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. 2009 Jun;21(4):567-80.
doi: 10.1177/0898264309332836. Epub 2009 Apr 1.

Medication adherence in healthy elders: small cognitive changes make a big difference

Tamara L Hayes  1 , Nicole Larimer, Andre Adami, Jeffrey A Kaye
Affiliations

Medication adherence in healthy elders: small cognitive changes make a big difference

Tamara L Hayes et al. J Aging Health. 2009 Jun.

Abstract

Objective: This was a cross-sectional study of the ability of independently living healthy elders to follow a medication regimen. Participants were divided into a group with High Cognitive Function (HCF) or Low Cognitive Function (LCF) based on their scores on the ADAS-Cog.

Method: Thirty-eight participants aged 65 or older and living independently in the community followed a twice-daily vitamin C regimen for 5 weeks. Adherence was measured using an electronic 7-day pillbox.

Results: The LCF group had significantly poorer total adherence than the HCF group (LCF: 63.9 +/- 11.2%, HCF: 86.8 +/- 4.3%, t( 36) = 2.57, p = .007), and there was a 4.1 relative risk of non-adherence in the LCF group as compared to the HCF group.

Discussion: This study has important implications for the conduct of clinical drug trials, as it provides strong evidence that even very mild cognitive impairment in healthy elderly has a detrimental impact on medication adherence.

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Figures

Figure 1
Figure 1
The instrumented pillbox used in this study. The 7-day reminder box was identical to that used by many participants to manage their non-study medications.
Figure 2
Figure 2
Plot of data from one subject. The abscissa is the date of monitoring (shaded bars show alternating days) and the ordinate shows the time of day the pill was taken. The dots indicate the times at which pills were taken. The solid horizontal lines indicate the morning and evening time at which pills were supposed to be taken; the dotted horizontal lines delineate one hour before this time and two hours after this time – that is, the window during which the participant was considered to be adherent to the regimen. The arrows show pills that were taken outside of this window. The X's indicate that a pill was missed. Total adherence is then calculated as the percentage of days in which two pills were taken (for this participant, 71.4%). Adherence to regimen is calculated as the percentage of days in which pills were taken within the specified window (78.6%). Regimen adherence can also be calculated for morning only (91.4%) or evening only (65.7%).
Figure 3
Figure 3
Means (with standard error bars) of adherence between the High Cognitive Function (gray bars) and Low Cognitive Function (hashed bars) groups, on four measures: adherence to a twice-daily schedule, adherence to the prescribed regimen (dose taken one hour before or two hours after the prescribed times), adherence to the morning regimen, and adherence to the afternoon regimen. All measures were significantly different between groups (see text)
See this image and copyright information in PMC

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