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Healthcare and Medication Adherence among Older Adults with Chronic Diseases
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Older adults account for almost one-third of all medications prescribed in the US. Of special concerns are the high rates of medication non-adherence in this population. Understanding the drivers of the medication non-adherence among the older population can inform effective public health interventions. This dissertation is divided into three separate sections, and each section examines different determinants of the medication non-adherence. The first section used systematic literature review and meta-analysis to describe the prevalence of medication non-adherence and overview the association between patient-provider relationship and medication non-adherence among community-dwelling older adults. Ten studies were included in this review. The mean prevalence rate of medication non-adherence was 33%. Information exchange was positively associated with medication non-adherence, but discussion about barriers was negatively associated with medication non-adherence. The second section used multiple linear mixed-effects models to examine the long-term impacts of the Chronic Disease Self-Management Program (CDSMP) on medication non-adherence in older adults. Medication adherence did not improve significantly at the 6-month follow-up assessment (p=0.518) but improved significantly at the 12-month follow-up assessment (p=0.021). Among those with major depression at the baseline assessment, the short-term improvements in depression (p=0.002) and self- iii rated health (p=0.045) were associated with improved medication adherence at the 12-month follow-up assessment. The third section used structural equation modeling to examine the causal paths between poverty, patient attitudes, and cost-related medication non-adherence (CRN). Six percent of the participants reported CRN in the past 12-months. The final model showed a good-to-fair fit. As hypothesized, the effects of poverty on CRN was mediated through the medication affordability, access to healthcare, and overall patient satisfaction. Medication non-adherence is a complex problem that is rooted in multitudes of inter-related factors, and the three sections have examined multiple modifiable factors, suggesting several points of intervention for improving medication adherence among older adults. We call for more senior-friendly public health interventions that address the modifiable barriers (e.g., patient-provider relationship, depression, self-rated health, and patient attitudes). Future studies are needed to understand the underlying complexity and guide the future interventions.
Lee, Shin Duk (2018). Healthcare and Medication Adherence among Older Adults with Chronic Diseases. Doctoral dissertation, Texas A & M University. Available electronically from