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Strategies Used by Older Adults with Asthma for Adherence to Inhaled Corticosteroids

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A Capsule Commentary to this article was published on 23 August 2014

ABSTRACT

BACKGROUND

Older adults with asthma have low levels of adherence to their prescribed inhaled corticosteroids (ICS). While prior research has identified demographic and cognitive factors associated with ICS adherence among elderly asthmatics, little is known about the strategies that older adults use to achieve daily use of their medications. Identifying such strategies could provide clinicians with useful advice for patients when counseling their patients about ICS adherence.

OBJECTIVE

To identify medication use strategies associated with good ICS adherence in older adults.

PARTICIPANTS

English-speaking and Spanish-speaking adults ages 60 years and older with moderate or severe asthma were recruited from primary care and pulmonary practices in New York City, NY, and Chicago, IL. Patients with chronic obstructive pulmonary disease, other chronic lung diseases or a smoking history of greater than 10 pack-years were excluded.

MAIN MEASURES

Medication adherence was assessed with the Medication Adherence Rating Scale (MARS). Medication use strategies were assessed via open-ended questioning. “Good adherence” was defined as a mean MARS score of 4.5 or greater.

KEY RESULTS

The rate of good adherence to ICS was 37 %. We identified six general categories of medication adherence strategies: keeping the medication in a usual location (44.2 %), integrating medication use with a daily routine (32.6 %), taking the medication at a specific time (21.7 %), taking the medication with other medications (13.4 %), using the medication only when needed (13.4 %), and using other reminders (11.9 %). The good adherence rate was greater among individuals who kept their ICS medication in the bathroom (adjusted odds ration [AOR] 3.05, 95 % CI 1.03–9.02, p = 0.04) or integrated its use into a daily routine (AOR 3.77, 95 % CI: 1.62–8.77, p = 0.002).

CONCLUSIONS

Keeping ICS medications in the bathroom and integrating them into daily routines are strategies associated with good ICS adherence. Clinicians concerned with adherence should consider recommending these strategies to their older asthmatic patients, although additional research is needed to determine whether such advice would improve adherence behaviors.

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Acknowledgements

The ABLE study was supported by a grant from the National Heart, Lung and Blood Institute (R01HL096612). Ms. Brooks was supported through Project Learn of the Robert Wood Johnson Foundation.

Conflict of Interest

The authors declare that they do not have any conflicts of interest.

Author information

Authors and Affiliations

  1. New York University, New York, NY, USA

    Taylor L. Brooks

  2. Institute of Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ, USA

    Howard Leventhal PhD

  3. Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Michael S. Wolf PhD & Rachel O’Conor MPH

  4. Division of General Internal Medicine, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1087, New York, NY, 10025, USA

    Jose Morillo BA, Melissa Martynenko MPA, MPH, Juan P. Wisnivesky MD, DrPH & Alex D. Federman MD, MPH

  5. Division of Pulmonary, Critical Care and Sleep Medicine, Mount Sinai School of Medicine, New York, NY, USA

    Juan P. Wisnivesky MD, DrPH

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  1. Taylor L. Brooks
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  2. Howard Leventhal PhD
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  3. Michael S. Wolf PhD
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  4. Rachel O’Conor MPH
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  6. Melissa Martynenko MPA, MPH
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  8. Alex D. Federman MD, MPH
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Corresponding author

Correspondence to Alex D. Federman MD, MPH.

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Brooks, T.L., Leventhal, H., Wolf, M.S. et al. Strategies Used by Older Adults with Asthma for Adherence to Inhaled Corticosteroids. J GEN INTERN MED 29, 1506–1512 (2014). https://doi.org/10.1007/s11606-014-2940-8

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  • DOI: https://doi.org/10.1007/s11606-014-2940-8

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