title: Medication non-adherence among elderly patients newly discharged and receiving polypharmacy.
abstract: BACKGROUND
  Poor adherence may have a major impact on clinical outcome, contributing to substantial worsening of disease, increased health care costs and even death. With increasing numbers of medications, low adherence is a growing concern, seriously undermining the benefits of current medical care. Little is known about medication adherence among older adults living at home and requiring complex medication regimens.
  
  
  OBJECTIVE
  The aim of this study was to describe adherence to drug prescriptions in a cohort of elderly patients receiving polypharmacy, discharged from an internal medicine ward.
  
  
  METHODS
  A sample of elderly patients (65 years of age or older) discharged from an internal medicine ward in Italy throughout 2012 were enrolled. They were followed for 3 months after discharge with a structured telephone interview to collect information on drug regimens and medication adherence 15-30 days (first follow-up) and 3 months (second follow-up) after discharge. Demographic variables including age, sex, marital status and caregiver were collected.
  
  
  RESULTS
  Among 100 patients recruited, information on medication adherence was available for, respectively, 89 and 79 patients at the first and second follow-ups. Non-adherence was reported for 49 patients (55.1 %) at the first follow-up and for 55 (69.6 %) 3 months from discharge. Voluntary withdrawal of a drug and change of dosage without medical consultation were the main reasons for non-adherence at both follow-ups. The number of drugs prescribed at discharge was related to medication non-adherence at both follow-up interviews. No association was found between age and non-adherence. Only 25 patients (28.1 %) at the first follow-up and 20 (25.3 %) at the second understood the reasons for their medications.
  
  
  CONCLUSIONS
  Low medication adherence is a real, complex problem for older patients receiving polypharmacy. We found that the increasing number of drugs prescribed at hospital discharge is correlated to non-adherence and a high percentage of patients did not understand the purpose of their medications. Simplification of drug regimens and reduction of pill burdens as well as better explanations of the reason for the medications should be targets for intervention.
authors.affiliation: Laboratory for Quality Assessment of Geriatric Therapies and Services, Drug Information Service for the Elderly, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Via Giuseppe La Masa 19, 20156, Milan, Italy, luca.pasina@marionegri.it.
authors.forename: L
authors.initials: L
authors.lastname: Pasina
authors.forename: A L
authors.initials: AL
authors.lastname: Brucato
authors.forename: C
authors.initials: C
authors.lastname: Falcone
authors.forename: E
authors.initials: E
authors.lastname: Cucchi
authors.forename: A
authors.initials: A
authors.lastname: Bresciani
authors.forename: M
authors.initials: M
authors.lastname: Sottocorno
authors.forename: G C
authors.initials: GC
authors.lastname: Taddei
authors.forename: M
authors.initials: M
authors.lastname: Casati
authors.forename: C
authors.initials: C
authors.lastname: Franchi
authors.forename: C D
authors.initials: CD
authors.lastname: Djade
authors.forename: A
authors.initials: A
authors.lastname: Nobili
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D010351:Patient Discharge; D019338:Polypharmacy; D016903:Drug Monitoring