Download Patient non-compliance is the major obstacle to a dementia

Patient non-compliance is the major obstacle to a dementia prevention program in the
primary care setting. Polypharmacy, adverse drug reactions, and patient non-compliance
are common problems in patients over the age of 65 that contribute to many hospital
admissions. Studies show that between 10-20% of medications consumed by elders are
used in error, producing 10% of hospitalizations. Duplicate therapy, incorrect
prescriptions, inaccurate dosing, and drug-drug interactions are common problems.
Psychotropic medications are often misprescribed, especially benzodiazepines or
narcotics such as Darvon. Many older persons intentionally use excessive medications or
those prescribed for others; especially psychotropic or analgesic drugs. The adverse
health effects of inappropriate medications are significant. Inappropriate consumption of
psychotropic medications can produce delirium that results in disability or nursing home
admission.
Therapeutic non-compliance produces serious medical complications in elders.
Depressed elders, elders treated by multiple doctors or those who use multiple
medications have greater risk for non-compliance. Elders with unrecognized dementia
may forget symptoms, instructions, or dosage changes. Elders may fail to comply with
diet, medication, and lifestyle changes for many reasons. About 1/3 of elders admit to
medication non-compliance and 3/4 are non-compliant during direct monitoring. Many
elders fail to use written instructions for medications and rely on their memory for
compliance. Physicians must communicate directly with the older patient to enhance
their sense of self-determination and responsibility for their health (Click here for
references – 2514.13).
Recommendation
Elders should be encouraged to bring all consumed medications to every office visit and
seek consultations from their local pharmacist. Discuss compliance and prevention in
explicit concrete terms with the older patient. Provide written instructions and frequent
reminders about medication. Include family caregiver in the discussion about
medication. Advise elders to cross-check all medications with their pharmacist,
including over-the-counter medications. For more information, click here – 2514.11,
2514.15.
 Richard E. Powers, MD (2006) – Bureau of Geriatric Psychiatry
DEMENTIA EDUCATION & TRAINING PROGRAM – 1-800-457-5679