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Nursing care plan for medication non-adherence in elderly

Medication compliance is a passive act of the patient to follow the providers orders.

Medication adherence is defined as the extent to which patients take medications as prescribed by health care providers.

Medication non-compliance: a passive or active process whereby the patient chooses to deviate from the treatment regimen.

Compliance to medications has always been a problem among geriatric patients. As the elderly are prone to multiple comorbidities, they are at higher risk of polypharmacy, and higher risk of non-compliance to medications compared to the younger population.

This results in:
  1. decreased therapeutic benefits for the patient
  2. frequent hospital
  3. physician visits due to the deterioration of their medical condition
  4. increased health care expenditure
  5. overtreatment of a condition.

Causes of medication non-compliance among elderly

Causes of medication non-compliance among elderly can be classified into five categories:
  1. Patient factors
  2. Medication factors
  3. Health care provider factors
  4. Health care system factors
  5. Socioeconomic factors

Patient factors

Medication non-compliance depends on different patient factors that may affect an individual's willingness and ability to adhere to a medication schedule. These factors from various different studies have been grouped under subcategories such as:
  • mental state
    • Memory
    • Lower cognitive function
    • Executive function
    • Sleep disturbances
    • Depression / Anxiety
  • physical health
  • Demographics
    • Low education level
    • Marriage
  • past medical history
  • behavior/attitudes/habits
    • Nonadherence to follow ups
    • Personality: neuroticism
    • Use of complementary and alternative medicines
    • Concurrent use of OTC
    • Problem drinking
    • Lower self-care
    • Resisting care
    • Lack of interpersonal relationships
  • knowledge/beliefs
    • Beliefs about medication (ex: a pill for every ill)
    • Health literacy (Lack of knowledge about medications or condition \ Lack of perceived benefit of medications)
    • Misunderstanding of verbal instructions
    • Lack of threatening view of illness

Medication factors

Different medication factors such as:
  1. formulation and packaging
  2. drug regimen
  3. drug handling
  4. presence of adverse drug reactions
  5. drug interactions
  6. poor labeling instruction
  7. lack of consequences when missed doses would inadvertently affect compliance to medications, especially in the elderly.
  8. cost of medication

Health care providers factors

In an ideal health care provider–patient relationship, the patient would trust that the health care provider is acting in their best interests and would be more likely to adhere to the medications given.

Health care providers factors affecting medication compliance:
  1. Poor communication
  2. Lack patient involvement
  3. Lack of confidence in health care providers
  4. Prescription by non-specialists
  5. Lack of trust
  6. Lack of review of medications
  7. Dissatisfaction with doctor visits

Health care system factors

Health care system factors would include issues such as:
  1. lack of health teaching
  2. lack of follow up
  3. lack of medication schedule given
  4. short duration of prescription
  5. lack of community nursing services to pack medications
With a shorter duration of prescription, the elderly could feel inconvenienced as there is a need for more trips to be made to the pharmacy for medication refills, thus increasing the risk of medication non adherence when medications are not refilled.

when there is a lack of health teaching, the patient may not understand the importance of taking medications especially for chronic diseases such as hypertension, diabetes, and hypercholesterolemia.

They may have the misconception that “I'm well, I've no symptoms, there is no need for me to take medications everyday”. These misconceptions need to be corrected with patient education.

Socioeconomic factors

issues with caregiver such as:
  1. lack of caregivers
  2. large caregiver burden where patients were reported to have a higher degree of nonadherence to medications.

Nursing care plan for medication non-adherence in elderly

Know what hinders Patients from adhering to medication regimen:

  1. Ask patients if they have trouble preparing or taking medications
  2. Ask patients if they can't afford their prescribed medications.
  3. Create a blame-free environment so patients feel comfortable speaking the real reasons.
  4. Make patients expect and understand possible side effects:
  5. Give Patients health teaching about the potential side effects in advance.
  6. Explain to patients the probability of those side effects, and if they resolve without intervention, or what treatment plan is followed if they don’t resolve?
  7. After giving patients a health teaching session, allow them to summarize what they understood.
  8. Provide medication calendars, pill cards, schedules, or charts that specify when and how to take medications.

Collaborate with patients:

  1. Ask patients about the time they would like to take medications during.
  2. Link medication taking with habits that the patient adheres to (prayers, waking up, meals).
  3. Consider the financial burden to patients, refer patients to physician to seek cheaper alternatives, or refer patients to their health insurance which provides 30-days medication supply to patients.

Educational interventions:

  1. Asses patient health literacy, the degree to which individuals are able to obtain, process, and understand basic health information and services, which greatly affect patient compliance with medication.
  2. According to patient needs provide appropriate interventions, so patients understand when, how, and why to take their medications.
  3. Patient may find it harder to stick to regimen due to complexity of the drug regimen. Collaborate with physician to prescribe combination products or to prescribe medications with once-daily dosing instead of multiple doses per day.

During follow-up appointments:

  1. Assess patient's medication compliance and whether they understand why they need to take their medication as prescribed even when they’re symptom-free.
  2. Create with the patient a system of rewards that follow successful compliance, this is due to the fact that rewards provides positive reinforcements for compliant behavior.
  3. Educate the patient and the family members on the treatment regimen that the patient will undergo.
  4. Provide specific instructions as indicated and as asked by the patient, Information allows the patient to better take control in selecting and implementing required changes in behavior.
  5. Provide social support through the patient’s family and self-help groups.


  1. Alloway, R. R. (2017, April 17). U.S. food and Drug Administration. Retrieved April 08, 2021, from
  2. Angela Frances Yap, Thiru Thirumoorthy, Yu Heng Kwan, Medication adherence in the elderly, Journal of Clinical Gerontology and Geriatrics, Volume 7, Issue 2, 2016, Pages 64-67, ISSN 2210-8335, retrieved from:
  3. Costa, E., Giardini, A., Savin, M., Menditto, E., Lehane, E., Laosa, O., Pecorelli, S., Monaco, A., & Marengoni, A. (2015). Interventional tools to improve medication adherence: review of literature. Patient preference and adherence, 9, 1303–1314. retrieved from:
  4. Toni L. Apgar, BS, RN, and Mark Nunlist, MD, MS (2016). Practical Ways to Improve Medication Adherence,
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