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A Caregiver's Guide to Medication Adherence

By November 12, 2015Aging in Place

Medication adherence is a problem of such worldwide magnitude that the World Health Organization (WHO) launched a global initiative to address it. Adherence to long-term medication therapies is only 50 percent in developed countries. As a result, chronic diseases that could be treated, will instead exceed 65 percent of all diseases by 2020.

The lack of medication adherence causes poor health, places patients with multiple chronic conditions in life-threatening situations, and prevents medical advances from working. WHO has stated that low cost medication adherence may be more effective in improving population health than improvements in specific medical treatments.

Caregivers are on the front lines of improving medication adherence. As WHO stated,
“Health providers can have a significant impact by assessing risk of nonadherence and delivering interventions to optimize adherence. For the effective provision of care for chronic conditions,it is necessary that the patient, the family and the community that supports the patient all play an active role. Informal or formal support received by patients from other members of their community has been consistently reported as an important factor affecting health outcomes and behaviors.”

Caregivers need to know that adherence is influenced by several factors:

  • The readiness and ability of the patient to follow treatment plans
  • The patient’s environment may not be conducive to complying with treatment regimens
  • The patient’s chronic illness may interfere with adherence
  • The patient may not perceive that the benefits of the therapy is worth adherence
  • Patient cognition, ability to get up to take medication impacts adherence
  • Multiple therapies make adherence difficult: nearly 20 percent of seniors 65 and older take 10 or more medications.

    Communication and the lack thereof significantly impact adherence. Multiple physicians may be prescribing medications, without knowing what others are prescribing. Home visits are not widely conducted. As a result, the physician has no way of knowing if the patient is taking medicine correctly or what home factors may interfere with adherence.

    It is very difficult for clinicians to identify non-adherence issues in their elderly patients. WHO recommends that clinicians have to learn to ask about medication adherence, and do so using nonjudgmental, open-ended questions. Caregivers can be the physician’s eyes and ears on site. They are with the patient at home and can tell if medications are being taken appropriately. They can see what environmental factors may be affecting adherence:
    Is the medication to be taken with food, but the patient doesn’t go to the store?
    Is nutrition an obstacle, as evidenced by fast food containers?
    Is the person depressed, sleeping a lot, and missing medication dose times?
    Is the person exhibiting signs of early cognitive decline that results in missed doses?

    Caregivers can track medication adherence, and send the report to the patient’s physician. Some advanced health systems may have computerized systems, with a link that can be accessed from the patient’s home or the caregiver’s laptop. These digital communications make coordination and knowledge of medication adherence easier, and are a step forward in improving adherence to improve health.

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