MEDICATION COMPLIANCE IN THE ELDERLY

The consequences of drug noncompliance may be serious in older patient s. Estimates of the extent of noncompliance in the elderly vary, rangi ng from 40% to a high of 75%. Three common forms of drug treatment non compliance are found in the elderly: overuse and abuse, forgetting, an d alteration of schedules and doses. Some older patients who are acute ly ill may take more than the prescribed dose of a medication in the m istaken belief that more of the drug will speed their recovery. Such o veruse has clearly been associated with adverse drug effects. Forgetti ng to take a medication is a common problem in older people and is esp ecially likely when an older patient takes several drugs simultaneousl y. Data suggest that the use of three or more drugs a day places elder ly people at particular risk of poor compliance. The use of at least t hree drugs, and often more, is common in the elderly, with estimates o f as many as 25% of older people taking at least three drugs. Averages of drug use among elderly hospitalized patients suggest that eight dr ugs taken simultaneously may be typical. Problems may also arise when dementia or depression is present, which may interfere with memory. Th e most common noncompliant behavior of the elderly appears to be under use of the prescribed drug. Inappropriate drug discontinuation, furthe rmore, may occur in up to 40% of prescribing situations, particularly within the first year of a chronic care regimen. As many as 10% of eld erly people may take drugs prescribed for others; more than 20% may ta ke drugs not currently prescribed by a physician. Techniques for impro ving compliance in the elderly include educating physicians regarding the doctor/patient relationship: providing medication compliance assis tance to the older patient, such as pill containers with easier access ibility, large-print labeling, and daily dosing pillboxes; simplifying multidrug treatment regimens and dosage schedules; improving diagnost ic and evaluation criteria/techniques for late-life dementia and depre ssion; carefully considering over-the-counter medication as a source o f potential noncompliance of prescribed drugs; and improving research and education regarding psychotropic side effects, pharmacokinetic fac tors, and drug interactions.