Intentional Prescription Nonadherence (Noncompliance) by the Elderly

Abstract

Prescription drugs are not always taken as directed. When there is a discrepancy between the use of a drug and the prescription directions, the drug-taking behavior is considered "nonadherent." To determine the extent of prescription non adherence by old persons and the reasons for nonadherence, an in-home survey was made of 111 elderly subjects who were taking prescription drugs. Drug-taking behavior was compared with the behavior implied by the prescription instructions, the reasons for the differences were sought. Of the study sample, 43 per cent showed such differences in use of one or more prescription drugs. The chief type of discrepancy was underuse (90 per cent of nonadherence). No difference was observed in most of the psychosocial variables studied between those who took drugs as directed and those who did not. Hypertensive subjects did not differ from those without hypertension. A large proportion of nonadherence (73 per cent) was intentional. Intentional nonadherence was more likely to occur in subjects who used two or more pharmacies and two or more physicians. Traditional efforts aimed at reducing the incidence of forgetting to take medicines would not seem to be helpful in cases of intentional nonadherence.

Treatment non-adherence among patients with poorly controlled type 2 diabetes in ambulatory care settings in southwestern Nigeria

“…Summarily, unintentional reasons for non-adherence mostly due to knowledge and practical barriers were more frequent than intentional non-adherence behaviors which were mostly attitudinal. This finding may probably be in contrast to a study which reported that intentional reasons for non-adherence are common than unintentional non-adherence 29 , nonetheless, the finding further underscores the need to encourage the use of patientcentered questioning approach as entrenched in RIM model 22 as a reasonable strategy in resolving non-adherence problems in routine clinical practice.…”

Congruence of Medication Information from a Brown Bag Data Collection and Pharmacy Records: Findings from the Seattle Longitudinal Study

“…A final possibility is nonadherence to prescription dosing instructions. Cooper, Love, and Raffoul (1982) found that most nonadherence in their sample of elderly persons was intentional and extended the length of a prescription. Underdosing has also been found in other studies of compliance or adherence (e.g., Isaac, Tamblyn, & the McGill-Calgary Drug Research Team, 1993).…”

The Impact of a Multidisciplinary Information Technology–Supported Program on Blood Pressure Control in Primary Care

“…A sample size of 250 patients per group would have a power of 80% to detect a difference in compliance rates of 5% (effect size of 0.25) at a standard deviation of 20%. 22,23 This sample size had more than 99% power to detect a difference in 24 hour SBP or DBP change from baseline (the primary end point) larger than 3.5 mm Hg (with standard deviations up to 7 mm Hg). 24…”