Because elderly patients often have multimorbidity which requires medical treatment, it is usually assumed that poor medication adherence is more common in the elderly. Thus, it is vital to understand the variables impacting medication adherence in the elderly in order to take appropriate efforts to enhance it. The present study aimed to determine the factors associated with medication adherence in the elderly with chronic multimorbidity.
Increasing the number of chronic diseases in the elderly decreased the mean score of medication adherence. Various studies indicated that the elderly with chronic multimorbidity and consumption of separate medication prescriptions for each disease had less medication adherence than the elderly who had fewer chronic diseases and simpler medication schedules[20, 21]. Multidrug therapy in terms of the presence of several diseases, complex treatment regimens, and doses more than twice a day are among the factors with negative effects on medication adherence, and continued consumption of medication in the elderly[22, 23]. Moreover, living alone, and the inability to plan for daily medication can be associated with non-adherence to medication in the elderly[24, 25]. The results of our study were consistent with other studies in this field [26–31] .
The current research discovered that as the number of chronic diseases in the elderly increased, their mean satisfaction with the way doctors communicated declined. Other studies have emphasized the critical nature of clinicians' ability to communicate with patients. Rowland-Morin et al. thought that active listening to patients had the potential to improve patient satisfaction and medication adherence . Furthermore, listening to the patients and paying attention to their emotions strengthened the physician-patient relationship, increased the patient trust in physicians, and improved health outcomes. It seems that the physicians’ empathy and effective relationship with the patients play important role in coping with and accepting the diseases and can be the main factor in medication adherence . Patients' satisfaction in terms of communicating with physicians is a key factor in advancing the treatment process and achieving the treatment process and can affect the control and treatment of diseases because patients, who have a satisfactory relationship with their physicians, are more likely to follow physicians' instructions[19, 35]. To improve medication adherence in the elderly, the physicians should teach patients to promote medication adherence by an adequate explanation of the drug instructions and can increase patients' beliefs and knowledge about health and related therapies by consulting with them about any reluctance or hesitation in taking drugs[5, 11, 36].
The results indicated that medication adherence decreased with age in the elderly with one chronic disease. In older patients, the belief that drugs did not help them and had no effect on their diseases might be a factor in non-adherence to medication. It might be the reason why many elderly people refuse to take their prescriptions or stop receiving therapy. Furthermore, limitations such as hearing or vision loss, as well as loss of skills owing to severe osteoarthritis of the limbs, may make it difficult for them to appropriately consume their medications. In some countries, the unaffordability of drug treatment is another major constraint on medication adherence in the elderly.
Considering the important role of medication adherence in managing chronic diseases, the following interventions are suggested to improve it in the elderly.
In terms of adherence, the goal of behavioral interventions is to correct the elderly's behavior towards medication, such as holding structured counseling sessions by a trained nurse and holding a drug management program by pharmacists.
Healthcare providers can teach the elderly to promote medication adherence by providing enough explanation about the way of taking medication, talking to the elderly about unwillingness to take medication, and discussing their beliefs and knowledge about health and related therapies. Interventions for improving adherence should not only focus on the elderly, but should also cover the broader context, and other components of the healthcare system.
Integrative care is defined as a set of organizational techniques and models to increase connectivity, coherence, and collaboration within and between healthcare providers at different levels, and it can be important to the success of an intervention and determines its effectiveness. Therefore, improving medication adherence in the elderly requires coordination and cooperation of relevant elements.
Self-management intervention aims to inform the patients about their diseases to play a more active role in treatment. Using technological tools in self-management interventions is increasing, including telephone support/counseling alone, telemedicine/ telehealth/ telecare/ telemonitoring, web-based interventions/ interactive computer health communications, and cell phones/ text messages. Self-management interventions have benefits for the patients with chronic diseases in terms of knowledge, self-efficacy, and health status.
Risk communication interventions
Perceived risk is the main dimension of intentional non-adherence to medication and is defined as perceived probability, probability, or susceptibility to harm, and is a prominent construct in many explanatory theories of health behavior . In texts about adherence, the extent to which patients engage in a behavior, in this instance medication adherence, is determined by their unique evaluation of the risk associated with the action and the consequent detrimental or protective outcomes. Therefore, healthcare providers need to have effective risk communications to ensure accurate information about risks and benefits and enable the patients to make informed decisions.
Packing and daily reminders
There are many different types of reminders, such as reminder phone calls, text messages, pagers, interactive voice response (IVR) systems, video calls, medicine boxes, or personalized towels that can be used to improve medication adherence in the elderly.
Cognitive impairment in the elderly is a challenge to optimize their care and treatment, and it requires adjustment via attention to environmental barriers and facilitators.
It is suggested to detect determinants of medication adherence in the elderly with chronic multimorbidity through qualitative studies.
The limitations of the present study included the completion of questionnaires by self-report, and interviews by interviewers.