Abstract
Background: Detailed knowledge about nonadherence to medication could improve medical care in elderly patients. We aimed to explore patterns and reasons for nonadherence in people with Parkinson's disease (PD) aged 60 years and older.Methods: Detailed clinical data and adherence (German Stendal Adherence with Medication Score) were assessed in 230 patients with PD (without dementia). Descriptive statistics were used to study reasons for nonadherence in detail, and general linear models were used to study associations between clusters of nonadherence and clinical parameters.Results: Overall, 14.2% (n = 32) of the patients were fully adherent, 66.8% (n = 151) were moderately nonadherent, and 19.0% (n = 43) showed clinically meaningful nonadherence. In the multivariable analysis, nonadherence was associated with a lower education level, higher motor impairment in activities of daily living, higher number of medications per day, and motor complications of PD. Three clusters of nonadherence were observed: 59 (30.4%) patients reported intentional nonadherence by medication modification; in 72 (37.1%) patients, nonadherence was associated with forgetting to take medication; and 63 (32.5%) patients had poor knowledge about the prescribed medication. A lower education level was mainly associated with modification of medication and poorer knowledge about prescribed medication, but not with forgetting to take medication. Patients with motor complications, which frequently occur in those with advanced disease stages, tend to be intentionally nonadherent by modifying their prescribed medication. Increased motor problems and a higher total number of drugs per day were associated with less knowledge about the names, reasons, and dosages of their prescribed medication.Conclusions: Elderly patients with PD report many reasons for intentional and non-intentional nonadherence. Understanding the impact of clinical parameters on different patterns of nonadherence may facilitate tailoring of interventions and counseling to improve outcomes.
Highlights
Parkinson’s disease (PD) is the second most common neurodegenerative disease [1]
Several clinical parameters were recorded: the total daily number of medications administered in any pharmaceutical form, the levodopa equivalent daily dose [15], the Movement Disorder Society (MDS)-sponsored revision of the Unified Parkinson’s Disease Rating Scale (MDS-UPDRS), the revised non-motor symptoms questionnaire (NMS-Quest), and Hoehn & Yahr staging
Nonadherence was associated with a lower education level (β = 0.40, p = 0.002), higher rate of motor impairment in activities of daily living (MDS-UPDRS II, β = 0.35, p = 0.004), TABLE 1 | Principal component analysis
Summary
Parkinson’s disease (PD) is the second most common neurodegenerative disease [1]. Both the prevalence and incidence of Parkinson’s disease increase continuously with age. It is well known that nonadherence to medication is a major issue in chronic disorders such as Parkinson’s disease (PD) [2,3,4,5,6]. The factors associated with adherence to medications can be divided into patient characteristics, disease-related factors, financial and health system barriers, patient–provider relationship factors, and treatment-related factors [10, 11]. Several studies and reviews explored epidemiological and clinical factors associated with nonadherence to medication in PD, such as younger age, education level, marital status, mood disorders, cognition, disease duration, and regimen complexity [2, 4, 6, 11, 12]. We aimed to explore patterns and reasons for nonadherence in people with Parkinson’s disease (PD) aged 60 years and older
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