Medication understanding 373 Am J Health-Syst Pharm—Vol 61 Feb 15, 2004 REPORTS MARY V. SPIERS, PH.D., is Associate Professor of Psychology, Depart- ment of Psychology, and DAVID M. KUTZIK, PH.D., is Associate Pro- fessor of Sociology, Department of Culture and Communication, Drexel University, Philadelphia, PA. MELISSA LAMAR, PH.D., is Assis- tant Professor of Clinical Neurosciences, Department of Psychiatry, Columbia University, New York, NY. Address correspondence to Dr. Spiers at the Department of Psy- Variation in medication understanding among the elderly MARY V. SPIERS, D AVID M. KUTZIK, AND MELISSA L AMAR chology, Drexel University, 3141 Chestnut Street, Philadelphia, PA 19104 (spiersm@drexel.edu). Supported by a grant from the Philadelphia Corporation for Aging. Copyright © 2004, American Society of Health-System Pharma- cists, Inc. All rights reserved. 1079-2082/04/0202-0373$06.00. Purpose. Types of medication misunder- standing among community-dwelling eld- erly people were studied. Methods. Community-dwelling people who were at least 65 years of age and who volunteered to participate in a medication- review program were recruited for the study. A structured interview including a background interview, attitudinal ques- tions, and questions related to dosage, fre- quency, timing, and what to do if a dose was missed was conducted. Results. A total of 375 people were includ- ed in the study. Of these, 232 (62%) showed perfect understanding of their medication regimens. Twenty-eight (7.5%) of the sub- jects with less than perfect understanding misunderstood a limited aspect of their regimens across multiple medications, most frequently what to do if a dose was missed. These subjects had the least com- plex regimens, could name their medica- tions and describe their purpose, and rated themselves as having few medical prob- lems. Their lack of knowledge was not at- tributed to cognitive problems. Twenty- seven subjects (7%) did not know multiple aspects of at least one medication and ap- peared to be at high risk for nonadherence. These individuals had the most complex regimens, had difficulty naming and ex- plaining the purpose of their medications, and rated themselves as less adherent. Eighty-eight subjects (23.5%) demonstrated mixed problems with understanding; they did not show a defined pattern attributable to cognitive or noncognitive factors. Conclusion. A majority of people over the age of 65 years had good understanding of the drugs they were taking. Index terms: Compliance; Comprehension; Dosage schedules; Geriatrics Am J Health-Syst Pharm. 2004; 61:373-80 T he elderly are not necessarily less adherent to drug regimens than younger people, but they are at higher risk of adverse health effects as a consequence of nonadherence. 1,2 Poor medication adherence has signif- icant economic and social conse- quences in terms of increased morbid- ity and mortality. 3 Considering that 75% of the population over the age of 65 years takes at least one prescription medication and that the average num- ber of medications being taken by those over 65 ranges from two to four, the issue of nonadherence affects a majority of elderly people. 4-6 Although age itself is not consis- tently a predictor of medication ad- herence or the ability to remember to take medications, the range of cogni- tive variation among those older than 65 is wide. 7,8 Many people can be described as “successful agers,” with relative cognitive stability and high adherence to medications. 9,10 In contrast, those in cognitive decline may show a very different profile and require targeted interventions. The sheer number of medications being consumed by older adults, coupled with possible declines in cognitive function, suggests that cognitive variables play a large part in adher- ence in the elderly. 11 Individual demographic, medical, and behavioral predictors of nonad- herence are well documented. 7 De- creases in adherence are associated with both larger numbers of medica- tions taken and more complex med- ication regimens. 12,13 Surveys of personal medication use have consis- tently found that about 10% of older individuals do not understand the purpose of their medications. 14-16 Studies concerned with everyday knowledge of dosages and dosage