title: Strategies for coping in a complex world: adherence behavior among older adults with chronic illness.
abstract: BACKGROUND
  Increasing numbers of medicines increase nonadherence. Little is known about how older adults manage multiple medicines for multiple illnesses.
  
  
  OBJECTIVE
  To explore how older adults with multiple illnesses make choices about medicines.
  
  
  METHODS
  Semistructured interviews with older adults taking several medications. Accounts of respondents' medicine-taking behavior were collected.
  
  
  METHODS
  Twenty community-dwelling seniors with health insurance, in Eastern Massachusetts, aged 67-90, (4-12 medicines, 3-9 comorbidities).
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: School of Pharmacy and Pharmaceutical Sciences, University of Manchester, Oxford Road, Manchester, M13 9PL, United Kingdom. Rachel.Elliott@manchester.ac.uk
authors.forename: Rachel A
authors.initials: RA
authors.lastname: Elliott
authors.forename: Dennis
authors.initials: D
authors.lastname: Ross-Degnan
authors.forename: Alyce S
authors.initials: AS
authors.lastname: Adams
authors.forename: Dana Gelb
authors.initials: DG
authors.lastname: Safran
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Soumerai
mesh_terms: D000223:Adaptation, Psychological; D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D002908:Chronic Disease / Q000188:drug therapy* / Q000523:psychology*; D015897:Comorbidity; D003657:Decision Making; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D010349:Patient Compliance; D019338:Polypharmacy