Abstract
Background: Medication adherence (MA) is the most important controlling factor of high blood pressure (HBP). There are a few MA models, but they have not been successful in predicting MA completely. Thus, this study aimed to ex-pand a conceptual model of MA based on an ecological approach. Methods: An integrative review of the literature based on theoretical and empirical studies was completed. Data source com-prised: Medline (including PubMed and Ovid), ISI, Embase, Google scholar, and internal databases such as Magiran, Google, SID, and internal magazines. Primary English and Persian language studies were collected from 1940 to 2018. The steps of study included: (a) problem identification, (b) literature review and extracting studies, (c) appraising study quality, (d) gathering data, (e) data analysis using the directed content analysis, (f) concluding. Results: Thirty-six articles were finally included and analyzed. After analysis, predictors of MA in older adults with hyper-tension were categorized into personal, interpersonal, organizational, and social factors. Although the personal factors have the most predictors in sub-categories of behavioral, biological, psychological, knowledge, disease, and medication agents, social, organizational and interpersonal factors can have indirect and important effects on elderly MA. Conclusion: There are many factors influencing MA of elderly with HBP. The personal factor has the most predictors. The designed model of MA because of covering all predictor factors, can be considered as a comprehensive MA model. It is sug-gested that future studies should select factors for study from all levels of the model.
Highlights
Despite recent advances in prevention, diagnosis and treatment of high blood pressure (HBP), as the silent killer continues with its major health and economic damages [1]
The personal factors have the most predictors in sub-categories of behavioral, biological, psychological, knowledge, disease, and medication agents, social, organizational and interpersonal factors can have indirect and important effects on elderly Medication adherence (MA)
The conceptual model of MA in older adults with HBP was shown in Fig. (2)
Summary
Despite recent advances in prevention, diagnosis and treatment of high blood pressure (HBP), as the silent killer continues with its major health and economic damages [1]. Medication non-adherence results in decreased treatment benefits for hypertensive patients, frequent hospital readmissions and physician visits due to deterioration of their medical condition and suffering from its complications such as coronary artery disease, heart failure, or cerebrovascular disease, and increased health costs [8, 9]. Because of reduced functional abilities, have multiple chronic diseases and polypharmacy that cannot take their medications properly [10]. They experience more challenges in MA than younger groups [5]. Medication adherence (MA) is the most important controlling factor of high blood pressure (HBP). This study aimed to expand a conceptual model of MA based on an ecological approach.
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