Promoting Medication Adherence in the Elderly: Factors and Insights From a Cross‐Sectional Study

To compare two health literacy measurements' ability to assess older adults' medication adherence by using the Korean Health Literacy Screening Questions (KHLSQ) and the Modified Korean Functional Health Literacy Test (M-KFHLT), and to identify an appropriate health literacy measurement. Lower health literacy has been associated with poorer medication adherence. Thus, health professionals should evaluate the available health literacy assessment instruments they are using and choose an appropriate instrument to assess health literacy to increase older adults' medication adherence. Following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist, a descriptive, cross-sectional study was conducted. From November 2017-May 2018, 116 community-dwelling older adults were recruited in South Korea. Questionnaires were completed during a face-to-face interview with each participant in a private room; health literacy was assessed using the KHLSQ and the M-KFHLT and medication adherence using the Morisky Medication Adherence Scale. Health literacy assessed using the KHLSQ was found to be a predictor of medication adherence, but was not a predictor when measured by the M-KFHLT. Having low income, multiple chronic diseases and vision problems were also significant factors related to medication adherence. This study suggests that health literacy was negatively associated with medication adherence. Furthermore, KHLSQ is an appropriate tool for healthcare providers to use when assessing health literacy to predict older adults' medication adherence. This finding indicated that healthcare providers should select an appropriate health literacy measurement that suits their purposes and the population they serve, particularly for older adults.

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.

Although the optimal use of prescribed medications for stroke survivors is critical for preventing secondary stroke, longitudinal observations of the natural course of medication persistence and adherence in Korean stroke survivors are rare. Furthermore, studies are needed to identify strong predictors influencing medication adherence and to determine whether these predictors change over time. To evaluate the longitudinal medication persistence and adherence at 3 months and 1 year after discharge in all stroke patients and to identify predictors of long-term medication adherence in patients who can self-medicate. A multicentre, prospective, longitudinal descriptive study. A total of 600 consecutive ischaemic stroke patients were recruited from three stroke centres across Korea, from 1 September, 2017 to 28 February, 2019. Various factors related to medication adherence suggested by the World Health Organisation were investigated through face-to-face interviews at each centre during hospitalisation. Medication persistence and adherence were assessed at 3 months and 1 year after discharge using the eight-item Morisky Medication Adherence Scale through telephone interviews. Of 537 survivors at 3 months, 526 (98.0%) were persistent and 472 (89.7%) were adherent. Of 493 survivors at 1 year, 477 (96.8%) were persistent and 392 (82.2%) were adherent. Medication belief, income and health literacy were statistically significant predictors of three-month medication adherence, which predicted one-year medication adherence with older age and low income. Among Korean stroke survivors, three-month and one-year medication persistence and adherence were relatively good. Medication beliefs and three-month medication adherence were important and modifiable factors predicting three-month adherence and one-year adherence, respectively. To increase long-term adherence to medication, various strategies are needed to improve beliefs about medication, taking into account the patient's age and level of knowledge. These interventions need to be initiated during hospitalisation to form early medication habits after discharge.

With advances in science and technology and improvements in health literacy, more studies have focused on frailty prevention by promoting medication adherence, emphasizing the role of eHealth literacy. However, the association between eHealth literacy and medication adherence in frail older adults has not been well studied, and it is unknown whether urban-rural differences exist in this relationship. This study aims to examine the relationship between eHealth literacy and medication adherence in older people with different frailty statuses, emphasizing variations between rural and urban areas. Between November and December 2020, a total of 4218 urban and rural community members (aged ≥60 years) in China were recruited as participants using a multistage random sampling method. A face-to-face structured questionnaire survey was conducted to collect information on demographic characteristics, eHealth literacy (consisting of application, evaluation, and decision dimensions), and medication adherence. eHealth literacy was assessed using the Chinese version of the eHealth Literacy Scale developed by Norman and Skinner, and medication adherence was measured using the 4-item Morisky scale. We used a general descriptive analysis and stratified logistic regression models to examine how eHealth literacy is linked to medication adherence and urban-rural differences. There were 4218 respondents, of which 2316 (54.9%) lived in urban areas and 1902 (45.1%) in rural areas, respectively. After adjusting for potential confounders, among participants with prefrailty, eHealth literacy was associated with medication adherence in urban areas in terms of less application (adjusted odds ratio [AOR] 1.16, 95% CI 0.82-1.63), less evaluation (AOR 1.29, 95% CI 0.92-1.81), and less decision ability (AOR 1.20, 95% CI 0.86-1.68); eHealth literacy was linked with medication adherence in the rural areas in terms of less application (AOR 1.10, 95% CI 0.56-2.13), less evaluation (AOR 1.05, 95% CI 0.61-1.79), and less decision ability (AOR 1.10, 95% CI 0.64-1.90). Among frail participants, less eHealth literacy (AOR 0.85, 95% CI 0.48-1.51), along with its dimensions, including less application (AOR 0.85, 95% CI 0.47-1.54), evaluation (AOR 0.89, 95% CI 0.50-1.57), and decision ability (AOR 0.99, 95% CI 0.55-1.76), were associated with medication adherence in urban areas; less eHealth literacy (AOR 0.89, 95% CI 0.48-1.65), along with its dimensions, including less application (AOR 1.23, 95% CI 0.62-2.44), evaluation (AOR 0.98, 95% CI 0.53-1.82), and decision ability (AOR 0.90, 95% CI 0.49-1.67), were associated with medication adherence in rural areas. The results of this study suggest that there is an association between eHealth literacy and medication adherence among older people with frailty and prefrailty. To promote medication adherence, eHealth literacy can be helpful in tailoring interventions.

