**5. Interventions to promote adherence**

To improve adherence to therapy in the elderly, there are many questions that need to be addressed and deserve all the attention, once they are the basis for deciding what course to take (**Figure 4**) [43].

regimen. Moreover, communication between health professionals and patients is an extremely important step toward promoting adherence to treatment. The preparation of the patient for adherence must include health literacy, once patients with basic or below basic health literacy may be unable to understand what information the box and the medicine data sheet has. Also, the patient should be provided with all specific information about the treatment such as the objectives of the therapy, the risks and benefits and expected results as well as the conse-

Adherence to Medication in Older Adults as a Way to Improve Health Outcomes and Reduce…

http://dx.doi.org/10.5772/intechopen.72070

35

quences of adherence or non-adherence. Behavioural interventions aim to:

• Provide supporting documentation and reward for improved adherence [14].

Patients should be actively involved in their treatment using strategies to prevent non-adherence. For that, the medicinal regimen should be changed as little as possible, since it interferes with the memorization, leading to forgetfulness and, consequently, non-adherence. Medical or nursing appointments are used to communicate or advise the patient and his/her family, keeping them

Counselling includes information about the drugs, their indications, side effects and how to overcome them. To encourage adherence to therapy, health professionals can use the following

• adapt the frequency of consultations according to the needs of the patients, always refer-

According to Osterberg and Blaschke [17], the methods to increase adherence to the therapeu-

• Involve patients in treatment; • Simplify therapeutic regimens;

informed of progress and results [15].

strategies [25]:

• listen to the patient;

**1.** patient education;

• Facilitate compliance with proposed treatments;

• Incorporate adaptation mechanisms into daily practice; and

• ask the patient to repeat the actions he/she should take;

• contact the patient if he or she misses an appointment;

• use methods of counting medicines taken;

tic regimen can be grouped into four categories:

• provide clear instructions as to drug taking, preferably in writing;

• propose a simpler therapeutic regimen that considers patient routines;

ring to the importance of adherence to the therapeutic regimen; and

**2.** communication between health professionals and the patient;

• reinforce positive behaviours and involve the family in the process of adherence.

**Figure 4.** Questions to be addressed to the patient to choose how adherence can be improved.

Just as there are many reasons for a patient to not adhere to the therapy, there is no single solution to this problem. Interventions should be planned and appropriate to each patient, since each patient is unique, with her/his particularities and specificities. Therefore, health professionals should develop strategies that focus not only on the problem of adherence to therapy but also on all aspects that have directly or indirectly influenced it. The intervention of health professionals, to promote behavioural changes, should be based on the creation of a link with the patient and the informal care provider, through the establishment of an empathic relationship, always considering the sociocultural characteristics and the need for social support [12, 14].

To improve adherence, educational and behavioural interventions are needed. Educational interventions are simple measures that promote knowledge regarding both illness and medication and allow the provision of individual and/or group information, whether through oral, written, audiovisual and/or computerized transmission. To avoid barriers between the health professional and the patient, the language should be clear and objective, in line with the patient's level of knowledge and easy to memorize. Educational interventions that involve the patient, relatives or caregivers, are promoters of changes in adherence to the therapeutic regimen. Moreover, communication between health professionals and patients is an extremely important step toward promoting adherence to treatment. The preparation of the patient for adherence must include health literacy, once patients with basic or below basic health literacy may be unable to understand what information the box and the medicine data sheet has. Also, the patient should be provided with all specific information about the treatment such as the objectives of the therapy, the risks and benefits and expected results as well as the consequences of adherence or non-adherence. Behavioural interventions aim to:


Patients should be actively involved in their treatment using strategies to prevent non-adherence. For that, the medicinal regimen should be changed as little as possible, since it interferes with the memorization, leading to forgetfulness and, consequently, non-adherence. Medical or nursing appointments are used to communicate or advise the patient and his/her family, keeping them informed of progress and results [15].

