Adherence In Older Adults Research Articles

A systematic scoping review of interventions to optimise medication prescribing and adherence in older adults with cancer.

Older adults with cancer often require multiple medications (polypharmacy) comprising cancer-specific treatments, supportive care medications (e.g. analgesics), and medications for pre-existing health conditions. Increasing numbers of medications may increase risks of potentially inappropriate prescribing and non-adherence. To provide an overview of evaluations of interventions aimed at optimising medication prescribing and/or adherence in older adults with cancer. A systematic scoping review was undertaken. Four databases (PubMed, EMBASE, CINAHL, PsycINFO) were searched using relevant search terms (e.g. cancer, older adults). Eligible studies evaluated interventions seeking to improve medication prescribing and/or adherence in older adults (≥65 years) with cancer using a comparative evaluation. All outcomes for studies that met inclusion criteria were included in the review. Extracted data were collated using tables and accompanying narrative descriptive summaries. The review was reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. Nine studies met inclusion criteria comprising five randomised controlled trials (RCTs) and four before-and-after study designs. Studies were primarily conducted in oncology clinics, ranging from single study sites to 109 oncology clinics. Sample sizes ranged between 33 and 4844 patients. Interventions most commonly involved patient education (n=6) delivered by pharmacists or nurses. Three studies reported on prescribing-related outcomes and seven studies reported on adherence-related outcomes, using different terminology and assessment methods. Prescribing-related outcomes focused on medication appropriateness (using Beers criteria) and drug-related problems including drug interactions. Adherence-related outcomes included assessments of self-reported medication adherence and calculation of patients' medication possession ratio. This scoping review highlights a lack of robust evaluations of interventions aimed at optimising medication prescribing and adherence in older adults with cancer. Future research should improve rigour during intervention development, evaluation and reporting in order to generate findings that could inform future practice.

Self-management and Medication Adherence in Older Adults with Type II Diabetes Referring to the Endocrinology Clinics of the Teaching Hospital Affiliated to Iran University of Medical Sciences (2019)

Self-management and Medication Adherence in Older Adults with Type II Diabetes Referring to the Endocrinology Clinics of the Teaching Hospital Affiliated to Iran University of Medical Sciences (2019)

Interventions to optimise medication prescribing and adherence in older people with cancer: A systematic scoping review

Abstract Introduction Older adults with cancer often require multiple medications (polypharmacy) comprising cancer-specific treatments, supportive care medications (e.g. analgesics) and medications for pre-existing conditions. The reported prevalence of polypharmacy in older adults with cancer ranges from 13–92% (1). Increasing numbers of medications pose risks of potentially inappropriate prescribing and medication non-adherence. Aim The aim of this scoping review was to provide an overview of evaluations of interventions to optimise medication prescribing and/or adherence in older adults with cancer, with a particular focus on the interventions, study populations and outcome measures that have been assessed in previous evaluations. Methods Four databases (PubMed, EMBASE, CINAHL, PsycINFO) were searched from inception to 29th November 2019 using relevant search terms (e.g. cancer, older adults, prescribing, adherence). Eligible studies evaluated interventions seeking to improve medication prescribing and/or adherence in older adults (≥65 years) with an active cancer diagnosis using a comparative evaluation (e.g. inclusion of a control group). All outcomes for studies that met inclusion criteria were included in the review. Two reviewers independently screened relevant abstracts for inclusion and performed data extraction. As a scoping review aims to provide a broad overview of existing literature, formal assessments of methodological quality of included studies were not undertaken. Extracted data were collated using tables and accompanying narrative descriptive summaries. The review was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) guidelines (2). Results The electronic searches yielded 21,136 citations (Figure 1). Nine studies met inclusion criteria. Included studies consisted of five randomised controlled trials (RCTs), including one cluster RCT, and four before-and-after study designs. Studies were primarily conducted in oncology clinics, ranging from single study sites to 109 oncology clinics. Sample sizes ranged from 33 to 4844 patients. All studies had a sample population with a mean/median age of ≥65 years, however, only two studies focused specifically on older populations. Interventions most commonly involved patient education (n=6), and were delivered by pharmacists or nurses. Five studies referred to the intervention development process and no studies reported any theoretical underpinning. Three studies reported on prescribing-related outcomes and seven studies reported on adherence-related outcomes, using different terminology and a range of assessments. Prescribing-related outcomes comprised assessments of medication appropriateness (using Beers criteria), drug-related problems and drug interactions. Adherence-related outcomes included assessments of self-reported medication adherence and calculation of patients’ medication possession ratio. Conclusion The main strength of this scoping review is that it provides a broad overview of the existing literature on interventions aimed at optimising medication prescribing and adherence in older adults with cancer. The review highlights a lack of robust studies specifically targeting this patient population and limited scope to pool outcome data across included studies. Limitations of the review were that searches were restricted to English language publications and no grey literature was searched. Future research should focus specifically on older patients with cancer, and exercise rigour during intervention development, evaluation and reporting in order to generate findings that could inform future practice.

