SG: More young vs older adults don’t take their medicines, despite similar reasons

Medication nonadherence is more common among young than older adults in Singapore, but the reasons for it do not differ by much, according to a study.

A cross-sectional population health survey conducted in 1,528 community-dwelling adults showed that 38.4 percent of 766 young adults and 22.3 percent of 762 older adults reported nonadherence to their prescribed medications. [BMC Health Serv Res 2023;23:905]

“The prevalence of overall medication nonadherence observed in this study (30.4 percent) was relatively higher than that reported among type 2 diabetes adult patients (21–27 percent) in the US and lower than the pooled prevalence (42.6 percent) among people living with multimorbidity,” the investigators noted. [Nutr Metabolism Cardiovasc Dis 2022;32:151-159; BMJ Open 2021;11:e044987]

“Similar to the findings of a Japan study, our results also showed that young adults had much higher prevalence of intentional and unintentional medication nonadherence than older adults, and prevalence of unintentional nonadherence was more than two times higher than intentional nonadherence in both young and older adults,” they added. [Pharm 2021;9:90]

Being afraid of developing medication dependence was the top reason for nonadherence in both age groups (74.8 percent and 73.5 percent). This was followed by problems with taking medication at specific time (24.8 percent) and the act of forgetting (20.0 percent) for young adults, and then by taking a number of medications several times a day (24.1 percent) and problems with taking medication at specific time (21.8 percent) for older adults.

Across the 17 reasons for medication nonadherence, only the inability to read or understand medication labels differed significantly between the two age groups, being more prevalent in older than young adults (8.8 percent vs 3.7 percent).

Predictors of nonadherence

Multivariable logistic regression showed that the presence of depressive symptoms was a strong predictor of medication nonadherence in both young (odds ratio [OR], 3.00, 95 percent confidence interval [CI], 1.79–5.05) and older adults (OR, 4.16, 95 percent CI, 2.31–7.51).

In young adults, being employed (OR, 2.92, 95 percent CI, 1.76–4.84) and taking at least two medications (OR, 1.42, 95 percent CI, 1.04–1.95) were also associated with a higher likelihood of nonadherence, whereas a personal income of SGD 1,000-4,000 (OR, 0.53, 95 percent CI, 0.36–0.77) and current smoking (OR, 0.61, 95 percent CI, 0.39–0.95) were associated with a lower likelihood.

In older adults, on the other hand, having a diagnosis of diabetes, hypertension, or dyslipidaemia was associated with greater odds of nonadherence (OR, 2.63, 95 percent CI, 1.25–5.53).

Hope for improvement

“Our findings could potentially guide healthcare professionals including community pharmacists and nurses in designing tailored strategies or interventions to improve medication adherence in different age groups,” according to the investigators.

There are several ways, they said. For example, education and support programs for patients should be able to increase their knowledge of the importance of medication adherence for chronic disease management, as well as address their medication concerns and the management of side effects. Medication labels in languages other than English can also be pasted to bottles or packages for non-English speaking older adults, while automated text messaging programs to send medication reminders can be developed with the assistance of current technologies and provided to those who need these reminders.

Finally, “the consistent association between presence of depressive symptoms and medication nonadherence in both young and older adults suggest that poor mental health or mental state might be a risk factor of nonadherence. Hence, additional strategies for medication adherence should be developed for patients with depressive symptoms or mental health concerns,” according to the investigators.