last 3 months (N = 1,240)					0.782
No	551	28.3	1	1
Yes	689	29.0	1.03	0.86;1.22

Level 3^b

Self-perceived health (N = 1,206)					0.079
Very good/Good	716	26.4	1	1
Regular/Bad/Very bad	490	31.0	1.18	0.98;1.41
Number of reported morbidities (N = 1,242)^e					0.004
0	226	23.5	1	1
1	305	27.2	1.16	0.86;1.56
2	333	26.1	1.11	0.83;1.50
3 or +	378	35.4	1.51	1.15;1.98
IADL incapacity (N = 1,238)^f					0.009
No	810	26.2	1	1
Yes	428	33.2	1.27	1.06;1.51
Depression (N = 1,184)					0.491
No	1,007	28.0	1	1
Yes	177	30.5	1.09	0.85;1.39
Cognitive deficit (N = 1,184)					0.673
No	1,025	28.7	1	1
Yes	159	27.0	0.94	0.72;1.24
Total medications used (N = 1,241)					< 0.001
1	300	3.7	1	1
2	291	24.7	6.75	3.65;12.47
3 or +	650	42.0	11.45	6.37;20.61

Variable	n	% Low adherence	Adjusted PR	95%CI	p^c
Age (years) (N = 1,242)					0.052
60 to 64	307	26.4	1	1
65 to 74	562	32.2	1.25	1.00;1.56
75 or more	373	25.5	1.01	0.78;1.31
Private health insurance (N = 1,236)					0.028
No	792	31.1	1.00	1
Yes	444	25.0	0.81	0.67;0.98
Source of medication (N = 1,241)					< 0.001
Health care center	465	24.1	1	1
Pay for	558	25.3	1.07	0.86;1.33
Partly at the health care center and partly paid for	218	47.7	1.97	1.59;2.44
Number of reported morbidities (N = 1,242)^d					0.012
0	226	23.5	1	1
1	305	27.2	1.04	0.78;1.40
2	333	26.1	1.09	0.81;1.46
3 or +	378	35.4	1.39	1.06;1.82
IADL Incapacity (N = 1,238)^e					0.011
No	810	26.2	1	1
Yes	428	33.2	1.25	1.05;1.49
Number of medications used (N = 1,241)					< 0.001
1	300	3.7	1	1
2	291	24.7	6.50	3.52;12.01
3 or +	650	42.0	10.18	5.65;18.33

Faculdade de Saúde Pública da Universidade de São Paulo Avenida Dr. Arnaldo, 715, 01246-904 São Paulo SP Brazil, Tel./Fax: +55 11 3061-7985 - São Paulo - SP - Brazil
E-mail: revsp@usp.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Correspondence
: Noemia Urruth Leão Tavares. Faculdade de Ciências da Saúde – UnB. Campus Universitário Darcy Ribeiro. 70910-900 Brasília, DF, Brasil. E-mail: nul.tavares@gmail.com