The impact of comorbidity on medication adherence and therapeutic goals

Abstract

IntroductionPrescribing medications is often challenging in olderpeople with multiple chronic diseases. Non-adherenceto prescribed medications is among the most importantproblems, so that many people are not benefiting prop-erly from the drugs they are prescribed. Additionally,this also represents a costly waste for health services [1].Comorbidity and medication adherencePoor adherence to the prescribed therapy is highly pre-valent in older patients. Prevailing evidence suggeststhat age per se should not be considered as a risk factorfor poor adherence [2]. Lower educational level, lessaffluent economic status, cognitive/physical impairment,being assisted by foreign caregivers, and some chronicdiseases, such as chronic renal failure, are commonlyreported poorly modifiable correlates of non-adherence.Regimen complexity represents a to some extent modifi-able correlate [2]. Vision impairment, reduced manualdexterity, and patients’ perception of medication impor-tance may contribute to determine the relationshipbetween regimen complexity and non-adherence. Thereis minimal evidence to support interventions thatimprove medication adherence, and the effects of psy-chosocial interventions are largely unknown [1].Therapeutic goals in patients with multiplechronic conditionsPatients with multiple chronic conditions may vary inregard to their opinion about health outcomes such aslonger survival, prevention of disease-specific events,physical and cognitive function, and tolerable risk ofadverse drug reactions. A paradigmatic example of howchallenging this issue can be in clinical practice is thedifficulty in rational prescribing for older patients withmultiple chronic conditions and reduced life expectancy,when the likelihood of benefit and goals of care mustalso be considered in addition to satisfying the basicprinciples of optimal medication use in the elderly [3].