Skip to main content
SpringerLink
Log in

Challenges of Treatment Adherence in Older Patients with Parkinson’s Disease

  • Review Article
  • Published:
Drugs & Aging Aims and scope Submit manuscript

Abstract

Patient adherence to a medication regimen is critical to treatment outcome, quality of life and future healthcare costs. For elderly patients with Parkinson’s disease, obstacles to adherence can be particularly complex. Beyond age-related and economic factors, elderly patients with Parkinson’s disease often require complicated dosing or titration schedules and have multiple co-morbidities that necessitate administration of therapies from multiple drug classes. In addition, neuropsychiatric disturbances and cognitive impairment, which are often part of the disease process, can affect adherence, as can variable responses to antiparkinsonian agents as the disease progresses. Several recent studies in patients with Parkinson’s disease point to the need for establishing good adherence patterns early and maintaining these throughout the course of treatment. To achieve optimal adherence in elderly patients with Parkinson’s disease, a combination of pharmacological and non-pharmacological approaches appears to be the best strategy for success. Examples include a strong provider-patient relationship, educational intervention by phone or face-to-face contact, simplified dosing and administration schedules, management and understanding of medication adverse events, and the use of adherence aids such as pill boxes and hour-by-hour organizational charts. Research into new avenues that include improved drug monitoring, pharmacogenetics and neuroprotective regimens may give rise to better adherence in elderly patients with Parkinson’s disease in the future.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Table I
Table II

Similar content being viewed by others

References

  1. MacLaughlin EJ, Raehl CL, Treadway AK, et al. Assessing medication adherence in the elderly: which tools to use in clinical practice? Drugs Aging 2005; 22(3): 231–55

    Article  PubMed  Google Scholar 

  2. Playfer JR. The therapeutic challenges in the older Parkinson’s disease patient. Eur J Neurol 2002; 9: 55–8

    Article  PubMed  Google Scholar 

  3. Grosset KA, Reid JL, Grosset DG. Medicine-taking behavior: implications of suboptimal compliance in Parkinson’s disease. Mov Disord 2005; 20(11): 1397–404

    Article  PubMed  Google Scholar 

  4. Grosset KA, Bone I, Grosset DG. Suboptimal medication adherence in Parkinson’s disease. Mov Disord 2005; 20(11): 1502–7

    Article  PubMed  Google Scholar 

  5. Leopold NA, Polansky M, Hurka MR. Drug adherence in Parkinson’s disease. Mov Disord 2004; 19(5): 513–7

    Article  PubMed  Google Scholar 

  6. Hughes CM. Medication non-adherence in the elderly: how big is the problem? Drugs Aging 2004; 21(12): 793–811

    Article  PubMed  Google Scholar 

  7. Schlenk EA, Dunbar-Jacob J, Engberg S. Medication non-adherence among older adults: a review of strategies and interventions for improvement. J Gerontol Nurs 2004; 30(7): 33–43

    PubMed  Google Scholar 

  8. Morrell RW, Park DC, Kidder DP, et al. Adherence to antihypertensive medications across the life span. Gerontologist 1997; 37(5): 609–19

    Article  PubMed  CAS  Google Scholar 

  9. Schectman JM, Nadkarni MM, Voss JD. The association between diabetes metabolic control and drug adherence in an indigent population. Diabetes Care 2002; 25(6): 1015–21

    Article  PubMed  Google Scholar 

  10. Corden ZM, Bosley CM, Rees PJ, et al. Home nebulized therapy for patients with COPD: patient compliance with treatment and its relation to quality of life. Chest 1997 Nov 5; 112(5): 1278–82

    Article  PubMed  CAS  Google Scholar 

  11. Salzman C. Medication compliance in the elderly. J Clin Psychiatry 1995; 56: 18–22

    PubMed  Google Scholar 

  12. Vik SA, Maxwell CJ, Hogan DB. Measurement, correlates, and health outcomes of medication adherence among seniors. Ann Pharmacother 2004; 38(2): 303–12

    Article  PubMed  Google Scholar 

  13. Nichol MB, Venturini F, Sung JCY. A critical evaluation of the methodology of the literature on medication compliance. Ann Pharmacother 1999; 33(5): 531–40

    Article  PubMed  CAS  Google Scholar 

  14. Ranelli PL, Aversa SL. Medication-related Stressors among family caregivers. Am J Hosp Pharm 1994; 51: 75–9

    PubMed  CAS  Google Scholar 

  15. Stewart RB, Caranasos GJ. Medication compliance in the elderly. Med Clin North Am 1989; 73(6): 1551–63

    PubMed  CAS  Google Scholar 

  16. Balkrishnan R. Predictors of medication adherence in the elderly. Clin Ther 1998; 20(4): 764–71

    Article  PubMed  CAS  Google Scholar 

  17. Claxton AJ, Cramer J, Pierce C. A systematic review of the associations between dose regimens and medication compliance. Clin Ther 2001; 23(8): 1296–310

    Article  PubMed  CAS  Google Scholar 

  18. Cramer J, Vachon L, Desforges C, et al. Dose frequency and dose interval compliance with multiple antiepileptic medications during a controlled clinical trial. Epilepsia 1995; 36(11): 1111–7

