Aging population and adherence to treatment
The aging process is characterized by a high level of complexity which makes the care of older adults and in particular the use of medications a challenging task.
Typically, older adults show the co-occurrence of multiple chronic diseases (multimorbidity) and conditions (the so-called geriatric syndromes, such as urine incontinence, delirium or falls) that cannot be ascribed to a specific organ system pathology and frequently have multiple causes.
Older subjects are the major drugs consumers , with more than 90% of them receiving drug prescriptions. It has been reported that around 50% of older subjects receive 5 and 10% 10 drugs. Of note, polypharmacy increases the risk of adverse drug reactions and poor health outcomes including falls, hospitalization and death.
Nonetheless, suboptimal drugs prescription is very common in older subjects (12% to 40%, depending on the indicators used). Taken together, all these factors negatively affect adherence to medical prescription. Poor adherence to treatment regimens has long been recognized as a substantial roadblock to achieving better outcomes for patients. Data from the United States show that as many as half of all patients do not adhere to the medication regimen prescribed and it has been estimated that more than $100 billion are spent each year on avoidable hospitalizations.
Non-adherence to medication regimens also affects the quality and length of life. The growing population aging is the successful result of public health policies, but it also represents a burden for economic sustainability and functioning of health systems. The classification of poor adherence to pharmaceutical treatment, especially in chronic, life-threatening diseases, as a high priority issue for European health systems is justified by the extensive evidence demonstrating the high proportion of patients, especially the older ones, with limited adherence to treatment, and the negative effect of this behaviour on the benefits expected from the cure.