‘A Spoon Full of Sugar’ Part 1: Medication Adherence Issues in those we Love

Are you frustrated by an older parent who isn’t sticking to their medication routine? Or perhaps you have a partner who fails to take their medication as prescribed. If so, you very likely believe your loved one is unusual in this regard, but you are far from alone with your concerns. Research tells us approximately 40-75% of older people, and 50% of people, world-wide, face medication adherence challenges. In fact, the issue is so common there is an entire field of medical study devoted to it. In a series of three articles, we’ll be taking you on a journey into this complex and very serious subject, looking at: what is medication adherence and why it can be a challenge, the personal consequences and wider ramifications of medical adherence issues, and how we can work towards overcoming this common problem in those we love and care for. So let’s start at the beginning:

What is medication adherence?

Once called ‘medication compliance,’ ‘medication adherence’ refers to just how closely a patient follows the medication routine their health professional has prescribed. We’re not simply talking about whether a patient takes all, some, none, or too much of their medication. Medication adherence also includes its delivery to our bodies (whether, for example, we take it with food, inhale, inject, or patch it), as well as taking it at the correct time and frequency. For many people, getting all this correct is a difficult task. Let’s take a look at just some of the reasons why:

Why is medication adherence a challenge for some patients?

Medication adherence is a challenge for many people but it becomes even harder as we age. For everyone, however, the following are common barriers to adherence:

Trust

Most patients aren’t medical professionals and, at a critical time in their life, have to accept and trust the direction of another who is. Even though a medical professional has their certificate on the wall, it can still be tempting for some patients to take their own advice rather than that of their medical professional.

Fear

A patient may know they require medication but, at the same time, fear the possible side effects of taking it. Or worry they may become addicted to it. Sometimes, this is based on something they’ve read, or on a comment made by a friend or family member who is taking the same or similar medication. A patient may also be afraid to discuss these concerns with their health professional for fear of appearing untrusting, know-all, or neurotic.

Suspicion

Some patients are suspicious of the companies making prescription medications. They may wonder if their doctor has been influenced by pharmaceutical advertising, or if a particular brand of medication is being prescribed because it is cheaper for the health system to provide than another the patient feels would produce better results or fewer side effects. In an age when we have so much (often unreliable) information at our fingertips, suspicion can be easily aroused.

Admission of illness

Strange though it may sound, some patients can feel taking medication is an admission to themselves, and others, they do in fact have a health issue. They may even feel taking less medication than prescribed means their health issue isn’t as serious as it actually is. While this isn’t rational – human beings are not always rational in their thinking.

Cost

Prescription payment may not be affordable to some patients, especially if they are not aware of subsidies and other assistance they are entitled to. While a patient may be willing to have their health professional forward their prescription to their pharmacist, if the patient is in financial difficulty, they may never go to collect the medication.

As well as these barriers to medication adherence, there are others that can be more common in older patients. These include:

Misunderstanding

There are many reasons why a patient may misunderstand their health professional’s advice, but an older person may also be struggling with hearing loss and cognitive decline. Although prescription advice should be clearly indicated on labels and packaging, tiredness, poor eyesight, or confusion, can mean the information fails to be understood by the patient.

Memory loss

A patient may have all the will in the world to take their medication as directed, but if they are struggling with memory loss, they can still fail when it comes to medication adherence. Furthermore, it is well documented the more medications a patient is prescribed, the less likely full medication adherence is achieved.

Loss of control

Health issues often become more frequent as a patient ages. This, along with many other age-related challenges, can leave an older person feeling as if they have little control over their own lives. At an unconscious level, refusing to adhere to a medication routine can allow an older person to feel as if they are taking back control of at least one area of life – even when doing so is to their detriment.

Medication adherence is complicated – and there are so many reasons why it can fail. In our next article, we’ll be looking at the consequences of failing – for whatever reason, to adhere to a prescribed medication routine.