Introduction

Following the doctor's orders is technically referred to by health care professionals as "treatment adherence". Treatment adherence includes not only taking medications, but also following appropriate diets for one's health and making broader changes in one's lifestyle. The term also covers a range of health related behaviors such as keeping medical appointments, engaging in physical exercise and taking preventive measures such as getting immunized. However, most of the research to date on the topic of treatment adherence has focused on taking medications according to recommendations, and that will be the focus of this article.

Understanding poor treatment adherence

The single biggest problem area within treatment adherence is that of taking less prescription medication than the amount prescribed. Interestingly, the pattern of taking less medication than recommended has been noted in various patient settings and regardless of the type of medication prescribed.

Treatment adherence is influenced by various factors that can be broken down into three broad categories:

• Those related to characteristics of the patient
• Those related to characteristics of the treatment
• Those related to characteristics of the health care provider and the health care setting

Patient Characteristics

Older age is associated with several conditions such as limitations in physical function, possible slowdown of the thought processes, social isolation and depression. All of these may have an effect on a person's ability to read labels, keep track of complex medication schedules, swallow large tablets and open medication packaging.

Support and contact from friends and loved ones can also help a senior to better stick with recommendations. Support can take the form of reminding the senior to take his or her medications, getting prescriptions filled- especially for those with mobility problems, and contacting the health care provider when problems arise. Isolation can also increase symptoms of depression, which then feeds into a person's sense of inadequacy with regard to carrying out tasks of daily living.

As people age, their physiology tends to change. Thus, senior patients may be more likely to experience negative side effects of medications. Interestingly, this is not something that has been documented extensively in medical research. Yet, many health care practitioners do find it to be a significant issue at times.

Treatment related factors

The more complex a medication regimen is, the less likely a patient is to stick to it. Patients are also less likely to stick with regimens for more chronic (long-term) conditions such as diabetes and heart failure.

The cost of medications is also a factor for people who have limited incomes and who cannot afford to pay for their medicines.

Aspects of the health care provider and setting

How a health care provider communicates with his or her patient also has an impact on how well a patient sticks with his or her regimen. It is important that health care providers strive to give clear and easy to understand instructions, and do so in an empathic way.

What can be done to help seniors stick with regimens?

If you are a senior yourself, or are someone involved in the care of a senior, here are some concrete tips to help increase the likelihood of sticking with treatment recommendations and regimens:

Patient Education: This is very crucial in helping people do what they are expected to do. In addition to verbal instructions, written materials such as patient education booklets and medication cards can be useful. If no such items are available, then consider writing down key bits of information on several index cards and keeping them posted in places such as the fridge door and medication cabinet.

In addition to informing a person as to when they are to take a medication, it is useful to tell them why. For instance you can say, "This one is for your blood pressure; and this one is for diabetes."

Behavioral Strategies: Most people experience some degree of success, even if they cannot follow a recommended regimen one hundred per cent. Look for these instances of success and learn from them. Point them out to the patient if you are helping them.

Too often people overlook things that seem to work well, and only focus on that which doesn't. For example, a person may only focus on the times he or she forgot to take their medication and not recall the times they did manage to take it. Being reminded of one's success offers encouragement and increases a person's self-confidence in their ability to carry out similar tasks in the future.

In addition, persons might find it helpful to use a medication check-off list, or a tablet box with the medications and the days of the week marked. Leaving medications in a particular location, taking them in association with meals, or using reminders such as alarm clocks can also be helpful.

Social Support: If you are a senior facing a complex medical regimen, try to seek the support of a friend or family member. Support can take various forms, such as reminders to take your medication, helping solve medication related problems or questions, or even simple encouragement when you are faced with a complex regimen.

Getting support from significant others in your life is not a sign of weakness or infirmity; everyone needs support in various forms through out their lifetime. And research shows that support is associated with better adherence to treatment and positive health outcomes.

Problem solving

If you are not sure if a person is taking their medications as often as they should, you can find clues in such things as the frequency of refills.

Sometimes a straightforward question about whether a person is taking his or her medication can also reveal problems. In addition, missed medical appointments and, in some cases, a failure to respond to treatment may offer clues about problems in adherence.

If you or your loved one have difficulty with sticking to medication regimens, try to solve the problem in a systematic way. First, make sure obvious physical and psychological problems have been addressed. People may have trouble with tasks such as injecting themselves. Or they may be depressed and feel it is useless to take their medication.

Involve the health care provider in the process of problem solving. If the primary care physician is too busy or unable to help, you can try discussing the problem with the nursing staff, medical social worker, or psychologist.

While there is no one single approach that works for all seniors and all treatment regimens, the methods and strategies described in this article can be used alone or in combination, and thereby increase the likelihood of sticking with prescribed regimens.