Abstract
Background. Geriatric syndromes (GS) exhibit high prevalence in patients with end-stage renal disease (ESRD) under chronic dialysis irrespective of age. We sought to determine whether GS influences medication adherence in ESRD patients.Methods. A prospective cohort of chronic dialysis patients was assembled. The presence of GS components, including frailty/prefrailty, polypharmacy, and malnutrition, were ascertained through a validated questionnaire, electronic records and chart abstraction, and laboratory tests. The severity of medication non-adherence was defined using the eight-item Morisky Medication Adherence Scale (MMAS). Multiple logistic regression analysis was performed targeting MMAS results and incorporating relevant clinical features and GS.Results. The prevalence of frailty/pre-frailty, polypharmacy, and hypoalbuminemia/ malnutrition among the enrolled participants was 66.7%, 94%, and 14%, respectively. The average MMAS scores in these dialysis patients were 2 ± 1.7 (range, 0–6), with only 15.7% exhibiting high medication adherence. Multiple regression analyses showed that the absence of frailty/pre-frailty (P = 0.01) were significantly associated with poorer medication adherence, while the presence of polypharmacy (P = 0.02) and lower serum albumin, a potential sign of malnutrition (P = 0.03), were associated with poor adherence in another model.Conclusion. This study is among the very few reports addressing GS and medication adherence, especially in ESRD patients. Interventions targeting frailty, polypharmacy, and malnutrition might potentially improve the medication non-adherence and symptom control in these pill-burdened patients.
Highlights
Treatment adherence implies the extent to which patients’ behavior corresponds with the mutual agreement between patients and their care providers, and the scopes include but are not limited to prescribed medications, dietary advice, and diagnostic and treatment planning (Cutler & Everett, 2010)
We previously found that frailty, a type of Geriatric syndromes (GS) suggesting increased vulnerability to external stressors, occurs in 32%–80% chronic dialysis patients; the presence of frailty correlates with multimorbidity and hypoalbuminemia, both critical determinants of patient survival (Chao et al, 2015a)
With Morisky Medication Adherence Scale (MMAS) score as the dependent variable, we discovered that the presence of frailty/pre-frailty was independently associated with lower MMAS scores (P = 0.01)
Summary
Treatment adherence implies the extent to which patients’ behavior corresponds with the mutual agreement between patients and their care providers, and the scopes include but are not limited to prescribed medications, dietary advice, and diagnostic and treatment planning (Cutler & Everett, 2010). How to cite this article Chao et al (2016), Geriatric syndromes are potential determinants of the medication adherence status in prevalent dialysis patients. Failure to take appropriate medications constitutes a major barrier to successful treatment, increases patient–physician mistrust, and predisposes patients to complications stemming from chronic illnesses (Cutler & Everett, 2010; McDonald, Garg & Haynes, 2002). The average MMAS scores in these dialysis patients were 2 ± 1.7 (range, 0–6), with only 15.7% exhibiting high medication adherence. Multiple regression analyses showed that the absence of frailty/pre-frailty (P = 0.01) were significantly associated with poorer medication adherence, while the presence of polypharmacy (P = 0.02) and lower serum albumin, a potential sign of malnutrition (P = 0.03), were associated with poor adherence in another model. Interventions targeting frailty, polypharmacy, and malnutrition might potentially improve the medication non-adherence and symptom control in these pill-burdened patients
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