Non-Adherence to Physician’s Recommendations and Associated Risk Factors in Patients Aged 60 Years and Older

AIM. This study aimed to evaluate risk factors of low medication adherence in outpatients aged 60 and over.

MATERIALS AND METHODS. A total of 224 participants aged 60 years and over were included in the study. The mean age was 71.2±6.6 years, with 129 (57,6%) being female. General clinical examination, probable frailty screening using the «Age is Not a Hindrance» questionnaire were performed. Medication adherence was assessed using the four-item Morisky Medication Adherence Scale.

RESULTS. Adherent and non-adherent patients were comparable in terms of age (p = 0,598), gender (p = 0,563), intake of drug groups, adherence to healthy lifestyle principles, concomitant diseases, with the exception of diabetes mellitus, which was more common (p = 0,037) among non-adherent patients. A negative correlation was established between adherence to treatment and probable frailty (r = −0,24, p < 0,001), diabetes mellitus (= −0,14, p = 0,032). Non-adherence to the treatment regimen was associated with probable frailty (OR 0.26, 95% CI 0.12–0.56; p < 0.001), and the absence of the frailty and diabetes mellitus was associated with high adherence to treatment (OR 4,58, 95% CI 1,24–16,87, p = 0.022).

CONCLUSION. Medication non-adherence was found in 38,8% outpatients aged 60 and over. Multimorbid older patients with probable frailty and diabetes mellitus have a high risk of non-adherence to treatment.

1. Sabaté E., Bender B., Boulet LP., et al. Adherence to LongTerm Therapies: Evidence for Action [Internet]. World Health Organization — Institutional Repository for Information Sharing; 2003. Available from: https://apps.who.int/iris/handle/10665/42682

2. Приверженность лечению. Российское национальное руководство. Сетевое научное издание. Коллектив авторов. 2022. ИД «Академия Естествознания». АНО «Академия Естествознания». 224 c. ISBN 978-5-91327-746-6. [Adherence to treatment. Russian national guidelines. Online scientific publication. Collective of authors. 2022. Publishing House «Academy of Natural Sciences». ANO «Academy of Natural Sciences». 224 p. ISBN 978-5-91327-746-6. (In Russ.)].

3. Лукина Ю.В., Кутишенко Н.П., Марцевич С.Ю., Драпкина О.М. Новый метод комплексной оценки качества и приверженности фармакотерапии у пациентов с сердечно-сосудистыми заболеваниями. Кардиоваскулярная терапия и профилактика. 2023;22(1):3522. [Lukina Yu.V., Kutishenko N.P., Martsevich S.Yu., Drapkina O.M. Novel approaches to the comprehensive assessment of the quality and adherence to pharmacotherapy and its use in cardiovascular patients. Cardiovascular Therapy and Prevention. 2023;22(1):3522. (In Russ.)] doi: 10.15829/1728-8800-2023-3522.

4. Бойцов С.А., Карпов Ю.А., Логунова Н.А., Бурцев Ю.П., Квасников Б.Б., Хомицкая Ю.В. Пути повышения приверженности к антигипертензивной терапии. Российский кардиологический журнал. 2022;27(9):5202. [Boytsov S.A., Karpov Yu.A., Logunova N.A., Burtsev Yu.P., Kvasnikov B.B., Khomitskaya Yu.V. Ways to increase adherence to antihypertensive therapy. Russian Journal of Cardiology. 2022;27(9):5202. (In Russ.)] doi: 10.15829/1560-4071-2022-5202.

5. Николаев Н.А., Мартынов А.И., Скирденко Ю.П., Андреев К.А., Горбенко А.В. [и др.]. Международная декларация о приверженности лечению 2023 (Омская декларация.): презентация для российских читателей. Медицинский вестник Северного Кавказа. 2024;19(1):1–9. [Nikolaev N.A., Martynov A.I., Skirdenko Yu.P., Andreev K.A., Gorbenko A.V. [et al.]. International Declaration of Adherence to Treatment 2023 (Omsk Declaration.): Presentation for Russian readers. Medical News of North Caucasus. 2024;19(1):1–9. (In Russ.)] https://doi.org/10.14300/mnnc.2024.19001

6. Jansen E.M., van de Hei S.J., Dierick B.J.H., Kerstjens H.A.M., Kocks J.W.H., van Boven J.F.M. Global burden of medication nonadherence in chronic obstructive pulmonary disease (COPD) and asthma: a narrative review of the clinical and economic case for smart inhalers. J Thorac Dis. 2021;13(6):3846–3864. doi: 10.21037/jtd-20-2360.

