Assessment of Knowledge and reasons for Medication non-Adherence in Ambulatory Elderly Patients with Hypertension and Diabetes Mellitus in a Geriatric Centre in Nigeria

Abstract

Introduction: Hypertension and type 2 Diabetes mellitus are global health disorders afflicting millions of elderlypatients worldwide with an ever-increasing incidence andprevalence. Non-adherence to medications affects the qualityand length of life, and has been associated with negativehealth outcomes and increasing healthcare costs especiallyin the elderly [1]. Few empirical data exist on the knowledge and medication adherence among elderly patients insub-Saharan Africa countries.Aim: This study aimed to assess the knowledge, medication adherence, and the factors associated with patient'sknowledge on diabetes mellitus and hypertension.Methods: A cross-sectional study of 423 elderly patientsaged =60 years diagnosed with hypertension and diabetesmellitus, selected consecutively at the Geriatric centre inthe University College Teaching Hospital, Ibadan was carried out between October 2019 and January 2020. Sociodemographic information, knowledge of the indication ofthe medications, possible side effects, and details of medication adherence level with reasons for non-adherence wereobtained using interviewer-administered semi-structuredquestionnaire. Bivariate and multivariate analyses were carried out using SPSS 23. Alpha was set at 0.05.Results: The mean age (±SD) of the older patients was69.6 ± 6.4 years and 253 (59.8%) were females. Aboutthree-quarter of participants (320; 75.7%) were retired.Majority of the elderly (381; 90.1%) were hypertensive,while 270 (63.8 %) were diabetic, and 85 (20.1%) hadmultimorbidity of both hypertension and diabetes mellitus. Patients that were non-adherent with their medicationwere 138 (32.6%). The most common reasons reported fornon-adherence included patient slept off (41; 56.6%), preoccupation (24; 33.1%) and unavailability of medications(12; 16.6%). Thirty-seven (8.7%) participants intentionallymissed doses, out of which 22 (59.5%) reported pill burdenas its reason for medication non-adherence. All patients 423(100.0%) knew the indication for their medications and 20(4.7%) experienced medication-related side effects. Overall,299 (70.6%) and 309 (73.0%) of patients with hypertensionand diabetes mellitus showed good knowledge about theirconditions. Adherence to medication was associated withgood knowledge in hypertensive patients (p=0.002), whilebeing male (p=0.002), age-group of 60-69 (p=0.001) andpoor adherence (p=0.001) were associated with good knowledge in diabetes mellitus patients.Conclusion: We found non-adherence was mainly as aresult of patients' behaviors, attitude, and unavailability ofmedications which could be the cause of low medication adherence among the elderly patients. A systematic review onfactors associated with medication adherence in older patientsreported medication review aimed at simplifying regimensand educating patients about their treatment as interventionto improve adherence [2]. Thus, we recommend educationalintervention among the elderly patients. The elderly patientsdemonstrated good knowledge about their conditions andmedication. However, the relatively good knowledge did notappear to have significant impact on patient's adherence tomedication. Improvement in medication adherence throughinterdisciplinary approach may improve clinical outcomes.