Monday, April 8, 2013
Medical Compliance and Older Adults
I have chosen to describe a program aimed to help older adults comply with medical recommendations for taking prescription medications. Research suggests many patients do not understand the information written on their prescription bottle label or the instruction communicated by their doctor (Carmona, 2007; Liechty, 2011). Older adults are prone to a number of chronic conditions that require medical and medicine adherence. Health literacy in older adults may vary; whereas some may have a good understanding of how to take their medication and why they take it, others do not have a full grasp on medical instructions. Older adults are particularly ambivalent about change and approximately 50% of older adults with chronic conditions are medically non-compliant. Failure to take medications properly contributes to one in ten hospitalizations for this age group (Kier et al., 2012).
Important factors to consider for this population are age, health literacy, and culture. It would be important to understand that older adults are an especially vulnerable population, although equally important to communicate and guide them without perpetuating ageist views (Nolan, 2011).
One factor to consider is the client's level of health literacy. Health literacy can affect an individual's adherence to medical treatment and it may prevent them from fully understanding the implications of not taking their medications or taking them incorrectly (Kier et al., 2012). Health literacy strongly influences health outcomes (Weekes, 2012). It is important that the individuals participating in the program understand the scope of the intervention and how it will affect their health. A lack of health literacy is implicated in poorer health outcomes for the elderly and those with chronic illness (Von Wagner et al., 2007).
Another consideration is the age of the participants in this program. Older adults may find it more difficult to understand the information conveyed to them, and they may be more forgetful than other age groups (Prabhavalkar & Chintamaneni, 2010). They may have fewer resources available to them, or they may not be aware of the resources that are available. To effect change in this population, information must be communicated in a way that it can be realistically implemented into their lives (Bryant, 2011). Age contributes to a decline in cognitive abilities (Santrock, 2008). Many older adult patients may experience a range of issues with even low levels of dementia including challenges to memory and attention span, and language skills (Prabhavalkar & Chintamaneni, 2010). All of these have implications for effective communication.
The individual's culture must be a consideration as well because culture affects an individual's perceptions and fundamental belief systems that may help or hinder medical compliance (Sue & Sue, 2008; Wagner et al., 2007). Individuals not fully integrated into the majority culture, especially those who are not fluent in the primary language spoken, are more likely to not understand health recommendations, dosing instructions, or other aspects of medical compliance (Bryant, 2011). These individuals are more likely to lack health literacy and they tend to have poorer health outcomes (Bryant, 2011).
Utilizing Motivational Interviewing
I would utilize motivational interviewing (MI) to strengthen self-efficacy for this program for older adults. As expressed by Rollnick, Miller, & Butler (2008), it is not only necessary to initiate motivation but to engage individuals in commitment to change. It facilitates intrinsic motivation by resolving issues of ambivalence that may include self-efficacy (Irby, Kaplan, Garner-Edwards, Kolbash & Skelton, 2010). MI emphasizes being empathetic rather than confrontational, and supports clients' confidence in their ability to undertake medical compliance effectively. Based on the theory that inducing durable change must incorporate intrinsic motivation, it can also reduce older adult's ambivalence to change (Kier et al., 2012). MI has been effective in many applications with older adults, although some research determined that the brevity with which MI is often implemented may not be sufficient to induce long-term change in older adults (Cummings, Cooper, & Cassie, 2008). Although there is a paucity of research on the exact amount needed to effect durable change in older adults, more than usual may be necessary (Cummings et al., 2008).
Bryant, A. (2011). Low health literacy affecting client's ability to receive adequate health care education. JOCEPS: The Journal Of Chi Eta Phi Sorority, 55(1), 7-11.
Carmona, R. H. (2007). Improving Americans’ health literacy. Journal of the American Dietetic Association, 20, 422-425.
Cummings, S. M., Cooper, R. L., & Cassie, K. M. (2008). Motivational Interviewing to Affect Behavioral Change in Older Adults. Research on Social Work Practice, 19(2), 195-204. doi: 10.1177/1049731508320216
Irby, M., Kaplan, S., Garner-Edwards, D., Kolbash, S., & Skelton, J. A. (2010). Motivational interviewing in a family-based pediatric obesity program: A case study. Families, Systems, & Health, 28(3), 236-246. doi:10.1037/a0020101
Kier, F. J., Byrne, A. J., Snider-meyer, J. M., Levine, D. A., Gresser, S. K., & Smith, H. M. (2012). Effectiveness of motivational interviewing on medication compliance in a geriatric home care service. Washington, District of Columbia, US: American Psychological Association (APA).
Liechty, J. M. (2011). Health Literacy: Critical Opportunities for Social Work Leadership in Health Care and Research. Health & Social Work, 36(2), 99-107.
Marks, D. F., Murray, M., Evans, B., & Estacio, E. V. (2011). Health Psychology: Theory, Research, and Practice (3rd ed.). London: Sage.
Nolan, L. C. (2011). Dimensions of Aging and Belonging for the Older Person and the Effects of Ageism. BYU Journal of Public Law, 25, 317-339.
Prabhavalkar, K. S., & Chintamaneni, M. (2010). Diagnosis and treatment of mild cognitive impairment: A review. Journal of Pharmacy Research, 3(2), 388– 392.
Rollnick, S., Miller, W. R., & Butler, C. C. (2008). Motivational interviewing in health care. New York, NY: Guilford Press.
Santrock, J. W. (2011). A topical approach to life-span development (3rd ed.). New York, NY: McGraw-Hill.
Von Wagner, C., Knight, C., Steptoe, A., & Wardle, J. (2007). Functional health literacy and health promoting behavior in a national sample of British adults. Journal of Epidemiology and Community Health. 61(6), 1086-1091.
Weekes, C. V. (2012). African Americans and Health Literacy: A Systematic Review. ABNF Journal, 23(4), 76-80.