Exploring how age, medication usage, and dentures effect the sensory perception and liking of oral nutritional supplements in older adults

Sensory perception of Oral Nutritional Supplements (ONS) by older and younger adults has been investigated, but few studies have examined the sensory perception of ONS within different older adult cohorts. This study sought to investigate effects of older age, dentures, and medications on sensory perception, liking, and intake of a high- and low-viscosity ONS (0.009 and 0.177 Pa.s respectively at 50.1 s−1) and assess effects of ONS on appetite.Eighty older adults (51 aged 65–74 years, 29 aged 75 + years, mean age 74 ± 8 years, age range 65–97 years, 35 men, 45 women) evaluated two ONS over two different days. Each ONS (200 mL) was consumed over five sips (40 mL each). The panellists evaluated each sip using a check-all-that-apply questionnaire (CATA) comprising taste and texture attributes. After each CATA evaluation panellists recorded their liking using a 9-point hedonic scale followed by their hunger, fullness, desire to consume more ONS, and thirst using 100 mm visual analogue scales.The over 75 year olds had significantly lower appetite than the 65–74 year olds on tasting both ONS. Denture wearing influenced the mouthfeel while medication status effected the flavour perception of the high viscosity ONS. Liking did not change across the five sips for any study cohort, however, sensory perception changed with increasing sips. This study provides insight on factors affecting ONS adherence in older adults. Avoiding perceptions of watery/runny mouthfeel while maintaining creaminess may improve acceptability and adherence. The study justifies the CATA methodology for use in different older adult cohorts.

Cognitive Function and Functional Mobility Predict Exercise Adherence in Older Adults Who Fall

Introduction: Strength and balance exercises prevent falls. Yet, exercise adherence is often low. To maximize the benefit of exercise on falls prevention, we aimed to identify baseline cognitive and mobility factors that predict adherence to the Otago Exercise Program (OEP) – a home-based exercise program proven to prevent falls. Methods: We conducted a secondary longitudinal analysis of data from a randomized clinical trial (RCT) (OEP compared with usual care) among 172 participants who were assigned to the OEP intervention of the RCT. Adherence to the OEP was calculated as a percent score (i.e., [frequency of strength and balance retraining session per week/3 strength and balance retraining sessions per week] × 100). Executive function (i.e., mental flexibility) was measured using the Trail Making Tests (Part A and B: TMT B – TMT A) and the Digit Symbol Substitution Test (DSST). Short-term memory and encoding was measured using the Verbal Digits Forward test. Executive function (i.e., inhibition and working memory) was measured using the Stroop Color-Word Test and the Verbal Digits Forward minus Verbal Digits Backward test. Mobility was assessed using the Short Performance Physical Battery and the Timed Up and Go test. We used general estimation equations analysis to determine the predictors of adherence to the OEP. Results: Better set shifting (β = −0.06, z = −2.43, [SE = 0.02] p = 0.018] predicted greater OEP adherence. Greater attention and short-term memory (β = −6.99, z = −2.37 [SE = 2.95]) predicted poorer OEP adherence. Response inhibition, processing speed, working memory, and mobility assessed by the SPPB were not associated with adherence. Poorer baseline Timed Up and Go (β = 1.48 z = 1.94, [SE = 0.76]; p < 0.001), predicted better OEP adherence. Conclusion: Specific cognitive processes (i.e., executive function of set shifting, attention, and short-term memory) and functional mobility predicted exercise adherence. Further research needs to explore the pathways that explain why better attention and short-term memory predicted lower adherence and why poorer functional mobility led to better OEP adherence.

