Association of Depression with Antihypertensive Medication Adherence in Older Adults: Cross-Sectional and Longitudinal Findings from CoSMO

Abstract

Background Little is known about the associations between depressive symptoms, social support and antihypertensive medication adherence in older adults. Purpose We evaluated the cross-sectional and longitudinal associations between depressive symptoms, social support and antihypertensive medication adherence in a large cohort of older adults. Methods A cohort of 2,180 older adults with hypertension was administered questionnaires, which included the Center for Epidemiologic Studies-Depression Scale, the Medical Outcomes Study Social Support Index, and the hypertension-specific Morisky Medication Adherence Scale at baseline and 1 year later. Results Overall, 14.1% of participants had low medication adherence, 13.0% had depressive symptoms, and 33.9% had low social support. After multivariable adjustment, the odds ratios that participants with depressive symptoms and low social support would have low medication adherence were 1.96 (95% confidence interval (CI) 1.43, 2.70) and 1.27 (95% CI 0.98, 1.65), respectively, at baseline and 1.87 (95% CI 1.32, 2.66) and 1.30 (95% CI 0.98, 1.72), respectively, at 1 year follow-up. Conclusion Depressive symptoms may be an important modifiable barrier to antihypertensive medication adherence in older adults

Qualidade de vida e adesão ao tratamento farmacológico entre idosos hipertensos

“…The support of family is also important to assist and supervise the elderly (22) , especially among those experiencing visual problems in the proper use of medicines for SH, whenever necessary. Consistent with this research, an international study of elderly patients with SH in the US found that the presence of indicative of depression was associated with low adherence to pharmacological treatment (p<0.01) (23) . In the same study, the authors report that low social support may have negatively influenced the adherence to pharmacological treatment (23) .…”

“…Consistent with this research, an international study of elderly patients with SH in the US found that the presence of indicative of depression was associated with low adherence to pharmacological treatment (p<0.01) (23) . In the same study, the authors report that low social support may have negatively influenced the adherence to pharmacological treatment (23) . Moreover, although it has not been the focus of this research, it is possible that the presence of depressive symptoms interfere in stimulating self-care, impacting adherence to pharmacological treatment.…”

Factors Associated with Non-Adherence to Three Hypertension Self-Management Behaviors: Preliminary Data for a New Instrument

“…4,5 Because HTN self-management NA is modifiable, identifying non-adherent patients is essential. Despite recognizing the influence of demographic, psychosocial, socioeconomic, and health belief-related factors on HTN self-management NA, [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] physicians have difficulty identifying non-adherent patients. Existing HTN NA prediction instruments are often complex and none are widely accepted.…”

The Elusiveness of Population-Wide High Blood Pressure Control

“…A nonconcurrent prospective analysis in 1,762 patients with hypertension suggested that initial combination therapy, compared with monotherapy followed by combination therapy, resulted in more rapid achievement of therapeutic goals and significantly fewer CVD complications and less mortality (33). Recognition and management of other barriers to medication adherence, including depression, psychosocial stress, substance abuse, and cognitive impairment, may also be important, especially in seniors, minorities, and socially disadvantaged patients (12,56,57). Fixed-dose combinations have been advocated as a means to provide an inexpensive, patientfriendly polypill designed to combat several CVD risk factors at the same time (44,59,65,92).…”