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:

decreased therapeutic benefits for the patient
frequent hospital
physician visits due to the deterioration of their medical condition
increased health care expenditure
overtreatment of a condition.

Causes of medication non-compliance among elderly

Causes of medication non-compliance among elderly can be classified into five categories:

Patient factors
Medication factors
Health care provider factors
Health care system factors
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:

formulation and packaging
drug regimen
drug handling
presence of adverse drug reactions
drug interactions
poor labeling instruction
lack of consequences when missed doses would inadvertently affect compliance to medications, especially in the elderly.
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:

Poor communication
Lack patient involvement
Lack of confidence in health care providers
Prescription by non-specialists
Lack of trust
Lack of review of medications
Dissatisfaction with doctor visits

Health care system factors

Health care system factors would include issues such as:

lack of health teaching
lack of follow up
lack of medication schedule given
short duration of prescription
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:

lack of caregivers
large caregiver burden where patients were reported to have a higher degree of nonadherence to medications.