Context: One of the main factors related to health literacy in chronic kidney disease (CKD) is medication adherence. Aims: The present study aimed to investigate the factors associated with health literacy and medication adherence in older adults with CKD referring to Imam Khomeini Amol Nephrology Clinic in 2018. Setting and Design: This descriptive-analytical study was performed in 2018 in Imam Khomeini Amol Nephrology Clinic. Materials and Methods: This study was performed on 150 elderly CKD patients aged above 60 years. Sampling was done using available sampling method and with the anticipation of confounders. Demographic information, elderly health literacy, and medication adherence were assessed using a questionnaire and interview. Statistical Analysis Used: Data were described with mean, standard deviation, and frequency and analyzed using Chi-square tests. Results: The results showed that the age of the participants was 64.3 ± 3.89 years, and 40% of the elderly had an inadequate health literacy, 39.3% had insufficient health literacy, 20.7% had insufficient health literacy, and excellent health literacy was observed in none of the patients. The results showed that there was a statistically significant relationship between health literacy and medication adherence (P Conclusion: According to the results of the study on the low level of health literacy and its direct relationship with medication adherence, it can be said that more attention of nurses is needed to promote and follow drug adherence by educating patients with low levels of health literacy to prevent the progression of the disease and convert drug therapy to dialysis.

A prospective study was conducted to investigate the impact of treatment burden and health literacy on medication adherence among older adults with multiple chronic conditions (MCC) and to explore the potential moderating effects of demographic and clinical factors. Face-to-face structured interviews were conducted among older adults aged 60 and above using the Burden of Treatment Questionnaire (TBQ-15), Short Form Health Literacy Questionnaire (HLS-SF12), and Malaysia Medication Adherence Assessment Tool (MyMAAT). This study included 346 older adults aged 60 years and above with two or more chronic conditions (n = 346). Hypertension (30.2%), hyperlipidemia (24.0%), and diabetes (18.0%) were the most reported chronic conditions among participants. The mean score of treatment burden was 53.4 (SD = 28.2), indicating an acceptable burden of treatment. The mean score of health literacy was 16.4 (SD = 12.6), indicating a limited health literacy level among participants; meanwhile, the mean score of medication adherence was 32.6 (SD = 12.3), indicating medication non-adherence among participants. Medication adherence was significantly correlated with treatment burden (r = -0.22, p < 0.0001), health literacy (r = 0.36, p < 0.0001), number of chronic conditions (r = -0.23, p < 0.0001), and age (r = -0.11, p < 0.05). The study findings emphasize that multimorbid older adults with high treatment burdens and low health literacy are more likely to have poor medication adherence. This underscores the importance for clinicians to address these factors in order to improve medication adherence among older adults with multiple chronic conditions (MCC).

To review the relationship between health literacy and adherence to cardiovascular/diabetes medication. We searched EMBASE (1974-February 2012) and MEDLINE (1948-February 2012). Search terms included health literacy, numeracy, health education and related terms, health literacy measurement tools, and medication adherence. English-language articles of all study designs were considered. Articles were included if they had a measurement of health literacy and medication adherence and if participants were older adults taking drugs for cardiovascular illness or diabetes mellitus. A total of 1310 citations were reviewed, including 9 articles that reported on 7 research studies. Most studies were retrospective, and all were based in the US. Because there was considerable diversity in measurements, participant characteristics, and outcome measures, we conducted a narrative synthesis rather than a meta-analysis. In assessing study validity, we looked at participant selection, method of measuring health literacy and medication adherence, missing data or losses, and adjustment for confounders. Of the 7 included studies, only 1 found a demonstrable association between health literacy and refill adherence. One clinical trial failed to show significant improvements in medication adherence after an intervention to improve health literacy. The current evidence does not show a definite association between health literacy and medication adherence in older adults with cardiovascular disease or diabetes mellitus. In the absence of a definite link, efforts to develop interventions to improve health literacy would not necessarily improve adherence to cardiovascular medications. There is an urgent need for robust studies outside of the US, with wider, generalized recruitment of participants.

