Clinical Interventions in Aging is a reputable peer-reviewed journal that focuses on evidence-based research on the importance or lack thereof treatments to prevent or delay the beginning of maladaptive correlates of aging in human beings. The journal encourages accurate reporting and original research and reviews in aging patients. The reliance of this journal and educational benefits like; gaining more insights about patients with hypertension and researched and tested factors which influences their adherence to medication informed my decision to choose the following research article “factors influencing adherence to treatment in older adults with hypertension” for my review and discussion.
Hypertension is considered the most common disorder generally. Data indicates that older people suffer the most from this; challenges associated with older age and lack of enough education and capacity to fathom technicalities regarding the medication are among the contributors of adherence to medication for hypertension in older people (Uchmanowicz et al., 2018). However, the purpose of this research was to identify demographic, socioeconomic and clinical factors that affect the adherence of patients with HT (Uchmanowicz et al., 2018). Hypertension is a cardiovascular disease that causes some functional changes in the heart and vascular systems. This disorder affects 26.4% of the population globally; it occurs more in older people of 65 years of age and above.
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The independent and dependent variables of this study were; age of the patients that appeared as an independent variable, because the study sample were patients of 65 years and above and this could not be affected or change by the end of the study. Blood pressure measure mean of 130/80mmHg and adherence of patients to treatment were among the dependent variables of this study (Uchmanowiczet al., 2018). The decline in adherence or compliance to medication by hypertension patients in older age was attributed to challenges associated with older age, low level of education, side effects as a result of medication, socioeconomic challenges and lack of proper instruction on the use of medicine from healthcare professionals. Low level of education and awareness was especially a major contributor. Older people take the assumption that a one-time use of antihypertensive drugs will be enough, this lack of information and awareness about the consistency and frequency of using the medication affected medication adherence.
Despite recent advances in prevention, diagnosis and treatment of hypertension; Medical compliance is still a challenge to most patients, as a result, high blood pressure continues to be a silent killer disease and causing more damage. Lack of consistent medical adherence affects the effectiveness of the medication prescribed by physicians. This leads to readmissions and demand for extra care to ascertain compliance to medication (Rajpura & Nayak, 2014). According to Rajpura and Nayak (2014) reduction of functional abilities (capacity to read and understand information) in older patients and susceptibility to other chronic diseases and other polypharmacy factors alter medication adherence, this explains why younger patients have a high rate of medication adherence than the older group.
Interpersonal relationships between patient-hospital contributed to medical adherence immensely. The trust older patients have towards the quality of care and their physicians positively impact their adherence and vice versa (Krousel-Wood et al., 2009). The creation of friendly medication patterns combined with the values of the hospitals and good implementation of the program used to treat older patients with hypertension and evaluation of technicalities of the information about the medication for easy understanding and interpretation have been proofed to increase adherence levels to medications.
According to Krousel-Wood et al. (2009) socioeconomic factors like insurance coverage, family support, government support to patients suffering from hypertension, marriage, place of residence, the cost of health care and low level of education were the social factors found to influencing compliance or non-compliance to medication (Krousel-Wood et al., 2009). Older people living in urban settings, nursing homes, with family members and with enough retirement funds adhered to their medication unlike those who lived far from the hospital and with challenges economically and lack of family support.
This study had a sample of 150 older patients suffering from high blood pressure; the sample had 84 women and 66 men with an average mean age of 72.1 years. The Hill-Bone Compliance to High Blood Pressure Therapy Scale (Hill-Bone CHBPTS) was used to measure adherence to medical recommendations for hypertensive patients (Uchmanowicz et al., 2018). This was a cross-sectional clinical study to identify determining factors that influenced medication adherence by older patients with HT. The sample was considered based on the following criteria; previous diagnosis of HT at least 12 months before the study, 65 years of age and above, history of treatment, absence of cognitive impairment and mental disorders. Patients had the right to withdraw at any stage of the study and confidentiality of their information was assured (Uchmanowicz et al., 2018).
Sociodemographic and clinical data were collected by a specialist nurse both using interviews and access to some information from the patients’ records. This data was subjected to Hill-Bone CHBPTS to measure adherence. The questionnaire from the Hill-Bone CHBTS allowed the researchers to assess patients’ adherence to medical recommendations for HT therapy. The scores from the questionnaire ranged from 14-56. The higher the score, the lower the adherence levels and vice versa (Uchmanowicz et al., 2018). The Hill-Bone CHBTS measurement included; reduction in sodium intake, appointment keeping, medication taking and each item was scored at a 4-point scale. All patients acquired a mean of 20.19 from the Hill-Bone CHBTS scale and their scores ranged from 14-32 (Uchmanowicz et al., 2018). The obtained mean was positivity correlated with age and duration of the diseases and negatively with body mass index. The frequency of low adherence to appointment keeping was positively correlated with age and duration of the disease.
Men from the sample often disregarded reduction in sodium intake, widowed patients were found to be less compliant to medication. High education and level of awareness were associated with a higher probability of adherence to medication, retired patients and those who lived alone had a low rate of adherence. The use of cross-sectional study design limited the use of definitive statements about causation, the sample was also a limitation as it was small and recruited from a singer center. Identification of the underlying factors which influence medical adherence of older people living with hypertension will optimize care for these patients. In conclusion, this study found out that age and education level had a direct relation to adherence levels; the study recommended that physicians should pay close attention to age and education level when educating their patients about their medication. Medical practitioner should evaluate and breakdown technical information to their older patients with hypertension for easy understanding and interpretation, in order to improve compliance to medication.
References
Krousel-Wood, M., Muntner, P., Islam, T., Morisky, D. E., & Webber, L. (2009). Barriers to and Determinants of Medication Adherence in Hypertension Management: Perspective of the Cohort Study of Medication Adherence Among Older Adults. Medical Clinics of North America, 93 (3), 753-769.
Rajpura, J., & Nayak, R. (2014). Medication Adherence in a Sample of Elderly Suffering from Hypertension: Evaluating the Influence of Illness Perceptions, Treatment Beliefs, and Illness Burden. Journal of Managed Care & Speciality Pharmacy , 58-65.
Uchmanowicz, B., Chudiak, A., Uchmanowicz, I., Rosinczuk, J., & Froelicher, E. S. (2018). Factors influencing adherence to treatment in older adults with hypertension. Clinical Interventions in Aging, 13 , 2425-2441. Retrieved 4 8, 2020
