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Cited by 244Medication Adherence and ComplianceRheumatoid Arthritis Research and TherapiesPharmaceutical Practices and Patient Outcomes

Medication Adherence in Rheumatoid Arthritis Patients: Older Is Wiser

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Park, Denise C., Hertzog, Christopher, Leventhal, Howard, Morrell, Roger W., Leventhal, Elaine, Birchmore, Daniel, Martin, Mike, Bennett, Joan·1999·Journal of the American Geriatrics Society
DOI 10.1111/j.1532-5415.1999.tb04575.x
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Abstract

OBJECTIVES : To create a profile of individuals nonadherent to their medications in an age‐stratified sample (ages 34–84) of community‐dwelling rheumatoid arthritis patients. The relative contributions of age, cognitive function, disability, emotional state, lifestyle, and beliefs about illness to nonadherence were assessed. DESIGN : A direct observation approach was used in conjunction with structural equation modeling. All participants were administered a preliminary assessment battery. Medications were then transferred to vials with microelectronic caps that recorded medication events for all medications for the next 4 weeks. PARTICIPANTS AND SETTING : A volunteer sample of 121 community‐dwelling rheumatoid arthritis (RA) patients were recruited from newspaper ads, posters, and via informal physician contact from private rheumatology practices in Atlanta and Athens, Georgia. Written verification of the RA diagnosis and a disease severity rating were obtained from personal physicians before patients were enrolled in the study. Patients were tested in a private physician's office, and their medication adherence was monitored electronically for a month in their every‐day work and home settings. MEASUREMENTS AND RESULTS : Structural equation modeling techniques were used to develop a model of adherence behavior. Cognitive and psychosocial measures were used to construct latent variables to predict adherence errors. The model of medication adherence explained 39% of the variance in adherence errors. The model demonstrated that older adults made the fewest adherence errors, and middle‐aged adults made the most. A busy lifestyle, age, and cognitive deficits predicted nonadherence, whereas coping with arthritis‐related moods predicted adherence. Illness severity, medication load, and physical function did not predict adherence errors. Omission of medication accounted for nearly all errors. CONCLUSION : Despite strong evidence for normal, age‐related cognitive decline in this sample, older adults had sufficient cognitive function to manage medications. A busy lifestyle and middle age were more determinant of who was at risk of nonadherence than beliefs about medication or illness. Thus, practicing physicians should not assume that older adults have insufficient cognitive resources to manage medications and that they will be the most likely to make adherence errors. Very busy middle‐aged adults seem to be at the greatest risk of managing medications improperly. J Am Geriatr Soc 47:172–183, 1999.

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  • Older rheumatoid arthritis patients remember to take medications better than younger and middle-aged peers, probably because they develop helpful daily routines that support remembering in context.

    “older rheumatoid patients actually do better at remembering to take medications than do their younger and middle-aged peers, probably because they develop helpful daily routines that support remembering in context (Park et al., 1999).”

    From Enrichment Effects on Adult Cognitive Development: Can the Functional Capacity of Older Adults Be Preserved and Enhanced? (2008) · cites this paper as Park et al., 1999

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Authors
Park, D. C., Hertzog, C., Leventhal, H., Morrell, R. W., Leventhal, E., Birchmore, D., Martin, M., & Bennett, J.
Affiliations
  • University of Michigan (US)
  • Georgia Institute of Technology (US)
  • Rutgers, The State University of New Jersey (US)
  • University of Georgia (US)
  • University of Medicine and Dentistry of New Jersey (US)
  • Vanderbilt University (US)
  • Heidelberg University (DE)
Corresponding author
Park, Denise C.
ORCID
Venue
Journal of the American Geriatrics Society
Publisher
Wiley
Published
1999-02
Volume
47
Issue
2
Pages
172-183
ISSN
  • 0002-8614 (ISSN-L)
  • 1532-5415
DOI
10.1111/j.1532-5415.1999.tb04575.x
OpenAlex
W1976091401
Cited by
244
References
3
Citations by year
2025: 5 · 2024: 6 · 2023: 6 · 2022: 12 · 2021: 9 · 2020: 11 · 2019: 13 · 2018: 6 · 2017: 11 · 2016: 14 · 2015: 14 · 2014: 11 · 2013: 10 · 2012: 10
FWCI
7.21
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor, 5929 d)
Locations
  • Journal of the American Geriatrics Society (publishedVersion)
  • PubMed (publishedVersion)
  • Deep Blue (University of Michigan) (submittedVersion)
Funders
  • University of Michigan
  • National Institutes of Health (5r01ag009868-06)
  • National Institute on Aging (AG-11715, P50AG011715, 3RO1-AG09868)
Topics
  • Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
  • Health Sciences › Medicine › Rheumatology › Rheumatoid Arthritis Research and Therapies
  • Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
Keywords
medication adherence, rheumatoid arthritis, age differences, cognitive function, medication errors, busy lifestyle, illness beliefs, emotional state, middle-aged adults, older adults, electronic medication monitoring
MeSH terms
Adaptation, Psychological, Adult, Aged, Aged, 80 and over, Arthritis, Rheumatoid, Female, Georgia, Humans, Male, Middle Aged, Sick Role, Treatment Refusal, Antirheumatic Agents

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