title: Strategies used by older adults with asthma for adherence to inhaled corticosteroids.
abstract: BACKGROUND
  Older adults with asthma have low levels of adherence to their prescribed inhaled corticosteroids (ICS). While prior research has identified demographic and cognitive factors associated with ICS adherence among elderly asthmatics, little is known about the strategies that older adults use to achieve daily use of their medications. Identifying such strategies could provide clinicians with useful advice for patients when counseling their patients about ICS adherence.
  
  
  OBJECTIVE
  To identify medication use strategies associated with good ICS adherence in older adults.
  
  
  METHODS
  English-speaking and Spanish-speaking adults ages 60 years and older with moderate or severe asthma were recruited from primary care and pulmonary practices in New York City, NY, and Chicago, IL. Patients with chronic obstructive pulmonary disease, other chronic lung diseases or a smoking history of greater than 10 pack-years were excluded.
  
  
  METHODS
  Medication adherence was assessed with the Medication Adherence Rating Scale (MARS). Medication use strategies were assessed via open-ended questioning. "Good adherence" was defined as a mean MARS score of 4.5 or greater.
  
  
  RESULTS
  The rate of good adherence to ICS was 37 %. We identified six general categories of medication adherence strategies: keeping the medication in a usual location (44.2 %), integrating medication use with a daily routine (32.6 %), taking the medication at a specific time (21.7 %), taking the medication with other medications (13.4 %), using the medication only when needed (13.4 %), and using other reminders (11.9 %). The good adherence rate was greater among individuals who kept their ICS medication in the bathroom (adjusted odds ration [AOR] 3.05, 95 % CI 1.03-9.02, p = 0.04) or integrated its use into a daily routine (AOR 3.77, 95 % CI: 1.62-8.77, p = 0.002).
  
  
  CONCLUSIONS
  Keeping ICS medications in the bathroom and integrating them into daily routines are strategies associated with good ICS adherence. Clinicians concerned with adherence should consider recommending these strategies to their older asthmatic patients, although additional research is needed to determine whether such advice would improve adherence behaviors.
authors.affiliation: New York University, New York, NY, USA.
authors.forename: Taylor L
authors.initials: TL
authors.lastname: Brooks
authors.forename: Howard
authors.initials: H
authors.lastname: Leventhal
authors.forename: Michael S
authors.initials: MS
authors.lastname: Wolf
authors.forename: Rachel
authors.initials: R
authors.lastname: O'Conor
authors.forename: Jose
authors.initials: J
authors.lastname: Morillo
authors.forename: Melissa
authors.initials: M
authors.lastname: Martynenko
authors.forename: Juan P
authors.initials: JP
authors.lastname: Wisnivesky
authors.forename: Alex D
authors.initials: AD
authors.lastname: Federman
mesh_terms: D000280:Administration, Inhalation; D000368:Aged; D001249:Asthma / Q000188:drug therapy* / Q000523:psychology; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000627:therapeutic use; D057220:Health Literacy; D006801:Humans; D007087:Illinois; D008297:Male; D008875:Middle Aged; D009519:New York City; D011446:Prospective Studies; D011594:Psychometrics; D057566:Self Report; D012959:Socioeconomic Factors; D016903:Drug Monitoring
chemical_list: D005938:Glucocorticoids
references.citation: J Eval Clin Pract. 1999 May;5(2):213-21
references.pmid: 10471231
references.citation: Eur Respir J. 2008 Jan;31(1):143-78
references.pmid: 18166595
references.citation: J Gen Intern Med. 2013 Jan;28(1):67-73
references.pmid: 22878848
references.citation: Patient Educ Couns. 2013 Dec;93(3):586-95
references.pmid: 24007766
references.citation: MMWR Suppl. 2011 Jan 14;60(1):84-6
references.pmid: 21430629
references.citation: J Allergy Clin Immunol. 2003 Jun;111(6):1219-26
references.pmid: 12789220
references.citation: AIDS Care. 2003 Dec;15(6):795-806
references.pmid: 14617501
references.citation: AIDS Patient Care STDS. 2004 Jul;18(7):385-93
references.pmid: 15307927
references.citation: J Gen Intern Med. 2001 Sep;16(9):606-13
references.pmid: 11556941
references.citation: Chest. 2006 Mar;129(3):573-80
references.pmid: 16537854
references.citation: Ann Allergy Asthma Immunol. 2009 Oct;103(4):325-31
references.pmid: 19852197
references.citation: Arch Intern Med. 2006 May 22;166(10):1092-7
references.pmid: 16717171
references.citation: MMWR Surveill Summ. 2007 Oct 19;56(8):1-54
references.pmid: 17947969
references.citation: Psychol Health. 2013;28(10):1135-51
references.pmid: 23627524
references.citation: Patient Educ Couns. 2013 Aug;92(2):273-8
references.pmid: 23523196
references.citation: Gerontology. 1996;42(4):183-9
references.pmid: 8832265
references.citation: Ann Allergy Asthma Immunol. 2009 Jul;103(1):38-42
references.pmid: 19663125
references.citation: J Asthma. 2001 Feb;38(1):65-71
references.pmid: 11256556
references.citation: Drugs Aging. 2003;20(3):229-40
references.pmid: 12578402
references.citation: Patient Educ Couns. 1999 Sep;38(1):33-42
references.pmid: 14528569
references.citation: Ann Behav Med. 2011 Apr;41(2):152-63
references.pmid: 21136224
references.citation: Am J Med. 1996 Apr;100(4):386-94
references.pmid: 8610724
references.citation: Arch Intern Med. 1998 Mar 9;158(5):457-64
references.pmid: 9508223
references.citation: J Asthma. 2010 Aug;47(6):620-6
references.pmid: 20636188
references.citation: J Am Geriatr Soc. 2000 Jun;48(6):651-7
references.pmid: 10855601