    Article  PubMed  CAS  Google Scholar 

  19. Kruse W, Eggert-Kruse W, Rampmaier J, et al. Dosage frequency and drug-compliance behaviour: a comparative study on compliance with a medication to be taken twice or four times daily. Eur J Clin Pharmacol 1991; 41(6): 589–92

    Article  PubMed  CAS  Google Scholar 

  20. Coleman EA. Falling through the cracks: challenges and opportunities for improving transitional care for persons with continuous complex care needs. J Am Geriatr Soc 2003; 51(4): 549–55

    Article  PubMed  Google Scholar 

  21. Gray SL, Mahoney JE, Blough DK. Medication adherence in elderly patients receiving home health services following hospital discharge. Ann Pharmacother 2001; 35(5): 539–45

    Article  PubMed  CAS  Google Scholar 

  22. Ruscin JM, Semla TP. Assessment of medication management skills in older outpatients. Ann Pharmacother 1996; 30(10): 1083–8

    PubMed  CAS  Google Scholar 

  23. Fargel M, Grobe B, Oesterle E, et al. Treatment of Parkinson’s disease: a survey of patients and neurologists. Clin Drug Invest 2007; 27(3): 207–18

    Article  Google Scholar 

  24. Williams-Gray CH, Foltynie T, Lewis SJ, et al. Cognitive deficits and psychosis in Parkinson’s disease: a review of pathophysiology and therapeutic options. CNS Drugs 2006; 20(6): 477–505

    Article  PubMed  CAS  Google Scholar 

  25. Col N, Fanale JE, Kronholm P. The role of medication noncompliance and adverse drug reactions in hospitalizations of the elderly. Arch Intern Med 1990; 150(4): 841–5

    Article  PubMed  CAS  Google Scholar 

  26. Coons SJ, Sheahan SL, Martin SS, et al. Predictors of medication noncompliance in a sample of older adults. Clin Ther 1994; 16(1): 110–7

    PubMed  CAS  Google Scholar 

  27. Ciechanowski PS, Katon WJ, Russo JE. Depression and diabetes: impact of depressive symptoms on adherence, function, and costs. Arch Intern Med 2000; 160(21): 3278–85

    Article  PubMed  CAS  Google Scholar 

  28. DiMatteo MR, Lepper HS, Croghan TW. Depression is a risk factor for noncompliance with medical treatment: meta-analysis of the effects of anxiety and depression on patient adherence. Arch Intern Med 2000; 160(14): 2101–7

    Article  PubMed  CAS  Google Scholar 

  29. Chia LR, Schlenk EA, Dunbar-Jacob J. Effect of personal and cultural beliefs on medication adherence in the elderly. Drugs Aging 2006; 23(3): 191–202

    Article  PubMed  Google Scholar 

  30. Garay-Sevilla ME, Malacara HJM, Gonzalez-Parada F, et al. The belief in conventional medicine and adherence to treatment in non-insulin-dependent diabetes mellitus patients. J Diabetes Complications 1998; 12(5): 239–45

    Article  PubMed  CAS  Google Scholar 

  31. Neuman P, Strollo MK, Guterman S, et al. Medicare prescription drug benefit progress report: findings from a 2006 national survey of seniors. Health Aff (Millwood) 2007; 26(5): w630–43

    Article  Google Scholar 

  32. Scott MA, Jackson VL, Hitch WJ. Hospital admission associated with Medicare Part D “doughnut hole”. Am J Health Syst Pharm 2007 May 15; 64(10): 1029–30

    Article  PubMed  Google Scholar 

  33. Ridley DB, Axelsen KJ. Impact of Medicaid preferred drug lists on therapeutic adherence. Pharmacoeconomics 2006; 24: 65–78

    Article  PubMed  Google Scholar 

  34. Mind the gap: Medicare part D’s coverage gaps may affect patient adherence. Am Fam Physician 2006 Feb 1; 73(3): 404

    Google Scholar 

  35. Holley JL, DeVore CC. Why all prescribed medications are not taken: results from a survey of chronic dialysis patients. Adv Perit Dial 2006; 22: 162–6

    PubMed  Google Scholar 

  36. Lynch T. Medication costs as a primary cause of nonadherence in the elderly. Consult Pharm 2006; 21(2): 143–6

    Article  PubMed  Google Scholar 

  37. Nyholm D. Pharmacokinetic optimisation in the treatment of Parkinson’s disease: an update. Clin Pharmacokinet 2006; 45(2): 109–36

    Article  PubMed  CAS  Google Scholar 

  38. Rojo A, Aguilar M, Garolera MT, et al. Depression in Parkinson’s disease: clinical correlates and outcome. Parkinsonism Related Disord 2003; 10(1): 23–8

    Article  CAS  Google Scholar 

  39. Liepelt I, Maetzler W, Blaicher HP, et al. Treatment of dementia in parkinsonian syndromes with cholinesterase inhibitors. Dement Geriatr Cogn Disord 2007; 23(6): 351–67

