The influence of frailty syndrome on medication adherence among elderly patients with hypertension

Figures & data

Table 1 Clinical characteristics of patients with hypertension in relation to frailty syndrome

Variable	Total N=296	%	Frail N=198	%	Non-frail N=98	%	P-value
Tilburg frailty indicator, M ± SD	6.11±3.12		9.33±0.5		3.21±3.06		<0.001
Physical components, M ± SD	3.31±2.21		5.78±1.7		2.56±1.8
Psychological components, M ± SD	1.79±1.07		2.83±0.7		1.03±0.4
Social components, M ± SD	1.02±0.83		1.86±0.6		0.84±0.3
Duration of hypertension, M ± SD	12.3±8.8		12.6±9.0		11.7±8.2		0.362
Comorbidities
Diabetes mellitus	108	36.5%	79	39.9%	29	29.6%	0.084
Ischemic heart disease	77	26.0%	56	28.3%	21	21.4%	0.204
Renal insufficiency	48	16.2%	33	16.7%	15	15.3%	0.759
Chronic obstructive pulmonary disease	74	25.0%	52	26.3%	22	22.4%	0.466
Diary of self-control blood pressure
Yes	168	56.8%	118	59.6%	50	51.0%	0.202
Frequency of taking drugs							0.044
More often than once a day	86	45.3%	64	47.8%	22	39.3%
Once a day	104	54.8%	70	52.2%	34	60.7%
Knowledge of complications of untreated hypertension	164	55.4%	111	56.1%	53	54.1%	0.843
Knowledge of drug side effects	104	35.1%	69	34.8%	35	35.7%	0.986
Classification of blood pressure level according to ESC							0.004
Normal	21	7.1%	11	5.6%	10	10.2%
High normal	53	17.9%	20	12.1%	29	29.6%
Grade I hypertension	148	53.4%	109	55%	39	39.8%
Grade II hypertension	74	25%	54	27.3%	20	20.4%
Drugs taken
Angiotensin-converting enzyme inhibitors	132	44.6%	85	42.9%	47	48%	0.107
β-Blockers	82	27.7%	61	30.8%	21	21.4%	0.045
Angiotensin II receptor antagonist	17	5.7%	15	7.6%	2	2.0%	0.064
Thiazide-like diuretics	55	18.6%	32	16.2%	23	23.5%	0.502
Calcium antagonists	91	30.7%	57	28.8%	34	34.7%	0.313
Type of therapy
Monotherapy	169	57.1%	109	55.1%	60	61.2%	0.627
Polypharmacy	96	32.4%	75	37.9%	21	21.4%	0.047

Notes: Use of the ©MMAS is protected by US and International copyright laws. Permission for use is required. A license agreement is available from: Donald E Morisky, ScD, ScM, MSPH, Professor, Department of Community Health Sciences, UCLA School of Public Health, 650 Charles E. Young Drive South, Los Angeles, CA 90095-1772.^30–32

Abbreviations: N, sample size; P, significance level; ESC, European Society of Cardiology; M, mean; SD, standard deviation.

Table 2 Sociodemographic and clinical characteristics of patients with hypertension with respect to frailty syndrome

Variable	Total N=296	%	Frail N=198	%	Non-frail N=98	%	P-value
Age (years), M ± SD	68.8±8.0		70.0±8.2		66.3±7.1		<0.001
Female sex	165	55.7%	115	58.1%	50	51.0%	0.305
Marital status							0.050
Married/living with partner	177	59.8%	111	56.1%	66	67.3%
Single/divorced	118	40.2%	87	43.9%	32	32.7%
Education							0.122
None or primary	98	33.1%	73	36.9%	25	25.5%
Secondary	138	46.6%	89	44.9%	49	50.0%
University	60	20.3%	36	18.2%	24	24.5%
Professional activity							0.025
Employed	82	27.7%	44	22.2%	38	38.8%
Retired/disabled	209	70.6%	150	75.8%	59	60.2%
Unemployed	5	1.7%	4	2.0%	1	1.0%
Lives with
Alone	61	20.6%	52	26.3%	9	9.2%	0.004
With spouse/partner	231	51.4%	143	72.2%	88	89.8%	0.216
In organized senior center	4	1.3%	3	1.5%	1	1.0%	0.135
Household income per capita (PLN)
600–900	23	7.8%	19	9.6%	4	4.0%
901–1,200	77	26.0%	64	32.3%	13	13.3%
1,201–1,500	57	19.3%	41	20.7%	16	16.3%	<0.001
1,501–1,800	53	17.9%	24	12.1%	29	29.6%
1,801–2,100	36	12.2%	21	10.6%	15	15.3%
Over 2,100	50	16.9%	29	14.6%	21	21.4%
Traumatic/stressful events during the past year
Death of a loved one	60	20.3%	50	25.3%	10	10.2%	0.004
Serious illness	94	31.8%	81	40.9%	13	13.3%	<0.001
Serious illness in a loved one	75	25.3%	65	32.8%	10	10.2%	<0.001
Divorce or ending of an important intimate relationship	20	6.8%	19	9.6%	1	1.0%	0.005
Traffic accident	23	7.8%	21	10.6%	2	2.0%	0.010
Are you satisfied with your home living environment?
Yes	261	88.2%	168	84.8%	93	94.9%	0.012

Abbreviations: N, sample size; M, mean; SD, standard deviation; P, significance level.

