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ORIGINAL ARTICLE
Year : 2016  |  Volume : 29  |  Issue : 1  |  Page : 121-125

Comparative study between adult and elderly patients as regards adherence to antihypertensive medication


Department of Family Medicine, Faculty of Medicine, Menofia University, Al-Menoufia, Egypt

Date of Submission30-Nov-2014
Date of Acceptance01-Jan-2015
Date of Web Publication18-Mar-2016

Correspondence Address:
Aya M Barakat
MBBCh, Department of Family Medicine, Faculty of Medicine, Menoufia, University, Shebin Elkom, 32511 Al-Menoufia
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1110-2098.179001

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  Abstract 

Objectives
The aim of this study was to compare adherence to antihypertensive medication between adult and elderly patients and factors affecting it.
Background
Poor medication adherence is the most important cause of uncontrolled blood pressure. It is estimated that 50-70% of people do not take their antihypertensive medication as prescribed. Therefore, understanding barriers to antihypertensive medication adherence may help identify interventions to increase adherence and improve outcomes.
Literature and methods
This was a cross-sectional study conducted in Munshaat Sultan family health center, Menoufia governorate. A total of 120 hypertensive patients who attended the family health clinics during the period of the study were included. They were classified on the basis of age into adult patients aged 21-59 years and elderly patients aged 60 years or older and into adherent and nonadherent on the basis of adherence. A predesigned questionnaire was used to assess their adherence to medication using the Morisky scale and factors affecting it, such as patient, physician, disease, and drug.
Results
An overall 60.34% of elderly patient were adherent to medication, which was higher compared with adherence among adult patients (29.03%). There was statistically significant difference between the two groups as regards sex, education, and presence of family members helpful in reminding about medication, patients' belief about medication causing addiction, patient satisfaction toward healthcare providers and facility, frequency of drug doses, duration of hypertension, presence of another chronic illness, and hypertension complication.
Conclusion
In both groups, adherence was higher among patients who were married, patients having family members helpful in reminding medication, those receiving antihypertensive medication once daily, and those who had acceptable waiting time; therefore, interventions enhancing doctor - patient communication and empowering the patient have the potential to improve the adherence of hypertensive patients' medication and can consequently reduce hypertension-related costs.

Keywords: Adherence, hypertension, Morisky scale


How to cite this article:
Farahat TM, Shaheen HM, Khalil NA, Hegazy N N, Barakat AM. Comparative study between adult and elderly patients as regards adherence to antihypertensive medication. Menoufia Med J 2016;29:121-5

How to cite this URL:
Farahat TM, Shaheen HM, Khalil NA, Hegazy N N, Barakat AM. Comparative study between adult and elderly patients as regards adherence to antihypertensive medication. Menoufia Med J [serial online] 2016 [cited 2019 Sep 20];29:121-5. Available from: http://www.mmj.eg.net/text.asp?2016/29/1/121/179001


  Introduction Top


Hypertension is considered the most prevalent cardiovascular disorder all over the world [1]. It usually means the value of blood pressure (BP) is 140/90 mmHg or greater in the office. However, numerous studies have shown improvement of long-term prognosis by achieving target BP values lower than these. That is why today normal BP is less than 120/80 mmHg, and systolic pressure in the range of 120-139 mmHg, or diastolic in the range of 80-89 mmHg are classified as prehypertension [2].

High BP is a major risk factor for coronary heart disease (CHD) and ischemic as well as hemorrhagic stroke. In addition to CHDs and stroke, complications of high BP include heart failure, peripheral vascular disease, renal impairment, retinal hemorrhage, and visual impairment [3].

Secondary prevention with antihypertensive drugs has shown to decrease the risk by about 25% for CHD and stroke [1].

Studies worldwide indicate that despite the availability of effective medical therapy, over half of all hypertensive patients do not take any treatment, and more than half of those on treatment have BPs over the 140/90 mmHg threshold [4]. The WHO describes poor adherence as the most important cause of uncontrolled BP and estimates that 50-70% of people do not take their antihypertensive medication as prescribed [5].

Understanding barriers 'determinants of adherence' to antihypertensive medication adherence may help identify interventions to increase adherence and improve outcomes [6].

However, there are relatively few reports studying the adherence levels and their associated factors among Egyptian patients. Therefore, the aim of this study was to assess the adherence to antihypertensive management and determine the factors that are associated with antihypertensive drug adherence among Egyptian patients.


  Literature and methods Top


This was a cross-sectional study conducted in Munshaat Sultan family health center, Menoufia governorate. The participants included in the study were all hypertensive patients who attended family health center clinics from 10:00 a.m. until 2:00 p.m. for 3 days per week during the period from the 1st of July 2013 until the end of December 2013 and were more than 21 years of age. Communications with the university and health professions were oriented to the objectives and procedures of the study and permission was obtained to conduct the study. They were classified on the basis of age into two groups: group I included adults aged 21-59 years and group II included elderly patients aged 60 years or older. They were interviewed using a predesigned questionnaire including items related to assessment of medication adherence using the Morisky Medication Adherence Scale. According to the scoring system of the Morisky Medication Adherence Scale, scores ranged from 0 to 8. Scores less than 6 were considered nonadherent, whereas scores more than 6 were considered adherent. Therefore, each group was classified into two groups, adherent and nonadherent groups.

