title: Prevalence and correlates of self-reported medication non-adherence among older adults with coronary heart disease, diabetes mellitus, and/or hypertension.
abstract: BACKGROUND
  Information about the prevalence and correlates of self-reported medication nonadherence using multiple measures in older adults with chronic cardiovascular conditions is needed.
  
  
  OBJECTIVE
  To examine the prevalence and correlates of self-reported medication nonadherence among community-dwelling elders with chronic cardiovascular conditions.
  
  
  METHODS
  Participants (n = 897) included members from the Health, Aging and Body Composition Study with coronary heart disease, diabetes mellitus, and/or hypertension at Year 10. Self-reported nonadherence was measured by the 4-item Morisky Medication Adherence Scale (MMAS-4) and 2-item cost-related nonadherence (CRN-2) scale at Year 11. Factors (demographic, health status, and access to care) were examined for association with the MMAS-4 and then for association with the CRN-2 scale.
  
  
  RESULTS
  Nonadherence per the MMAS-4 and CRN-2 scale was reported by 40.7% and 7.7% of participants, respectively, with little overlap (3.7%). Multivariable logistic regression analyses found that black race was significantly associated with nonadherence per the MMAS-4 (P = 0.002) and the CRN-2 scale (P = 0.005). Other correlates of nonadherence per the MMAS-4 (with independent associations) included having cancer (P = 0.04), a history of falls (P = 0.02), sleep disturbances (P = 0.04) and having a hospitalization in the previous 6 months (P = 0.005). Conversely, being unmarried (P = 0.049), having worse self-reported health (P = 0.04) and needs being poorly met by income (P = 0.02) showed significant independent associations with nonadherence per the CRN-2 scale.
  
  
  CONCLUSIONS
  Self-reported medication nonadherence was common in older adults with chronic cardiovascular conditions and only one factor - race - was associated with both types. The research implication of this finding is that it highlights the need to measure both types of self-reported nonadherence in older adults. Moreover, the administration of these quick measures in the clinical setting should help identify specific actions such as patient education or greater use of generic medications or pill boxes that may address barriers to medication nonadherence.
authors.affiliation: Department of Medicine (Geriatrics), School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA. Electronic address: zam12@pitt.edu.
authors.forename: Zachary A
authors.initials: ZA
authors.lastname: Marcum
authors.forename: Yan
authors.initials: Y
authors.lastname: Zheng
authors.forename: Subashan
authors.initials: S
authors.lastname: Perera
authors.forename: Elsa
authors.initials: E
authors.lastname: Strotmeyer
authors.forename: Anne B
authors.initials: AB
authors.lastname: Newman
authors.forename: Eleanor M
authors.initials: EM
authors.lastname: Simonsick
authors.forename: Ronald I
authors.initials: RI
authors.lastname: Shorr
authors.forename: Douglas C
authors.initials: DC
authors.lastname: Bauer
authors.forename: Julie M
authors.initials: JM
authors.lastname: Donohue
authors.forename: Joseph T
authors.initials: JT
authors.lastname: Hanlon
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003327:Coronary Disease / Q000188:drug therapy*; D003920:Diabetes Mellitus / Q000188:drug therapy*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D008297:Male; D015995:Prevalence; D057566:Self Report; D016903:Drug Monitoring
keywords: Aged; Chronic disease; Medication adherence