Strategies for Coping in a Complex World: Adherence Behavior Among Older Adults with Chronic Illness

Background Increasing numbers of medicines increase nonadherence. Little is known about how older adults manage multiple medicines for multiple illnesses. Objectives To explore how older adults with multiple illnesses make choices about medicines. Design Semistructured interviews with older adults taking several medications. Accounts of respondents’ medicine-taking behavior were collected. Participants Twenty community-dwelling seniors with health insurance, in Eastern Massachusetts, aged 67–90, (4–12 medicines, 3–9 comorbidities). Approach Qualitative analysis using constant comparison to explain real choices made about medicines in the past (“historical”) and hypothetical (“future”) choices. Results Respondents reported both past (“historical”) choices and hypothetical (“future”) choices between medicines. Although people discussed effectiveness and future risk of the disease when prompted to prioritize their medicines (future choices), key factors leading to nonadherence (historical choices) were costs and side effects. Specific choices were generally dominated by 1 factor, and respondents rarely reported making explicit trade-offs between different factors. Factors affecting 1 choice were not necessarily the same as those affecting another choice in the same person. There was no evidence of “adherent” personalities. Conclusion Prescribing a new medicine, a change in provider or copayment can provoke new choices about both new and existing medications in older adults with multiple morbidities. This paper was presented as: (1) Towards an understanding of non-adherence in the elderly with multiple illnesses, at the RW Johnson Seminar Series, School of Medicine, University of Michigan, Ann Arbor, MI, USA, May 2005; (2) Barriers to medicines taking in vulnerable populations, at the Second Annual Symposium of the HMS Fellowship in Pharmaceutical Policy Research, Harvard Medical School, Boston, MA, USA, June 2005; (3) Barriers to medicines taking in vulnerable populations, at the Harkness Fellows in Health Policy Reporting Seminar, Boston, MA, USA, June 2005; (4) Elliott RA, Ross-Degnan D, Adams AS, Safran DG, Soumerai SB. Towards an understanding of medication non-adherence in the elderly with multiple illnesses. Society of Medical Decision Making, Birmingham June 2006. [oral]