The Medication adherence in elderly people referring to the primary health care centers and its effective factors in East Azerbaijan province -Iran: A mixed-method study

Main Article Content

Nurdiana Dewi

Keywords

Fish bone powder; Haruan fish; jaws and teeth development; mineralization

Abstract

Introduction


The high rate of population aging and the increasing use of multiple therapies has made Medication Adherence (MA) among the elderly very important issue. The aim of this study was to determine the level of MA and related factors in elderly people (60 years and over) with chronic disease referring to the Primary Health Care (PHC) centers in East Azerbaijan Province-Iran.


Methods:


This is a mixed-method study conducted in East Azerbaijan in 2020. The quantitative data were collected from 320 elderly people (60 years old and over). The qualitative data were collected from medicine experts, PHC providers and the elderly people. The data were collected using Medication Adherence Scale (MMAS-8) questionnaire, socio- demographic questionnaire and an open-ended questionnaire. The quantitative data analyzes was carried out using descriptive statistics and Chi-square, T-test, One Way ANOVA test, and the qualitative data analyzes was carried out using Content-Analysis method.


Results:


The mean score of MA was 3.14± 1.63. The majority of the elderly people, 251 (83.1%) had poor MA score. The most important factors affecting MA were categorized into four domains: the elderly self-esteem, provider-related factors, family-related factors, and other factors. The most important strategies for enhancing MA were divided into four domains: the education, medication management interventions, supportive measures and other strategies. The most important roles of the health system and the PHC providers were divided into six domains: the education, follow-up on medicine use, appropriate communication with the elderly, quality care provision, appropriate medicines preparation and administration, and collaboration with the elderly. The most important factors of non-adherence among the elderly were categorized in three domains: medicine related factors, elderly related factors and factors related to the access problems.


Conclusion


Our findings show that the mean score of the MA in the elderly referring to the PHC centers in East Azerbaijan province was low.