The questionnaire also included factors affecting adherence, such as patient (sociodemographic characteristic, belief about medication), healthcare provider and facility (explanation of the disease to patient and how to manage it, treatment of patient with respect and patience and, acceptable waiting time at the clinic), disease and drug-related factors (duration of hypertension, presence of complication and other chronic illness, and frequency of drug doses).


  Results Top


Medication adherence among the elderly patients was 60.34% compared with 29.03% among the adult patients. There was statistically significant difference between adult and elderly patients as regards sex (ν2 = 10.3 and P = 0.02), education (ν2 = 7.1 and P = 0.000), and presence of family members helpful in reminding about medication (ν2 = 40.8 and P = 0.00). Adherence was higher among elderly male patients (44.7%), elderly illiterate or primary educated patients (43.4%), and elderly patients having family members helpful in reminding about medication (48.1%) [Table 1]. There was statistically significant difference between adult and elderly patients as regards their belief about 'medication causing addiction' (ν2 = 7.8 and P = 0.05). In the adult nonadherent group, the belief that medication causes addiction was significantly high compared with the elderly adherent group (47.8 and 17.4%, respectively). There was no statistically significant difference in belief of medication being ineffective (ν2 = 4.1 and P = 0.2) [Table 2]. There was statistically significant difference between the adult and elderly patients as regards explanation of patient condition and management by the doctor (ν2 = 16.2 and P = 0.001), treatment of patient with respect and patience (ν2 = 10.2 and P = 0.02), and acceptable waiting time (ν2 = 20.8 and P = 0.000), as the greater percentage of patients who were explained about their condition by doctors and had an acceptable waiting time at the clinic were in adherent elderly group (40.4 and 47.1%, respectively). There was statistically significant difference between adult and elderly patients as regards the frequency of drug doses (ν2 = 14.2 and P = 0.03), duration of hypertension (ν2 = 32.1 and P = 0.000), presence of another chronic illness (ν2 = 7.2 and P = 0.05), and presence of hypertension complication (ν2 = 21.2 and P = 0.000). The highest percentage of adherence was among elderly patients who received one drug dose daily (41,7%), those having a duration of hypertension less than 2 years (57.1%), those having no other chronic illness (42.6%), and those having hypertension complications (44.6%).
Table 1: Comparison between adult and elderly patients as regards general characteristics and adherence

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Table 2: Comparison between adult and elderly patients as regards their belief about antihypertensive medication and
adherence


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  Discussion Top


This study showed that percentage of adherence among elderly patients was 60.34% and was higher than that reported among adult patients (29.03%) [Figure 1]; it was mainly due to better social support structure by the extended family system that has resulted in improved medication adherence. These results were similar to those reported in Southern Taiwan (57.6%) [7] and Iraq (41.3%) [1]. This finding is consistent with that reported in similar studies conducted in Pakistan [8], which found that adherence increased with age (P < 0.02) and that participants who were less than 40 years of age were less adherent compared with those older than 70 years (67.4%). However, there are studies that show either no association [9] or decreasing adherence with increasing age [10].
Figure 1: Difference between the two groups (adult and elderly) as regards their adherence to medication.

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This study showed that elderly male patients (44.7%) were more likely to be adherent to medication compared with elderly female patients (19.2%) and adult patients [Table 1]. This result was similar to those reported in a study conducted in Southern Taiwan, in which there was significant association between sex and medication adherence, and elderly male patients were more adherent to medication compared with elderly female patients [11]. This finding is inconsistent with those reported in other studies. Taira et al. [12] examined the predictors of antihypertensive adherence among 28 395 Asian Pacific Americans and found that sex was not significantly associated with medication adherence. The SHEP Pilot Study on 551 hypertensive patients aged 60 years and older showed that there was no significant difference between male and female patients with respect to adherence [7].

This study showed that about 48.1% of elderly patients having family members helpful in reminding about medication were adherent to therapy with higher percentage in comparison with adult patients (28.8%) [Table 1]. This can be explained by the fact that older people might have more concern about their health compared with younger patients; thus older patients' nonadherence is nonintentional in most cases. As a result, if they can get the necessary help from healthcare providers or family members, they may be more likely to be adherent with therapies.

The percentage of participants believing in the efficacy of antihypertensive medication was greater in the adherent elderly group (30.9%) [Table 2]. According to the Health Belief Model proposed by Hochbaum, people who believe that a particular behavior is beneficial to their physical health are more likely to actually engage in that behavior.

