Most adults with chronic health disorders are treated with medication, vitamins and minerals, or hormones. However, 50% of adults in the US living with chronic disorders do not take their daily medication (or other self-administered oral or IV therapies) as prescribed. According to a research article in The Permanente Journal, this results each year in around 100,000 preventable deaths and $100 B in preventable healthcare costs. Forgetfulness is not the only reason that medication nonadherence is so widespread, but this is a particular problem for the homebound elderly. Besides leading to worsened health status, not taking medication as prescribed is contributing to a worldwide public health problem.
Impact of antibiotic nonadherence and drug-resistant infections
The diagnosis of a skin, urinary tract, respiratory, or other bacterial infection often requires treatment with an oral antibiotic for five to seven days to eliminate the infection. However, people typically begin to feel better earlier than the last prescribed dosage day, so discontinue taking the prescribed antibiotic pills. Consequently, the bacteria that cause human diseases are becoming more drug-resistant. The Centers for Disease Control (CDC) reports that 2.8 million drug-resistant infections occur in the US per year, and with an estimated 35,000 resultant deaths. Therefore, the common occurrence of patients not taking a prescribed antibiotic for the full course prescribed to them has led to more bacteria becoming resistant to all antibiotics.
Methicillin is an antibiotic that is a derivative of penicillin, and people afflicted with Methicillin-Resistant Staph. Aureus (MRSA) infections are 64% more likely to die from this type of antibiotic-resistant infection. Since Staph. aureus is one of the most common skin infection-causing bacteria (as it is commonly found on our skin), the increasing ability of this bacteria to survive all antibiotic treatments is causing tremendous medical concern. Meanwhile, surgical patients remain the ones at highest risk for developing a Staph. aureus infection in the incision site, but MRSA can also be transmitted by an infected person to someone else through hand-to-skin contact. In 2019, 27,314 MRSA-infected people in high-income countries alone (and 93,767 elsewhere) died due to their antibiotic resistance.
Nonadherence to blood pressure medication and consequences
Nearly 66% of people diagnosed with hypertension who are prescribed drugs to lower their blood pressure are nonadherent to medication treatment, per an article in Medicine in 2017. Since 70% of adults aged 65+ have hypertension – and hypertension is strongly linked to a heightened risk for heart attack and stroke – lessening the prevalence of hypertension (high blood pressure) has been a major US healthcare goal to curb national healthcare costs. Meanwhile, heart disease is the foremost chronic health disorder in the US, and the leading worldwide cause of death in adults.
Diabetes Type-2 and nonadherence to medication
Study findings published in Patient Preference and Adherence revealed that 45% of adults with diabetes (Type-2) are not able to maintain glucose control, and poor medication adherence is a major reason. The lack of taking medication aimed at glucose control can result in diabetes-afflicted people developing diabetes complication such as peripheral neuropathy (nerve pain), heart disease, and kidney failure. In turn, these complications can result in permanent disability and a far lower overall “quality-of-life”.
Reasons for medication nonadherence
Described in a medical research article in 2019 are the following five dimensions that affect patient adherence to their prescribed medication:
- Social and economic factors (such as ability to afford the prescribed drugs);
- Therapy-related factors (such as understanding why the drugs are necessary);
- Disease-related factors;
- Patient-related factors;
- Healthcare system-related factors
For adults aged 65+ who are enrolled in a Medicare Part D drug plan, there are wide variations in the cost of a prescribed medication that must be borne by the enrollee. If not enrolled in a Part D drug plan (or without any other drug coverage), the older-aged person may be faced with paying for the medication “out-of-pocket”.
The average annual cost of taking an oral glucose-lowering medication to manage diabetes (Type-2) in 2017 was $2,727 – which had increased by 147% from 2015. It is well-recognized that the cost of prescribed medication to control diabetes (Type-2) is high, and this is a main reason that diabetics do not take the prescribed medication that could preserve their health and prevent premature death. Therefore, seniors – many of whom are living on fixed incomes – often fail to take their prescribed medication.
A tremendous problem for elderly people is polypharmacy – which is the daily taking of many prescribed drugs aimed at different health disorders. For example, a senior living with diabetes (Type2) may also need to take medication for heart disease, nerve pain, a scrape on the foot that has become infected, low thyroid level, and many other health problems. Consequently, mixing up pills (and taking too many of one drug and not enough of another) can easily occur.
Cognition worsens during aging – even in elderly adults not living with Alzheimer’s Disease – so remembering whether a given pill was taken or not with breakfast every day can become difficult. This type of forgetfulness can leave any older-aged person who has been prescribed multiple medication feeling extremely frustrated. Furthermore, the Alzheimer’s Association notes that around one in nine adults aged 65+ has Alzheimer’s Disease, so forgetting to take prescribed medication (and/or mixing them up) is even more likely in these senior-aged adults.
Strategies that foster improved medication adherence
Physician office phone calls to remind older-aged people to take their prescribed medication have been found to be effective in promoting medication adherence, as have daily text messages and automated reminders on digital wearables. Meanwhile, calls from pharmacies – and especially if an existing medication prescription is not re-filled – have been found to be effective, as well.
Besides reminders, physician-initiated discussions about the financial impact on a patient of a prescription can enable recognition if cost is the main factor. In that case, helping the patient to learn about ways to reduce the cost (such as through enrollment in a clinical trial where drug cost may be covered) can boost adherence to prescribed treatment.
Learning that a different Medicare Part D plan covers the cost of a specific prescribed drug (and then switching plans during Medicare’s “open enrollment” period) may be all it takes for a person with a history of medication nonadherence to change that behavior. The ease of comparing health insurance plans is increased for seniors through access to computer training in combination with ownership of a computer, so independent and assisted living facilities geared to older-aged adults can be part of the solution by engaging their residents in utilizing technological devices.
The Ōmcare Home Health Hub is an all-in-one home telehealth device aimed at senior-aged adults, and that can be used to promote medication adherence.