Effects of self-management programs on blood pressure, self-efficacy, medication adherence and body mass index in older adults with hypertension: Meta-analysis of randomized controlled trials.

To assess the effects of self-management interventions on systolic blood pressure, diastolic blood pressure, self-efficacy, medication adherence and body mass index in older adults with hypertension. Effective treatment of hypertension may require the practice of self-management behaviours. However, evidence on effects of self-management interventions on blood pressure, self-efficacy, medication adherence and body mass index in older adults with hypertension is lacking. A systematic review and meta-analysis. CINAHL, Cochrane Library, Embase, Ovid-Medline, PubMed, Scopus, Web of Science and other sources were searched to October 2020. Data were analysed using Comprehensive Meta-Analysis 2.0 and quality assessment was done using ROB 2.0. The pooled effect sizes were reported as Hedges' g values with corresponding 95% confidence intervals using a random-effects model. Twelve randomized controlled trials met our inclusion criteria. The results revealed that self-management interventions significantly decreased blood pressure and increased self-efficacy and medication adherence in older adult patients with hypertension, with no significant effect on body mass index. Self-management interventions have considerable beneficial effects in older adults with hypertension. Health care providers should implement self-management interventions to strengthen the patient's role in managing their health.

Factors associated with health literacy and medication adherence in the elderly patients with chronic kidney diseases

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.

Differential Diagnoses and Clinical Implications of Medication Nonadherence in Older Patients with Chronic Kidney Disease: A Review.

Older adults with chronic kidney disease (CKD) often have many comorbidities, which requires them to take multiple medications. As the number of daily medications prescribed increases, the risk for polypharmacy increases. Understanding and improving medication adherence in this patient population is vital to avoiding the drug-related adverse events of polypharmacy. The primary objective of this review is to summarize the existing literature and to understand the factors leading to medication nonadherence in older patients with CKD. In this review, we discuss the prevalence of polypharmacy, the current lack of consensus on the incidence of medication nonadherence, the heterogeneity of assessing medication adherence, and the most common differential diagnoses for medication nonadherence in this population. Specifically, the most common differential diagnoses for medication nonadherence in older adults with CKD are (1) medication complexity; (2) cognitive impairment; (3) low health literacy; and (4) systems-based barriers. We provide tailored strategies to address these differential diagnoses and subsequently improve medication adherence. The clinical implications include deprescribing to decrease medication complexity and polypharmacy, utilizing a team-based approach to identify and support patients with cognitive impairment, enriching communication between health providers and patients with low health literacy, and improving health care access to address systems-based barriers. Further research is needed to determine the effects of addressing these differential diagnoses and medication adherence in older adults with CKD.

Follow-up of a Wuqinxi exercise at home programme to reduce pain and improve function for knee osteoarthritis in older people: a randomised controlled trial.

