title: Toward appropriate criteria in medication adherence assessment in older persons: Position Paper.
abstract: Nonadherence to medication regimens is a worldwide challenge; adherence rates range from 38 to 57 % in older populations with an average rate of less than 45 % and nonadherence contributes to adverse drug events, increased emergency visits and hospitalisations. Accurate measurement of medication adherence is important in terms of both research and clinical practice. However, the identification of an objective approach to measure nonadherence is still an ongoing challenge. The aim of this Position Paper is to describe the advantages and disadvantages of the known medication adherence tools (self-report, pill count, medication event monitoring system (MEMS) and electronic monitoring devices, therapeutic drug monitoring, pharmacy records based on pharmacy refill and pharmacy claims databases) to provide the appropriate criteria to assess medication adherence in older persons. To the best of our knowledge, no gold standard has been identified in adherence measurement and no single method is sufficiently reliable and accurate. A combination of methods appears to be the most suitable. Secondly, adherence assessment should always consider tools enabling polypharmacy adherence assessment. Moreover, it is increasingly evident that adherence, as a process, has to be assessed over time and not just at one evaluation time point (drug discontinuation). When cognitive deficits or functional impairments may impair reliability of adherence assessment, a comprehensive geriatric assessment should be performed and the caregiver involved. Finally, studies considering the possible implementation in clinical practice of adherence assessment tools validated in research are needed.
authors.affiliation: Psychology Unit, Scientific Institute of Montescano (PV), Salvatore Maugeri Foundation, IRCCS, 27040, Montescano, PV, Italy. anna.giardini@fsm.it.
authors.forename: Anna
authors.initials: A
authors.lastname: Giardini
authors.affiliation: Pharmacy Service, Hospital Clínic Barcelona, Catalonia, Spain.
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Martin
authors.affiliation: Economic and Social Research Institute, Sir John Rogerson's Quay, Dublin, Ireland.|Department of Pharmacology and Therapeutics, St James's Hospital, Dublin, Ireland.
authors.forename: Caitriona
authors.initials: C
authors.lastname: Cahir
authors.affiliation: Catherine McAuley School of Nursing and Midwifery, Brookfield Health Sciences Complex, University College Cork, Cork, Ireland.
authors.forename: Elaine
authors.initials: E
authors.lastname: Lehane
authors.affiliation: School of Pharmacy, CIRFF/Center of Pharmacoeconomics, University of Naples Federico II, Naples, Italy.
authors.forename: Enrica
authors.initials: E
authors.lastname: Menditto
authors.affiliation: Medical Department, Daiichi-Sankyo, Rome, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Strano
authors.affiliation: Italian Medicines Agency - AIFA, Rome, Italy.|University of Brescia, Brescia, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Pecorelli
authors.affiliation: Italian Medicines Agency - AIFA, Rome, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Monaco
authors.affiliation: Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.|Geriatric Steering Committee, Italian Medicines Agency, Rome, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Marengoni
mesh_terms: D016907:Adverse Drug Reaction Reporting Systems / Q000706:statistics & numerical data; D000368:Aged; D062313:Databases, Pharmaceutical / Q000706:statistics & numerical data; D016903:Drug Monitoring / Q000379:methods; D015577:Geriatric Assessment / Q000379:methods*; D006299:Health Services for the Aged; D006801:Humans; D055118:Medication Adherence / Q000523:psychology*; D015203:Reproducibility of Results
keywords: Adherence; Chronic diseases; Elderly; Nonadherence; Polypharmacy; Tools