Counselling includes information about the drugs, their indications, side effects and how to overcome them. To encourage adherence to therapy, health professionals can use the following strategies [25]:

• listen to the patient;

Just as there are many reasons for a patient to not adhere to the therapy, there is no single solution to this problem. Interventions should be planned and appropriate to each patient, since each patient is unique, with her/his particularities and specificities. Therefore, health professionals should develop strategies that focus not only on the problem of adherence to therapy but also on all aspects that have directly or indirectly influenced it. The intervention of health professionals, to promote behavioural changes, should be based on the creation of a link with the patient and the informal care provider, through the establishment of an empathic relationship, always considering the sociocultural characteristics and the need for

**Figure 4.** Questions to be addressed to the patient to choose how adherence can be improved.

To improve adherence, educational and behavioural interventions are needed. Educational interventions are simple measures that promote knowledge regarding both illness and medication and allow the provision of individual and/or group information, whether through oral, written, audiovisual and/or computerized transmission. To avoid barriers between the health professional and the patient, the language should be clear and objective, in line with the patient's level of knowledge and easy to memorize. Educational interventions that involve the patient, relatives or caregivers, are promoters of changes in adherence to the therapeutic

social support [12, 14].

34 Gerontology


According to Osterberg and Blaschke [17], the methods to increase adherence to the therapeutic regimen can be grouped into four categories:


According to the WHO proposal, increased adherence is based on three measures:


Regardless of the classification used, the improvement in therapeutic adherence passes through the link between information and motivation. Knowing the concepts about diseases and treatments may result in the adoption of long-lasting behaviours and attitudes that favour adherence to treatment by patients.

**Author details**

, Anna Giardini<sup>2</sup>

\*Address all correspondence to: emcosta@ff.up.pt

Research Institute, IRCCS Montescano, Italy

10.1016/j.bpobgyn.2013.02.005

WPA2015\_Report.pdf

en.pdf

who.int/ageing/publications/global\_health.pdf

B. 2010;**365**:147-154. DOI: 10.1098/rstb.2009.0222

nih.gov/books/NBK19924/ [Accessed: Oct 3, 2017]

, Enrica Menditto<sup>3</sup>

4 Department of Family Medicine, Medical University of Lodz, Lodz, Poland

1 UCIBIO, REQUIMTE and Faculty of Pharmacy, University of Porto, Porto, Portugal 2 Psychology Unit, Instituti Clinici Scientifici Maugeri Spa – Società Benefit, Care and

3 School of Pharmacy, CIRFF/Center of Pharmacoeconomics, University of Naples Federico

[1] Lunenfeld B, Stratton P. The clinical consequences of an ageing world and preventive strategies. Best Practice & Research Clinical Obstetrics & Gynaecology. 2013;**27**(5):643-659. DOI:

[2] Divo MJ, Martinez CH, Mannino DM. Ageing and the epidemiology of multimorbidity. European Respiratory Journal. 2014;**44**(4):1055-1068. DOI: 10.1183/09031936.00059814 [3] HelpAge International. Global Ageing Statistics [Internet]. Sep 22, 2017. Available from:

[4] World Health Organization. World Population Ageing. 2015. DOI: ST/ESA/SER.A/390. http://www.un.org/en/development/desa/population/publications/pdf/ageing/

[5] World Health Organization. Global Health and Aging 2011. DOI: 11-7737. http://www.

[6] Breyer F, Costa-Font J, Felder S. Ageing, health, and healthcare. Oxford Review of

[7] World Health Organization. Constitution of the world health organization. Basic Documents. 1946. DOI: 12571729. http://www.who.int/governance/eb/who\_constitution\_

[8] Partridge L. The new biology of ageing. Philosophical Transactions of the Royal Society

[9] Hernandez LM, Blazer DG. The Impact of Social and Cultural Environment on Health [Internet]. USA: National Academies Press; 2006. Available from: https://www.ncbi.nlm.

http://www.helpage.org/resources/ageing-data/global-ageing-statistics/

Economic Policy. 2010;**26**(4):674-690. DOI: 10.1093/oxrep/grq032

, Przemyslaw Kardas4

Adherence to Medication in Older Adults as a Way to Improve Health Outcomes and Reduce…

and Elísio Costa<sup>1</sup>

http://dx.doi.org/10.5772/intechopen.72070

\*

37

Luís Midão<sup>1</sup>

II, Naples, Italy

**References**