Exercise therapy is a key intervention in the management of knee osteoarthritis (KOA) and recommended in international guidelines on KOA management. An effective home-exercise programme for frail older adults with KOA was successful in achieving high adherence. This randomised controlled trial was to compare the adherence to the exercise and lasting effects of follow-up 3months. Sixty-eight participants in the original Wuqinxi (WQX) exercise study were community dwelling older adults (age = 70.95 ± 9.85years) with KOA were categorised into 34 controls group, 34 WQX group adherers. The Western Ontario and Mc Master Universities Osteoarthritis Index questionnaire score (WOMAC) pain and Berg Balance Scale, Timed Up and Go Test, 6-min Walk Test, 30-s chair stand test, isokinetic muscle strength testing of knee flexion and extension measured at pre-test and post-test of the intervention period and follow-up for two groups. The WQX group maintained or improved in all nine measures from post-test to follow-up, whereas the control group significantly declined in WOMAC pain, Knee extensor strength and Knee flexor strength. The WQX programme was an effective home-exercise programme that achieves high adherence in older adults with KOA who lived in these communities.

Modifiable facilitators and barriers to exercise adherence in older adults with MCI/dementia using the Theoretical Domains Framework: a systematic review protocol

IntroductionExercise has multiple benefits on maintaining or improving cognitive function for people with mild cognitive impairment (MCI)/dementia. However, many older adults with MCI/dementia are not sufficiently active to achieve these...

What Types of Physical Function Predict Program Adherence in Older Adults?

Rehabilitation Nursing: 9/10 2020 - Volume 45 - Issue 5 - p E18-E19 doi: 10.1097/RNJ.0000000000000284

Factors Influencing Walking and Exercise Adherence in Healthy Older Adults Using Monitoring and Interfacing Technology: Preliminary Evidence.

Background: Monitoring and interfacing technologies may increase physical activity (PA) program adherence in older adults, but they should account for aspects influencing older adults’ PA behavior. This study aimed at gathering preliminary wrist-based PA adherence data in free-living and relate these to the influencing factors. Methods: Ten healthy older adults (4 females, aged 70–78 years) provided health, fatigue, activity levels, attitude towards pacing, and self-efficacy information and performed a 6 min-walk test to assess their fitness. After a baseline week they followed a two-week walking and exercise intervention. Participants saw their progress via a purposely designed mobile application. Results: Walking and exercise adherence did not increase during the intervention (p = 0.38, p = 0.65). Self-efficacy decreased (p = 0.024). The baseline physical component of the Short Form Health Survey was the most predictive variable of walking adherence. Baseline perceived risk of over-activity and resting heart rate (HRrest) were the most predictive variables of exercise adherence. When the latter two were used to cluster participants according to their exercise adherence, the fitness gap between exercise-adherent and non-adherent increased after the intervention (p = 0.004). Conclusions: Risk of over-activity and HRrest profiled short-term exercise adherence in older adults. If confirmed in a larger and longer study, these could personalize interventions aimed at increasing adherence.

Longitudinal Medication Adherence in Older Adults With Multimorbidity and Association With Health Care Utilization: Results From the Irish Longitudinal Study on Ageing.

The association between objectively measured nonadherence and health care utilization in multimorbid older people is unclear. To measure medication adherence across multiple chronic conditions, identify adherence patterns, and estimate the association between adherence and self-reported health care utilization. This is a retrospective cohort study of multimorbid participants aged ≥70 years in the Irish LongituDinal Study on Ageing (TILDA). Eligible participants had linked pharmacy claims data and completed TILDA wave 2 (2 years after wave 1). The RxRisk-V tool was used to identify multimorbidity. Average adherence (AA) across RxRisk-V conditions was estimated using the CMA7 function (AdhereR). Group-based trajectory models (GBTMs) identified adherence patterns in the 12 months following wave 1. Negative binomial regression was used to estimate the association between adherence and the rate of subsequent self-reported general practitioner [GP] visits, emergency department (ED) visits, outpatient visits, and hospitalizations in the 12 months following adherence measurement (reported at wave 2). Adjusted Incident Rate Ratios (aIRR) and 95% CIs are presented. Higher AA (CMA7) was associated with a small significant decrease in GP visit rate (aIRR = 0.70; CI = 0.53-0.94) and outpatient visit rate (aIRR = 0.44; CI = 0.23-0.81). GBTM identified 6 adherence groups (n = 1050). Compared with high adherers, group 1 (rapid decline, modest increase) membership (aIRR = 1.72; CI = 1.09-2.73) and group 4 (high adherence, delayed decline) membership (aIRR = 1.92; CI = 1.19-3.05) significantly increased ED visit rate. Suboptimal medication adherence in multimorbid older adults is associated with increased health care utilization. Identification of suboptimal adherence groups for medication management interventions may help decrease the health system burden and health care costs.