Abstract 78 | PDF Downloads 46

References

1. Salarvand Sh, Abedi H. The Elders' Experiences of Social Support in Nursing Home: A Qualitative Study. Iran Journal of Nursing. 2007;20(52):39-50.
2. Blake VK. WHO Study on global ageing. International journal of aging Medication
3. Lock CA, et al. Lifestyle interventions to prevent osteoporotic fractures: a systematic review. Osteoporosis international: a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA. 2006;17(1):20-8.
4. World Health Organization, World report on ageing and health; 2015
5. Berthoud R, Blekesaune M, Hancock R. Ageing, income and living standards: evidence from the British household panel survey. Ageing Soc. 2009;29: 1105–1122.
6. Mehri N, Messkoub, M, & Kunkel, S. (2019). Trends, determinants and the implications of population aging in Iran (No. 646). ISS Working Papers - General Series. International Institute of Social Studies of Erasmus University (ISS). Retrieved from http://hdl.handle.net/1765/118519.
7. Canbaz S, Sunter A, Dabak S, Peksen Y. The prevalence of chronic diseases and quality of life in elderly people in Samsun. Turkish Journal of Medical Sciences. 2003; 33:335-40.
8. Ahmadi B, Alimohamadian M, Mahmoodi M. Polypharmacy among older adults in Tehran. Tehran University Medical Journal. 2006;64(9):65-71.
9. Aronson JK. Medication errors: what they are, how they happen, and how to avoid them. QJM: An International Journal of Medicine. 2009;102(8):513-21.
10. Takane AK, Balignasay MD, Nigg CR. Polypharmacy reviews among elderly populations project: assessing needs in patient-provider communication. Hawai'i journal of medicine & public health: a journal of Asia Pacific Medicine & Public Health. 2013;72(1):15-22.
11. Lampela P, Hartikainen S, Sulkava R, Huupponen R. Adverse drug effects in elderly people -- a disparity between clinical examination and adverse effects self-reported by the patient. European journal of clinical pharmacology. 2007;63(5):509-15.8.
12. Mizokami F, Koide Y, Noro T, Furuta K. Polypharmacy with common diseases in hospitalized elderly patients. The American journal of geriatric pharmacotherapy. 2012;10(2):123-8.
13. Basu S, Millett C. Social epidemiology of hypertension in middle-income countries: determinants of prevalence, diagnosis, treatment, and control in the WHO SAGE study. Hypertension (Dallas, Tex : 1979). 2013;62(1):18-26.
14. Vrijens B, et al. Adherence to prescribed antihypertensive drug treatments: longitudinal study of electronically compiled dosing histories. BMJ (Clinical research ed). 2008;336(7653):1114-7.
15 .Berrut G. The medication adherence in the elderly: A collective goal 2014. 121-2 p.
16. jahani s, et al. Related of knowledge and attitude with medication control of tuberculosis patients referring to Ahwaz anti T.B center. Iranian Journal of Nursing Research. 2011;5(19):52-7.
17.Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care. 1986;24(1):67–74. doi: 10.1097/00005650-198601000-00007. [PubMed: 3945130]
18. Kooshyar H, et al. Health Literacy and its Relationship with Medical Adherence and Health-Related Quality of Life in Diabetic Community-Residing Elderly. Journal of Mazandaran University of Medical Sciences. 2014;23(1):134-43.
19. Bengtsson M. How to plan and perform a qualitative study using content analysis. NursingPlus Open. 2016; 2:8-14.
20. Guba, E. (1981). ERIC/ECTJ Annual Review Paper: Criteria for Assessing the Trustworthiness of Naturalistic Inquiries. Educational Communication and Technology, 29(2), 75-91. Retrieved March 13, 2020, from www.jstor.org/stable/30219811
21. Skov J, et al. Plenty of pills: polypharmacy prevails in patients of a Danish anticoagulant clinic. European journal of clinical pharmacology. 2011;67(11):1169-74.
22. Haider SI. et al. Analysis of the association between polypharmacy and socioeconomic position among elderly aged ? 77 years in Sweden. Clinical therapeutics. 2008;30(2):419-27.
23. Shahin W, Kennedy GA, Stupans I. The impact of personal and cultural beliefs on medication adherence of patients with chronic illnesses: a systematic review. Patient Prefer Adherence. 2019;13:1019-1035
https://doi.org/10.2147/PPA.S212046
24. Pasina, L., Brucato, A.L., Falcone, C. et al. Medication Non-Adherence Among Elderly Patients Newly Discharged and Receiving Polypharmacy. Drugs Aging 31, 283–289 (2014). https://doi.org/10.1007/s40266-014-0163-7
25. Zhou, P., Hughes, A.K., Grady, S.C. et al. Physical activity and chronic diseases among older people in a mid-size city in China: a longitudinal investigation of bipolar effects. BMC Public Health 18, 486 (2018). https://doi.org/10.1186/s12889-018-5408-7
26. Cramer J, et al. The significance of compliance and persistence in the treatment of diabetes, hypertension, and dyslipidaemia : A review. International journal of clinical practice. 2008; 62:76-87.
27. Borji M, et al. Adherence to treatment in older adults on hemodialysis in Ilam in 2014-15. nursing of the vulnerable journal. 2016;3(6):15-26.
28, Grant J, Hoorens S, Sivadasan S, van het Loo M, DaVanzo J, Hale L, et al. Low fertility and population ageing. 2004.
29. Kiani S, Bayanzadeh M. The Iranian population is graying: are we ready? Archives of Iranian medicine. 2010;13(4):333.
30. Danial Z, et al. Ageing in Iran. Lancet. 2014;384(9958):1927. DOI:https://doi.org/10.1016/S0140-6736(14)62278-9
31. Afshar PF, Asgari P, Shiri M, Bahramnezhad F. A review of the Iran's elderly status according to the census records. Galen Medical Journal. 2016;5(1):1-6.
32. Khosravi A, et al. Population ageing in IR Iran. Tehran, Iran: United Nations Population Fund in Iran. 2014.
33. Löckenhoff CE, et al. Perceptions of aging across 26 cultures and their culture-level associates. Psychology and aging. 2009;24(4):941.
34. Mayo-Gamble TL, Mouton C. Examining the Association Between Health Literacy and Medication Adherence Among Older Adults. Health Commun.2018;33(9):1124-30.
35. Löckenhoff CE, et al. Cross-cultural differences in attitudes about aging: Moving beyond the East-West dichotomy. Successful aging: Springer; 2015. p. 321-37.
36. Tabuchi H. Japan is paying immigrants to go home and not come back. The New York Times. 2009:1.
37. Amini R, Ingman S, Sahaf R. Aging in iran: past, present and future. The Journal of Aging in Emerging Economies. 2013; 4:17-34.
38. Masoudi R, et al. The effect of family centered empowerment model on the quality of life in elderly people. The Journal of Qazvin University of Medical Sciences. 2010;14(1):5, 64-7.
39. Fakhri A, Morshedi H, Mohammadi Zeidi I. Effectiveness of Theory Based Education on Medication Adherence in Older Adults with Hypertension. Jundishapur Sci Med J 2017;16(2):161-174.
40. Marcum ZA, Hanlon JT, Murray MD. Improving Medication Adherence and Health Outcomes in Older Adults: An Evidence-Based Review of Randomized Controlled Trials. Drugs Aging. 2017;34(3):191-201.