7. Ma W. The national economy in 2022 tops the pressure to reach new heights. National Statistics Bureau; 2023. Available from: http://www.gov.cn/xinwen/2023-01/17/content_5737453.htm. Accessed August 20, 2024.

8. Дедов И.И., Мокрышева Н.Г., Мельниченко Г.А., Трошина Е.А., Мазурина Н.В., Ершова Е.В., Комшилова К.А., Андреева Е.Н., Анциферов М.Б., Бирюкова Е.В., Бордан Н.С., Вагапова Г.Р., Волкова А.Р., Волкова Н.И., Волынкина А.П., Дзгоева Ф.Х., Киселева Т.П., Неймарк А.Е., Романцова Т.И., Руяткина Л.А., Суплотова Л.А., Халимов Ю.Ш., Яшков Ю.И. Ожирение. Клинические рекомендации. Consilium Medicum. 2021; 23 (4): 311–325. [Dedov I.I., Mokrysheva N.G., Mel’nichenko G.A., Troshina E.A., Mazurina N.V., Ershova E.V., Komshilova K.A., Andreeva E.N., Antsiferov M.B., Biriukova E.V., Bordan N.S., Vagapova G.R., Volkova A.R., Volkova N.I., Volynkina A.P., Dzgoeva F.Kh., Kiseleva T.P., Neimark A.E., Romantsova T.I., Ruiatkina L.A., Suplotova L.A., Khalimov Iu.Sh., Yashkov Iu.I. Obesity. Clinical guidelines. Consilium Medicum. 2021;23(4):311–325. (In Russ.)] doi: 10.26442/20751753.2021.4.200832.

9. Ткачева О.Н., Котовская Ю.В., Рунихина Н.К. [и др.]. Клинические рекомендации «Старческая астения». Российский журнал гериатрической медицины. 2020;1:11–46. [Tkacheva O.N., Kotovskaya Yu.V., Runikhina N.K., et al. Clinical guidelines on frailty. Russian Journal of Geriatric Medicine. 2020;(1):11–46. (In Russ.)] https://doi.org/10.37586/2686-8636-1-2020-11-46.

10. Лукина Ю.В., Кутишенко Н.П., Марцевич С.Ю., Драпкина О.М. Опросники и шкалы для оценки приверженности к лечению — преимущества и недостатки диагностического метода в научных исследованиях и реальной клинической практике. Кардиоваскулярная терапия и профилактика. 2020;19(3):2562. [Lukina Yu. V., Kutishenko N. P., Martsevich S. Yu., Drapkina O.M. Questionnaires and scores for assessing medication adherence — advantages and disadvantages of the diagnostic method in research and actual clinical practice. Cardiovascular Therapy and Prevention. 2020;19(3):2562. (In Russ.)] doi: 10.15829/1728-8800-2020-2562.

11. Драпкина О.М., Шепель Р.Н. Оценка уровня физической активности у пациентов с избыточной массой тела и ожирением в Российской Федерации (ФАКТОР-РФ): обоснование и дизайн исследования. Профилактическая медицина. 2020;23(3):7–19. [Drapkina O.M., Shepel R.N. Assessment of the level of physical activity in patients with overweight and obesity in the Russian Federation(FACTOR-RF): argumentation and study design. The Russian Journal of Preventive Medicine. 2020;23(3):7–19. (In Russ.)] https://doi.org/10.17116/profmed2020230317

12. Pietrzykowski Ł., Michalski P., Kosobucka A., Kasprzak M., Fabiszak T., Stolarek W., Siller-Matula J.M., Kubica A. Medication adherence and its determinants in patients after myocardial infarction. Sci Rep. 2020;10(1):12028. doi: 10.1038/s41598-020-68915-1.

13. Jeyalakshmi K. J, Mahadev R., Shashidhara Yn., Thunga G., Ravishankar N., Sudhakar C., Sanatombi Devi E. Determinants of Medication Non-Adherence Among the Elderly with CoExisting Hypertension and Type 2 Diabetes Mellitus in Rural Areas of Udupi District in Karnataka, India. Patient Prefer Adherence. 2023;17:1641–1656. doi: 10.2147/PPA.S380784.