    Article  PubMed  CAS  Google Scholar 

  40. Grosset KA, Bone I, Reid JL, et al. Measuring therapy adherence in Parkinson’s disease: a comparison of methods. J Neurol Neurosurg Psychiatry 2006; 77(2): 249–51

    Article  PubMed  CAS  Google Scholar 

  41. Grymonpre RE, Didur CD, Montgomery PR, et al. Pill count, self-report, and pharmacy claims data to measure medication adherence in the elderly. Ann Pharmacother 1998; 32(7–8): 749–54

    Article  PubMed  CAS  Google Scholar 

  42. Peterson AM, Takiya L, Finley R. Meta-analysis of trials of interventions to improve medication adherence. Am J Health Syst Pharm 2003; 60(7): 657–65

    PubMed  Google Scholar 

  43. Higgins N, Regan C. A systematic review of the effectiveness of interventions to help older people adhere to medication regimes. Age Ageing 2004; 33(3): 224–9

    Article  PubMed  Google Scholar 

  44. Huffman MH. Compliance, health outcomes, and partnering in PPS: acknowledging the patient’s agenda. Home Healthcare Nurse 2005; 23(1): 23–8

    PubMed  Google Scholar 

  45. Stewart MA. Effective physician-patient communication and health outcomes: a review. CMAJ 1995; 152(9): 1423–33

    PubMed  CAS  Google Scholar 

  46. Lowe CJ, Raynor DK, Purvis J, et al. Effects of a medicine review and education programme for older people in general practice. Br J Clin Pharmacol 2000; 50(2): 172–5

    Article  PubMed  CAS  Google Scholar 

  47. Cramer JA. Optimizing long-term patient compliance. Neurology 1995; 45(2): S25–8

    PubMed  CAS  Google Scholar 

  48. Bernsten C, Bjorkman I, Caramona M, et al. Improving the well-being of elderly patients via community pharmacy-based provision of pharmaceutical care. Drugs Aging 2001; 18: 63–77

    Article  PubMed  CAS  Google Scholar 

  49. Cramer JA, Scheyer RD, Mattson RH. Compliance declines between clinic visits. Arch Intern Med 1990; 150: 1509–10

    Article  PubMed  CAS  Google Scholar 

  50. Sturgess IK, McElnay JC, Hughes CM, et al. Community pharmacy based provision of pharmaceutical care to older patients. Pharm World Sci 2003; 25: 218–26

    Article  PubMed  Google Scholar 

  51. Varma S, McElnay JC, Hughes CM, et al. Pharmaceutical care of patients with congestive heart failure: interventions and outcomes. Pharmacotherapy 1999; 19: 860–9

    Article  PubMed  CAS  Google Scholar 

  52. Wu JY, Leung WY, Chang S, et al. Effectiveness of telephone counseling by a pharmacist in reducing mortality in patients receiving polypharmacy: randomized controlled trial. BMJ 2006; 333: 552

    Google Scholar 

  53. Richter A, Anton SF, Koch P, et al. The impact of reducing dose frequency on health outcomes. Clin Ther 2003; 25(8): 2307–35

    Article  PubMed  Google Scholar 

  54. Pahwa R, Factor SA, Lyons KE, et al. Practice parameter: treatment of Parkinson disease with motor fluctuations and dyskinesia (an evidence-based review). Neurology 2006; 66: 983–95

    Article  PubMed  CAS  Google Scholar 

  55. Park DC, Morrell RW, Frieske D, et al. Medication adherence behaviors in older adults: effects of external cognitive supports. Psychol Aging 1992; 7(2): 252–6

    Article  PubMed  CAS  Google Scholar 

  56. Orwig D, Brandt N, Gruber-Baldini AL. Medication management assessment for older adults in the community. Gerontologist 2006; 46: 661–8

    Article  PubMed  Google Scholar 

  57. Arbouw MEL, van Vugt JPP, Egberts TCG, et al. Pharmacogenetics of antiparkinsonian drug treatment: a systematic review. Pharmacogenomics 2007; 8(2): 159–76

    Article  PubMed  CAS  Google Scholar 

  58. Poewe W. The need for neuroprotective therapies in Parkinson’s disease: a clinical perspective. Neurology 2006 May 23; 66 (10 Suppl. 4): S2–9

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

No sources of funding were used to assist in the preparation of this review. The authors have no conflicts of interest that are directly relevant to the content of this review.

Author information

Authors and Affiliations

  1. Department of Clinical Pharmacy, University of Colorado Denver, Aurora, Colorado, USA

    Jacquelyn L. Bainbridge (Associate Professor)

  2. Department of Pharmacy Practice, Southern Illinois University of Edwardsville, Edwardsville, Illinois, USA

    J. Mark Ruscin

Authors
  1. Jacquelyn L. Bainbridge
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. Mark Ruscin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jacquelyn L. Bainbridge.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bainbridge, J.L., Ruscin, J.M. Challenges of Treatment Adherence in Older Patients with Parkinson’s Disease. Drugs Aging 26, 145–155 (2009). https://doi.org/10.2165/0002512-200926020-00006

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/0002512-200926020-00006

Keywords

Search

Navigation