BackgroundAlthough health literacy was considered to play a crucial role in non-communicable chronic disease (NCD) prevention and control, the relationship of health literacy and medication adherence has rarely given attention among older adult Chinese population in previous studies, especially considered that they might be with cognitive impairment.PurposeThis study aimed to investigate the association between health literacy and medication adherence and mediation by cognitive ability among community-based older adults with chronic disease in Beijing of China.MethodsThe older adults aged 60 years old or over were recruited in a cross-sectional survey conducted in Beijing of China by using multistage, stratified sampling method. Of those, the participants with chronic disease and need to take long-term medicine were included in our study. The information about sociodemographic characteristics, health literacy, cognition ability, and medication adherence was collected by the questionnaire. The univariate and multiple logistic regression analysis were used to measure the association of health literacy and adherence medication, and mediate effect by cognitive ability.ResultsThe total of 4,166 older adult populations (average age: 70.61 ± 7.38 years) was included in this study, 1,395 participants (33.49%) were non-adherence, 1,983 participants (47.60%) had two chronic conditions or more, and 1,459 participants (35.02%) screened as cognitive impairment. The health literacy was negatively associated with medication adherence. The lower total scores of health literacy were found with a high risk of non-adherence [p < 0.01, adjusted odds ratio (OR) = 0.988 per one point increase, 95% CI: 0.982–0.993] controlling other covariates. However, their association tended to be weakened or even disappeared among the older adults with cognitive impairment compared with the populations with normal cognitive.ConclusionImproving health literacy might be a public health strategy to increase the medication adherence of older adults, but need to first identify the potential target population based on their cognitive ability.

Examining the relationship between antihypertensive medication satisfaction and adherence in older patients.

Background: Poor medication adherence may cause unfortunate consequences such as disease progression and even death, particularly in older adults. This study aimed to evaluate the effect of pillbox use on medication adherence among older adults with cardiovascular diseases. Materials and Methods: This study was conducted as a two-group randomized controlled trial in a clinic in Kerman, Iran in 2017. Participants included seventy patients who were randomly allocated to either a control or an intervention group. The patients in the intervention group were verbally educated to manage their medications using a pillbox for four consecutive weeks while their counterparts received their medications without the use of any drug reminders. Results: The mean score of all participants’ medication adherence was 4.02±2.19 at the beginning of the study. Medication adherence significantly improved in the intervention group during the study (P&lt;0.001) while it remained poor in the control group (P&gt;0.99). Finally, medication adherence was significantly better in the intervention group compared to the control group at the end of the study (P=0.001). Conclusion: In general, pillbox use can promote medication adherence in older adults with cardiovascular diseases thus it is recommended for improving medication adherence and minimizing the consequences of non-adherence.

Medication adherence is a crucial factor in managing and treating chronic diseases in older adults. Health literacy (HL) skills and rational drug use (RDU) knowledge are important for individuals to make informed decisions about medication adherence behaviours. This study was conducted to determine the association between medication adherence and rational drug use knowledge and health literacy in older adults residing in nursing homes. The cross-sectional study was conducted with 121 older adults residing in a nursing home in Turkey. The data were collected using the Participant Information Form, the Medication Adherence Report Scale (MARS-5), the Rational Drug Use Scale (RDUS), and The Turkish version of the European Health Literacy Survey Questionnaire (HLS EUEU-Q-TR). The mean age of the older adults was 69.92 ± 6.45 years and 76.9% were male. The mean score of MARS-5 was 21.80 ± 3.55. Among older adults, 43.8% were found to have inadequate RDU knowledge, 28.9% had inadequate HL, and 46.3% had problematic-limited HL. The RDU knowledge was a statistically significant strong predictor of medication adherence (R2 = 0.495, p < 0.001). The HL was a statistically significant predictor of medication adherence (R2 = 0.037, p < 0.05). The study found that medication adherence among older adults residing in nursing homes was moderate, RDU knowledge and HL levels were low, and medication adherence increased as RDU knowledge and HL levels increased.