Comparative Responses To A Social Media Enhanced Physical Activity Program In Older Males And Females

Most older adults fail to adhere to the multicomponent (aerobic, muscle strengthening, balance training), 2018 Physical Activity (PA) Guidelines. Thus, effective and sustainable multicomponent PA programs that promote adherence in older adults remains a public health priority, especially for females given their higher rates of physical inactivity and risk for physical disability compared to males. PURPOSE: To examine if sex/gender influences the effects of a multicomponent 10-week PA intervention grounded in Social Cognitive Theory and augmented with social media (Facebook) on program attendance and engagement, PA behaviors, muscle capacity, and lower extremity physical function (LEPF) in older adults. METHODS: Physically inactive older adults (71.3 ± 4.3 yo; n=28, 64% female) completed a 10-week multicomponent PA program that included 1) a twice weekly supervised exercise class (muscle strength and balance training) with PA behavior education, 2) Facebook engagement, and 3) an unsupervised walking prescription. PA behaviors were assessed via accelerometer, questionnaires and pedometer step count logs. Conventional measures of leg strength and power along with a battery of LEPF tests were also employed [6-minute walk (6MW), 8-foot up and go (UPGO), chair stands (CHAIR), and transfer task (TRANSFER)]. A two-way [Gender (G) x Time (T)] ANOVA was utilized to determine significance of change. RESULTS: There was a trend for higher class attendance in females compared to males (96.7±3.8% vs. 92.0±6.7%, p=0.06). Females also had a 2.3-fold greater engagement in Facebook compared to males (p=0.01). Males and females improved PA behaviors similarly (T p<0.05; GxT and G p>0.05). Muscle capacity improved similarly (T p<0.05) with males, as expected, having higher leg strength and power (G p<0.05; GxT p>0.05). Regarding LEPF, improvements occurred in 6MW, UPGO and TRANSFER (T p<0.05; GxT p>0.05) with males also having higher functional capacity, as anticipated, in 6MW, UPGO, and CHAIR (G p<0.05). CONCLUSION: A 10-week PA/EX program improves PA behavior, muscle capacity, and LEPF similarly in older males and females. Implementation science research is needed to develop effective and sustainable multicomponent PA programs for older adults which may differ by social factors in older females compared to males.

Exergaming as a tool to enhance strength, balance, gait, mobility, participation, self-efficacy for exercise and adherence in older adults

Abstract Introduction It is projected that the number of adults aged 60 or above will be 1.4 billion in 2030 and 2.1 billion in 2050. With aging, mobility limitations can cause severe difficulties on being independent during activities of daily living. Exercise has been shown as effective to counteract the impact of aging, although it is hard to create adherence. Exergames, as they increase the appeal of exercise, show promising results in terms of participation and promotion of healthy behaviours. Objectives This study aimed at assessing the effectiveness of the Otago Exercise Program incorporated in FallSensing Exergames. Methodology Community-dwelling older adults aged 60 or over, were recruited from facilities in Coimbra, Portugal and randomized in two groups, 27 allocated to the intervention (IG) and 34 to the control (CG). Regular activities of daily living (CG) were compared to an Exergame program (IG). Assessments were made at baseline and re-assessments at 8 weeks/16 sessions, regarding strength, balance, walking speed, participation and self-efficacy for exercise. Results 61 older adults (77% female), mean ages were 82.22 (IG) and 87.26 (CG) years. After 8 weeks, CG demonstrated a decrease in functional ability. IG got improvement in Step test (p = 0.001), 4 Stage Balance Modified test (p = 0.001), Self-Efficacy for Exercise (p = 0.009) and Activities and Participation Profile Related to Mobility (p &amp;lt; 0.001) questionnaires. Conclusion Exergaming was safe and effective in improving functional ability, participation and self-efficacy. Nevertheless, some considerations are necessary when prescribing an Exergames, mainly concerning frequency and intensity of the exercise program and participants’ age.