14. Приказ от 27.04.2021 № 404н об утверждении порядка проведения профилактического медицинского осмотра и диспансеризации определенных групп взрослого населения) в рамках проекта «Московское долголетие» (Постановление правительства Москвы от 18.12.2018 № 1578-ПП «О реализации в городе Москве проекта „Московское долголетие“»). [Order of 27.04.2021 No. 404n on approval of the procedure for conducting preventive medical examinations and medical examinations of certain groups of the adult population) within the framework of the Moscow Longevity project (Resolution of the Moscow Government of 18.12.2018 No. 1578-PP «On the implementation of the Moscow Longevity project in the city of Moscow»). (In Russ.)]

15. Liu J., Rozelle S., Xu Q., Yu N., Zhou T. Social engagement and elderly health in China: evidence from the China Health and Retirement Longitudinal Survey (CHARLS). Int J Environ Res Public Health. 2019;16(2):278. https://doi.org/10.3390/ijerph16020278

16. Tan S., Liu D., Zhang Y., Li S., Zhang K., Zuo H. Trends in blood pressure and hypertension among older adults and oldestold individuals in China between 2008–2018. Hypertens Res. 2023;46(5):1145–1156. doi: 10.1038/s41440-023-01183-4.

17. Chowdhury S.R., Dipak C.D., Sunna T.C., Beyene J., Hossain A. Global and regional prevalence of multimorbidity in the adult population in community settings: a systematic review and meta-analysis. EClinicalMedicine. 2023;57:101860. doi: 10.1016/j.eclinm.2023.101860.

18. Tyagi S., Koh V., Koh G.C., Low L.L., Lee E.S. Defining and measuring multimorbidity in primary care in Singapore: Results of an online Delphi study. PLoS One. 2022;17(12):e0278559. doi: 10.1371/journal.pone.0278559.

19. Finley C.R., Chan D.S., Garrison S., Korownyk C., Kolber M.R., Campbell S., Eurich D.T., Lindblad A.J., Vandermeer B., Allan G.M. What are the most common conditions in primary care? Systematic review. Can Fam Physician. 2018;64(11):832–840.

20. Демидова Т.Ю., Кочина А.С. Особенности лечения пожилых пациентов с сахарным диабетом 2 типа. FOCUS Эндокринология. 2023;4(2):36–41. [Demidova T.Yu., Kochina A.S. Pecularities of treatment of elderly patients with type 2 diabetes mellitus.FOCUS. Endocrinology. 2023;4(2):36–41. (In Russ.)] https://doi.org/10.15829/1560-4071-2023-15

21. Ахундова Х.Р., Дудинская Е.Н., Ткачева О.Н. Гериатрические аспекты сахарного диабета. Российский журнал гериатрической медицины. 2020;3:250–259. [Akhundova K.R., Dudinskaya E.N., Tkacheva O.N. Geriatric aspects of diabetes mellitus. Russian Journal of Geriatric Medicine. 2020;3:250–259. (In Russ.)] doi: 10.37586/2686-8636-3-2020-250-259.

22. Rea F., Savaré L., Valsassina V., Ciardullo S., Perseghin G., Corrao G., Mancia G. Adherence to antidiabetic drug therapy and reduction of fatal events in elderly frail patients. Cardiovasc Diabetol. 2023;22(1):53. doi: 10.1186/s12933-023-01786-8.

23. Faller J.W., Pereira D.d.N., de Souza S., Nampo F.K., Orlandi F.d.S., Matumoto S. Instruments for the detection of frailty syndrome in older adults: A systematic review. PLoS ONE. 2019;14:e0216166. doi: 10.1371/journal.pone.0216166.

24. Collard R.M., Boter H., Schoevers R.A., Oude Voshaar R.C. Prevalence of frailty in community-dwelling older persons: A systematic review. J. Am. Geriatr. Soc. 2012;60:1487–1492. doi: 10.1111/j.1532-5415.2012.04054.x.

25. Ларина В.Н., Самкова И.А., Федорова Е.В. Преастения как возможный корригируемый фактор риска падений у пациентов с артериальной гипертензией: открытое одноцентровое одномоментное исследование // CardioСоматика. 2024. Т. 15, № 2. С. 97–106. [Larina V.N., Samkova I.A., Fedorova EV. Prefrailty as a possible correctable risk factor for falls in patients with arterial hypertension: An open, cross-sectional study. CardioSomatics. 2024;15(2):97–106. (In Russ.)] https://doi.org/10.17816/CS625393.