ABSTRACTHealth literacy plays a vital role in patients’ understanding of their prescribed medication instructions. To inform strategies to assist providers in communicating in a manner that is easily understood by patients, it would be beneficial to determine the relationship between health literacy and the day-to-day aspects of medication adherence. This study identified: 1) differences of health literacy levels in medication adherence; 2) the association between health literacy and medication adherence; and 3) and factors associated with medication adherence score. A convenience sample of older predominantly African-American patients (N = 389), over the age of 60, completed a cross-sectional survey. Chi-square analysis assessed health literacy differences in five aspects of medication adherence. Ordinary linear regression analysis determined factors associated with medication adherence score. Patients with limited health literacy were more likely to forget to take their medications and more likely to take less medication than instructed than patients with adequate health literacy (χ2(5) = 15.91, p = .007, χ2(5) = 10.31, p = .036, respectively). REALM score was also significantly associated with medication adherence score (β= .016, p < .001, β = .009, p = .033), respectively). Findings suggest that providers seeking to improve medication adherence in older adults, particularly African-American patients, should focus communication on assessing health literacy levels prior to discussing medication instructions.

"This analysis examines the intricate interactions that exist link medication adherence, health literacy, and the socio-economic effects on individuals with hypertension. Hypertension, one of the most prevalent chronic conditions worldwide, requires in-depth understanding of the intricate relationships that exist between patients’ access to health information, adherence to prescribed treatment plans, and the broader socio-economic context. The appraisal reviews recent studies on the health literacy’s effect on hypertension patients’ adherence to medicine, with a focus on the contributions of social, institutional, and personal factors. It also examines the socio-economic consequences of low medication adherence and health literacy, emphasizing disparities in healthcare outcomes, increased medical costs, and worse life quality. This study looks at different methods to raise the level of health literacy and medication adherence in hypertensive populations, both individual and systemic. It emphasizes the significance of patient education programs, tailored communication strategies, and system innovations to address the unique challenges confronted by people with differing degrees of health knowledge. Furthermore, the study investigates the potential financial benefits of enhancing medication compliance and health literacy, illustrating how targeted interventions could reduce medical expenses, prevent problems, and foster a more robust community. It emphasizes the need for collaboration between lawmakers, communities, and medical professionals in order to enact workable policies and decrease the socio-economic toll that hypertension has. The intricate interactions between medication adherence, health literacy, and socio-economic determinants in relation to hypertension are highlighted in the analysis’s conclusion. By understanding and addressing these characteristics, healthcare stakeholders can develop targeted treatments to improve outcomes for patients with hypertension, advance health equity, and improve societal well-being."

The global population is rapidly aging. Owing to their unique characteristics, older adults require innovative educational methods to optimize the effectiveness of behavioral change, and microlearning is a recent educational model. This study aimed to examine the impact of microlearning-based education on medication adherence and health literacy in the elderly population. This randomized controlled trial was conducted in 2024, with a trial registration number of (IRCT20191231045966N2) (10/04/2024). A total of 118 elderly participants were selected on the basis of the inclusion criteria and allocated to the intervention and control groups via the block randomization method. The data collection tools included demographic questionnaires, the Morisky medication adherence scale and the health literacy scale. The intervention group received video clips designed via the microlearning method, whereas the control group received standard interventions. The participants completed the aforementioned questionnaires at baseline and after 8 weeks. The collected data were entered into SPSS software version 22 and analyzed via descriptive (frequency, percentage, mean, standard deviation) and inferential (chi-square, Fisher’s exact test, independent t test) statistics. No significant differences were found between the intervention and control groups in terms of age, sex, marital status, education level, income status, type of disease, method of obtaining medication information, medication adherence level, or health literacy before the intervention, confirming homogeneity. The post intervention results revealed a significant difference in the mean medication adherence score between the intervention group (6.71 ± 1.78) and the control group (5.66 ± 2.10) (P = 0.001), indicating a greater level of medication adherence in the intervention group. However, in the health literacy domain, despite an increase in the mean health literacy score in the intervention group (66.96 ± 14.41) compared with that in the control group (63.03 ± 15.74), no statistically significant difference was observed between the two groups (P = 0.160). The microlearning training method is an effective educational approach for enhancing medication adherence in older adults. Proper medication use is likely to improve disease management and ensure a better quality of life for older adults. Therefore, the implementation of this educational method to increase health-related variables for this group is recommended.

ObjectivesTo give an overview over the associations between self-reported health literacy and medication adherence in older adults.DesignA systematic literature review of quantitative studies published in English and German.Data sourcesMEDLINE via...