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

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Abstract

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.

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Acknowledgments

RAE, DRD, ASA, and SBS developed the interview schedule and topic guide. RAE carried out the interviews, co-coordinated analysis of the transcripts and discussed the emerging coding schemes, decisions, and explanatory models with DRD, ASA, DGS, KP, SBS.

RAE, DRD, ASA, DGS, and SBS contributed to the drafting of the paper. Dr Katherine Payne, University of Manchester, contributed to the development of the coding schedule and carried out interrater reliability. RAE is guarantor.

This study was funded by the US National Institute on Aging, the Harvard Pilgrim Health Care Foundation, and The Commonwealth Fund, as part of a Commonwealth Fund Harkness Fellowship in Health Policy held by RE. Drs. Ross-Degnan and Soumerai are investigators in the HMO Research Network Center for Education and Research in Therapeutics, supported by the U.S. Agency for Health care Research and Quality (Grant no. U18HS1039-01). The Commonwealth Fund is a private independent foundation based in New York City.

The views presented here are those of the authors and not necessarily those of the funders, their directors, officers, or staff.

Sponsors were not involved in design, methods, subject recruitment, data collection, analysis, or preparation of the paper.

Conflict of Interest

None disclosed.

Ethics Approval

Harvard Pilgrim Health Care Institutional Review Board.

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Correspondence to Rachel A. Elliott PhD.

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Elliott, R.A., Ross-Degnan, D., Adams, A.S. et al. Strategies for Coping in a Complex World: Adherence Behavior Among Older Adults with Chronic Illness. J GEN INTERN MED 22, 805–810 (2007). https://doi.org/10.1007/s11606-007-0193-5

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  • DOI: https://doi.org/10.1007/s11606-007-0193-5

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