0861 Age, Race, And Continuous Positive Airway Pressure (CPAP) Confidence Score At 1-week Predict 3-month CPAP Adherence In Older Adults With Amnestic Mild Cognitive Impairment And Moderate To Severe Obstructive Sleep Apnea

Abstract Introduction Adherence to continuous positive airway pressure (CPAP) may delay cognitive decline in older adults with obstructive sleep apnea (OSA) and amnestic mild cognitive impairment (MCI), defined as deficits in memory that do not significantly impact daily functioning. The aim of this analysis was to identify predictors of CPAP adherence in this population. Methods Data are from Memories 2, an ongoing multisite clinical trial on the effect of treatment of moderate to severe OSA on cognitive decline in older adults 65-85 years of age who have amnestic MCI. Unadjusted and adjusted linear models were used to examine predictors of mean hours of CPAP use at 3 months. Predictors were age, sex (male/female), race (White/Non-White), education (more than high school, less than high school), Apnea-hypopnea index (AHI), Epworth Sleepiness Scale (ESS), and CPAP Comfort and Confidence scores at 7 days. Collinearity in the adjusted model for CPAP use at 3 months was examined using the variance inflation factor. Results Of 57 participants, most were male (54%), White (72%), with a mean age of 66.3 years (SD: 6.1). Mean AHI in this sample was 35.1 (SD: 19.9), with mean daily hours of CPAP use at 3 months 5.3 hours (SD: 2.3). Adjusted linear model results demonstrated that younger age (β=-0.13, SE=0.04, p=0.0032), White race (β=2.56, SE=0.58, p&amp;lt;0.0001), and higher 7-day CPAP Confidence score (β=0.48, SE=0.17, p=0.0086) were significantly associated with CPAP use at 3 months. Sex, education, AHI, ESS, and CPAP comfort were not statistically significant predictors of adherence. Conclusion Tailored interventions to increase self-efficacy during the first 7 days of CPAP treatment, especially in Non-Whites and those older than 74 years, may improve long-term CPAP adherence in older adults with amnestic MCI. Support R01AG054435

Changes in chronic medication adherence in older adults with cancer versus matched cancer-free cohorts

ObjectivesA cancer diagnosis can influence medication adherence for chronic conditions by shifting care priorities or reinforcing disease prevention. This study describes changes in adherence to medications for treating three common chronic conditions – diabetes, hyperlipidemia, and hypertension – among older adults newly diagnosed with non-metastatic breast, colorectal, lung, or prostate cancer. MethodsWe identified Medicare beneficiaries aged ≥66 years newly diagnosed with cancer and using medication for at least one chronic condition, and similar cohorts of matched individuals without cancer. To assess medication adherence, proportion of days covered (PDC) was measured in six-month windows starting six-months before through 24 months following cancer diagnosis or matched index date. Generalized estimating equations were used to estimate difference-in-differences (DID) comparing changes in PDCs across cohorts using the pre-diagnosis window as the referent. Analyses were run separately for each cancer type-chronic condition combination. ResultsAcross cancer types and non-cancer cohorts, adherence was highest for anti-hypertensives (90–92%) and lowest for statins (77–79%). In older adults with colorectal and lung cancer, adherence to anti-diabetics and statins declined post-diagnosis compared with the matched non-cancer cohorts, with estimates ranging from a DID of −2 to −4%. In older adults with breast and prostate cancer cohorts, changes in adherence for all medications were similar to non-cancer cohorts. ConclusionOur findings highlight variation in medication adherence by cancer type and chronic condition. As many older adults with early stage cancer eventually die from non-cancer causes, it is imperative that cancer survivorship interventions emphasize medication adherence for other chronic conditions.

