Antihypertensive medication adherence and associated factors in older adults requiring long-term care: the LIFE Study

Abstract

Background Consistent antihypertensive treatment reduces cardiovascular risk, but older adults requiring long-term care (LTC) due to functional impairment may have a diminished ability to adhere to treatment. Objective To examine antihypertensive medication adherence among older adults requiring LTC in Japan and to identify its associated factors. Design Retrospective cohort study. Setting 11 municipalities. Participants Individuals aged ≥65 years requiring LTC and diagnosed with hypertension between April 2016 and March 2020. Methods Medical claims data, LTC claims data and LTC certification data were analysed. The study outcome was antihypertensive medication adherence (proportion of days covered >0.8) over 1year. Using logistic regression analysis, we assessed the associations between adherence and the following factors: care needs levels, paralysis, visual function, hearing function, swallowing function, cognitive function and need for medication intake assistance. Results The study cohort comprised 69200 participants (nonadherent: 17523; 25.3%). At LTC certification application, most participants lived at home (78.3% adherent vs. 64.1% nonadherent). Adherence was negatively associated with high care needs levels (odds ratio: 0.241, 95% confidence interval: 0.222–0.263), bilateral upper limb paralysis (0.605, 0.565–0.648), bilateral lower limb paralysis (0.837, 0.803–0.873), left upper limb paralysis (0.820, 0.746–0.921), moderate visual impairment (0.738, 0.675–0.808), severe hearing impairment (0.683, 0.549–0.853), severe swallowing impairment (0.199, 0.169–0.234), severe cognitive impairment (0.652, 0.621–0.684) and need for full medication intake assistance (0.296, 0.279–0.315). Conclusions Over 25% of older adults requiring LTC were nonadherent to antihypertensive treatment. These findings may help to identify high-risk individuals who could benefit from targeted interventions to support medication management.