Coronary heart disease (CHD) remains the leading cause of death globally, claiming nine million lives annually. As the population ages, the incidence and mortality of CHD, including myocardial infarction, angina, and coronary artery bypass grafting, rise significantly. In the United States, CHD affects 19.7% of men and 12.6% of women aged 60 to 79, with the numbers jumping to 31% and 25.4% for those over 80, respectively.This is a stark contrast to the 6% prevalence among men and women aged 40 to 59 (Virani et al., 2020). More than 83% of CHD-related deaths occur in the elderly (Thom et al., 2006).
Drug therapy is crucial in preventing complications and managing CHD. Secondary prevention strategies typically involve four classes of drugs: renin-angiotensin system inhibitors, beta-blockers, hypolipidemics, and antiplatelets. However, adherence to these treatments is often suboptimal among seniors, particularly those over 75 years old. Compliance rates drop to 82.3% three months post-hospital discharge and plummet to around 53% after one year. This non-adherence increases the risk of hospitalization,mortality,and healthcare costs.
Previous studies have highlighted the role of socio-demographic factors, such as age, education level, income, and health insurance, in medication adherence. Seniors often have a less comprehensive understanding of their medications and conditions,struggle with medication management,and are frequently on multiple medications. Moreover,older adults receive less therapeutic education than younger individuals (Ali et al., 2009).
A Comprehensive review: The Impact of Education on Medication Adherence
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To investigate the effects of educational programs on medication adherence in older adults with CHD, a meta-analysis was conducted, reviewing randomized controlled trials (RCTs) up to January 2024. Twelve English and five Chinese databases were searched for RCTs focusing on educational interventions designed to improve medication adherence in seniors with CHD. The Cochrane risk of Bias tool v2 was used to assess study quality, and a meta-analysis was performed using Review Manager 5.3. A total of 6 RCTs (n = 1159) were included in the analysis.
The interventions were primarily nurse-led, initiated before hospital discharge or shortly after, and typically lasted 1 to 3 months.They often included skills training for improving compliance, such as using pill dispensers and calendars, knowledge about medications and CHD, and advice on lifestyle changes.
Enhanced Adherence: Short-Term and Long-Term Effects
The meta-analysis revealed that therapeutic education programs significantly improved medication adherence 2 to 6 months after the education phase (standardized mean difference (SMD): 1.13, 95% confidence interval (CI): 0.33 to 1.94, P = 0.006, moderate certainty of evidence). However, there was no significant enhancement in the month following the intervention (SMD: 2.18 [-1.22 to 5.58], P = 0.21, low certainty of evidence). The narrative synthesis suggested that education programs could potentially improve medication adherence, understanding of the condition, and medication management capacity beyond six months post-intervention.
Therapeutic education for seniors with CHD can significantly enhance medication compliance 2 to 6 months after intervention, with potential long-term benefits. However, the effect on compliance in the immediate month following the intervention remains uncertain. Developing educational programs based on theoretical frameworks can address the complex health needs of these patients. Further rigorous evaluation of these programs’ impact on medication adherence in older adults with CHD is warranted.
Improving Medication Adherence in Seniors with Coronary Heart Disease: An Interview with a Specialist
Coronary heart disease (CHD) is the leading cause of death worldwide, affecting millions, notably within the aging population. As treatment options evolve, understanding factors that influence medication adherence becomes crucial. In this interview, we speak with Dr. Emily Carter, a cardiologist specializing in geriatric care and medication management, to discuss the impact of educational interventions on improving adherence among older adults suffering from CHD.
The Growing Challenge of CHD in Seniors
Senior Editor: Dr. Carter, could you start by explaining why coronary heart disease has become such a critical issue in the elderly population?
Dr. Carter: Certainly. Coronary heart disease is a major health crisis, contributing to about nine million deaths globally each year. In the U.S., the prevalence is notably high among older adults—nearly 20% of those aged 60 to 79 and over 30% for those above 80 are affected. This is alarming because more than 83% of CHD-related deaths occur in the elderly, making it imperative to address this issue effectively.
The Role of drug Therapy in Managing CHD
Senior Editor: Drug therapy plays a vital role in managing CHD. Can you explain the importance of medication adherence in this context?
Dr. Carter: Absolutely. Drug therapy is essential for managing CHD and preventing complications. For elderly patients, adherence to prescribed medications is crucial; however, compliance rates tend to decline dramatically, especially in those over 75. For instance,after three months post-hospital discharge,adherence can drop to 82.3% and even further—to about 53%—after a year. This non-adherence increases risks for hospitalization and mortality.
Factors Influencing Medication Adherence
Senior Editor: What factors contribute to the observed non-adherence among seniors with CHD?
Dr. Carter: Several socio-demographic factors influence medication adherence, including age, education level, income, and access to health insurance. Many older adults struggle with medication management and often juggle multiple prescriptions. They might also have a less extensive understanding of their medications and conditions because they typically recieve less therapeutic education compared to younger individuals.
The Impact of Educational Programs
Senior Editor: Your recent meta-analysis looks into educational interventions. What did you find regarding their effects on medication adherence in seniors?
Dr. Carter: We found that educational programs,especially nurse-led initiatives initiated before hospital discharge or shortly after,substantially enhance medication adherence. The meta-analysis indicated a marked improvement in adherence rates 2 to 6 months after participating in therapeutic education. However, the immediate post-intervention period did not show statistically significant improvements, suggesting that the long-term effects of educational programs hold more promise.
Looking Ahead: The Future of Medication Management for Seniors
Senior Editor: Given your findings, how should healthcare providers approach medication management for older adults with CHD moving forward?
Dr.Carter: It’s essential to develop educational programs rooted in theoretical frameworks that address the complex health needs of seniors. Future research should focus on assessing these programs rigorously to ensure that we are providing optimal support that not only improves medication adherence but also enhances the overall understanding and management of their health conditions.
as CHD continues to challenge the aging population, addressing medication adherence through tailored educational interventions can make a profound difference in patient outcomes. Thank you, Dr. Carter, for sharing your insights on this critical issue.