Benefits of a transtheoretical model-based program on exercise adherence in older adults with knee osteoarthritis: A cluster randomized controlled trial.

Benefits of a transtheoretical model-based exercise program on exercise adherence (primary outcome) and secondary outcomes (self-efficacy, decisional balance, knee osteoarthritis symptoms, and physical function) were assessed among older adults with knee osteoarthritis. A two-arm, superiority, assessor-blinded, cluster randomized trial with randomization at the community level. Participants were recruited from 14 communities in Beijing between April - October 2018 (N=189). The intervention was a 24-week transtheoretical model-based exercise program and the control group underwent a non-theory-based exercise program. Exercise adherence was collected every 4weeks and secondary outcomes were measured at baseline, 12weeks, and 24weeks. An independent t test and repeated-measures ANOVA were the main statistical tests. Most participants were women (92.5%), married (81.4%), with high-school education (36.0%), with both knees affected (50.3%), and did not make use of a walker (93.8%). There were no significant differences between groups in any of the outcome measures at baseline. Repeated-measures ANOVA indicated that there was a significant difference in the trend of adherence scores between the two groups from 0-24weeks. The independent t test showed that scores in the intervention group were significantly better than in the control group at 16, 20, and 24weeks. Improvements in the intervention group were also significantly greater in all secondary outcomes than in the control group. A theory-based exercise program could improve exercise adherence, self-efficacy, decisional balance, knee osteoarthritis symptoms, and physical functioning in older adults with knee osteoarthritis. Chinese Clinical Trials Registry number ChiCTR1800015458. Registered 31 March 2018. The 24-week theory-based exercise program could improve exercise adherence, self-efficacy, decisional balance, symptoms of knee osteoarthritis, and physical functioning in older adults with knee osteoarthritis. The theory-based exercise program could help older adults with knee osteoarthritis to improve their symptoms and knee function.

Interventions for improving medication-taking ability and adherence in older adults prescribed multiple medications.

Interventions for improving medication-taking ability and adherence in older adults prescribed multiple medications.

Enhancing medication adherence in older adults at two nurse practitioner-owned clinics.

The World Health Organization identified medication adherence as the greatest opportunity to improve outcomes related to chronic disease. Adherence rates of 80% or greater, or taking medication as prescribed at least 80% of the time, can positively impact health outcomes. A prior study at two nurse practitioner (NP)-owned family practice clinics in New Hampshire measured medication adherence among adult type-2 diabetes mellitus (DM) patients at 77% and declining over a 4-year period. Patients' hemoglobin A1c rates were stagnant despite previous initiative to improve this biomarker. Nurse practitioners were educated on provider-driven strategies to improve medication adherence in the older adult with DM, hypertension, and hyperlipidemia. A review of medical records was performed on patients for 52 weeks before seminar and 13 weeks after seminar to capture medication adherence rates and clinical biomarkers. Pre- and postseminar data were analyzed to determine whether the seminar resulted in improved adherence and clinical outcomes. Preseminar medication adherence rates exceeded evidence-based standards of 80% for each condition. Postseminar, statistically significant improved adherence rates were seen among DM patients with hypertension. Adherence worsened among hyperlipidemia patients, although this change was not statistically significant. Clinical biomarkers saw little change. This quality improvement project found that educating NPs on strategies to improve medication adherence can improve adherence among DM and hypertension patients. Continued education and measurement of adherence and clinical biomarkers are encouraged to capture more postseminar visits. This project adds to the growing body of knowledge about patients managed by NPs and NP-owned practices.