This study showed that a greater percentage of patients who had received education about the disease and its management by doctors were in the adherent elderly group (40.4%) [Table 3]. Similar to result of a study conducted by Lin and colleagues, another study showed that the percentage was higher among adherent elderly patients compared with nonadherent elderly patients [13].
Table 3: Comparison between adult and elderly patients as regards patient satisfaction toward healthcare system and
healthcare providers and adherence


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This study showed that there was statistically significant difference between adherence and treatment of patient with respect and patience by doctor. The percentage of participants who had doctors treating them with respect and patience was higher in the nonadherent adult group than in the adherent adult and elderly groups (50, 12.9, and 21%, respectively).

This result is inconsistent with the result of a qualitative study conducted on hypertensive elderly patients, in which patients reported that positive communication with the healthcare providers is a factor in improving adherence; the patients reported that the doctors understand their concern and treat them with respect [14]. If patients have trust in their healthcare providers, they will adhere to their medication.

This study showed that adherence in elderly patients had statistically significant difference with the frequency of drug doses; the highest percentage of adherence was among elderly patients receiving one drug dose daily (41.7%) [Table 4]. This finding is consistent with the finding of Vrijens et al. [15].

This study showed that patients older than 60 years of age and with a diagnosis of hypertension less than 2 years were found to be more adherent to their medication regime compared with adult patients [Table 4]. This result was in variance with the result of Laliæ et al. [16], which showed that patients younger than 65 years of age and with a duration of hypertension less than 10 years were found to be more adherent to their medication regime compared with elderly patients. A statistically significant lower level of adherence was identified in elderly patients with longer duration of antihypertensive therapy and with reported side effects of drugs.
Table 4: Comparison between adult and elderly patients as regards disease and drug-related factors and adherence

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  Conclusion Top


This study showed comparison as regards medication adherence between adult and elderly patients. The percentage of adherence among elderly patients was higher compared with adult patients. In adult and elderly patients, adherence was higher among those who were married, illiterate or primary educated, having family members helpful in reminding medication, having acceptable waiting time at clinic, receiving health education from their doctors, having a duration of hypertension less than 2 years, and those receiving antihypertensive medication once daily. Adherence was increased in elderly patients in the presence of hypertension complication. These results could form the basis for designing effective interventions adjusted aiming at both enhancing doctor-patient communication and empowering the patient. Such interventions have the potential to improve the adherence of hypertensive patients' medication and can consequently reduce hypertension-related costs.


  Acknowledgements Top


Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Al-Dabbagh S, Aswad S. Compliance of hypertensive patients to management in Duhok governorate using Morisky-green test. Duhok Med J 2010; 4 :28-39.  Back to cited text no. 1
    
2.
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4.
Mathevula HM. Factors affecting adherence to treatment in patients on chronic medication at Mokopane Hospital: Doctoral dissertation, University of Limpopo, South Africa (Turfloop Campus); 2013. A Dissertation Submitted in Fulfillment of the Requirements for the Degree of Masters of Pharmacy (Pharmacology) http://ulspace.ul.ac.za/bitstream/handle/10386/1047/Mathevula_hm_2013.pdf?sequence=1&isAllowed=y (Last accessed on 2014 Oct).  Back to cited text no. 4
    
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Lin YP, Huang YH, Yang YC, Wu JS, Chang CJ, Lu FH, et al. Adherence to antihypertensive medications among the elderly: a community-based survey in Tainan City, Southern Taiwan. Taiwan Geriatr Gerontol 2007; 2 :176-189.  Back to cited text no. 7
    
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Hashmi SK, Afridi MB, Abbas K, Sajwani RA, Saleheen D, Frossard PM, et al. Factors associated with adherence to anti-hypertensive treatment in Pakistan. PLoS One 2007; 2 :e280.  Back to cited text no. 8
    
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Gryglewska B. How can we improve the effectiveness of treatment in elderly hypertensives? Blood Press Suppl 2005; 2 : :46-49.  Back to cited text no. 10
    
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Taira DA, Gelber RP, Davis J, Gronley K, Chung RS, Seto TB. Antihypertensive adherence and drug class among Asian Pacific Americans. Ethn Health 2007; 12 :265-281.  Back to cited text no. 12
    
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Wong MC, Jiang JY, Griffiths SM. Antihypertensive drug adherence among 6408 Chinese patients on angiotensin-converting enzyme inhibitors in Hong Kong: a cohort study. J Clin Pharmacol 2010; 50 :598-605.  Back to cited text no. 13
    
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Ha JF, Longnecker N. Doctor-patient communication: a review. Ochsner J 2010; 10 :38-43.  Back to cited text no. 14
    
15.
Vrijens B, Vincze G, Kristanto P, Urquhart J, Burnier M. Adherence to prescribed antihypertensive drug treatments: longitudinal study of electronically compiled dosing histories. BMJ 2008; 336 :1114-1117.  Back to cited text no. 15
    
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    Figures

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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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