Table 3 Analysis of the level of adherence (MMAS-8) in relation to frailty syndrome

Variable	Total N=296		Frail N=198		Non-frail N=98		P-value
Q1. Do you sometimes forget to take your antihypertensive pills? (No)	224	75.7%	140	70.7%	84	85.7%	0.007
Q2. People sometimes miss taking their medications for reasons other than forgetting. Thinking over the past 2 weeks: were there any days when you did not take your antihypertensive medicine? (No)	260	87.8%	168	84.8%	92	93.9%	0.041
Q3. Have you ever cut back or stopped taking your medication without telling your doctor, because you felt worse when you took it? (No)	255	86.2%	170	85.9%	85	86.7%	0.979
Q4. When you travel or leave home, do you sometimes forget to bring along your antihypertensive medicine? (No)	236	79.7%	153	77.3%	83	84.7%	0.180
Q5. Did you take your antihypertensive medicine yesterday? (Yes)	252	85.1%	169	85.4%	83	84.7%	0.981
Q6. When you feel like your antihypertensive is under control, do you sometimes stop taking your medicine? (No)	250	84.5%	161	81.3%	89	90.8%	0.034
Q7. Taking medication everyday is a real inconvenience for some people. Do you ever feel hassled about sticking to your antihypertensive treatment plan? (No)	257	86.8%	167	83.4%	90	91.8%	0.106
Q8. How often do you have difficulty remembering to take all your medications?
Never/rarely	4	1.4%	3	1.5%	1	1.0%	0.744
Sometimes	24	8.1%	18	9.1%	6	6.1%
Usually	43	14.5%	30	15.2%	13	13.3%
All the times	225	76.0%	147	74.2%	78	79.6%
MMAS-8 score
M ± SD	6.77±1.76		6.60±1.89		7.11±1.42		0.028
Me (Q1; Q3)	7 (6.5; 8)		7 (6; 8)		8 (7; 8)
Min–max	0.75–8		1–8		0.75–8
Adherence level
Low	54	18.2%	42	21.2%	12	12.3%	0.109
Medium	111	37.5%	75	37.9%	36	36.7%
High	131	44.3%	81	40.9%	50	51.0%

Notes: Use of the ©MMAS is protected by US and International copyright laws. Permission for use is required. A license agreement is available from: Donald E Morisky, ScD, ScM, MSPH, Professor, Department of Community Health Sciences, UCLA School of Public Health, 650 Charles E. Young Drive South, Los Angeles, CA 90095-1772.^30–32

Abbreviations: MMAS-8, 8-item Morisky Medication Adherence Scale; N, sample size; P, significance level; M, mean; SD, standard deviation; Min, minimum; max; maximum; Me, median.

Table 4 Spearman’s rank correlation coefficients of analyzed component of Tilburg questionnaire with the level of adherence (MMAS-8)

Determinants (variable)/TFI component	Rho	P-value	Beta	P-value
TFI – score	−0.183	0.002	0.069	0.292
TFI – physical component	−0.117	0.044	−0.048	0.317
TFI – psychological component	−0.183	0.002	−0.212	0.118
TFI – social component	−0.163	0.005	0.069	0.775

Notes: Data in bold indicates statistical significance (P<0.05). Use of the ©MMAS is protected by US and International copyright laws. Permission for use is required. A license agreement is available from: Donald E Morisky, ScD, ScM, MSPH, Professor, Department of Community Health Sciences, UCLA School of Public Health, 650 Charles E. Young Drive South, Los Angeles, CA 90095-1772.^30–32

Abbreviations: MMAS-8, 8-item Morisky Medication Adherence Scale; TFI, Tilburg frailty indicator; Rho, Spearman’s rank correlation coefficients; Beta, regression coefficient; P, significance level.

Table 5 Spearman’s rank correlation coefficients of analyzed sociodemographic and clinical variables with the level of adherence

Determinant (variable)	Rho	P-value	Beta	P-value
Age, years	−0.084	0.150
Sex	−0.068	0.242
Duration of a disease	0.006	0.919
Marital status (married/in a relation)	0.132	0.023	0.269	0.205
Higher education	0.052	0.371
Professional activity	0.009	0.881
Living alone	−0.117	0.044	−0.292	0.270
Severity of hypertension	0.093	0.110
Diabetes mellitus	0.008	0.891
Ischemic heart disease	−0.076	0.190
Renal insufficiency	0.012	0.856
Knowledge about complications of untreated hypertension	0.116	0.047	0.395	0.045
Knowledge about drug side effects	0.033	0.574
Treatment with angiotensin-converting enzyme inhibitors	0.003	0.956
Treatment with β-blockers	−0.072	0.217
Treatment with angiotensin II receptor antagonist	0.120	0.039	0.649	0.123
Treatment with thiazide-like diuretics	−0.075	0.197
Treatment with calcium antagonists	0.063	0.280
Monotherapy	−0.092	0.115
Death of a loved one during the past year	−0.138	0.018	0.014	0.963
Serious illness during the past year	−0.117	0.044	−0.075	0.751
Serious illness in a loved one during the past year	−0.178	0.002	−0.154	0.573
Divorce or ending of an important intimate relationship during the past year	−0.140	0.016	0.082	0.873
Traffic accident during the past year	−0.120	0.038	−0.281	0.557
Satisfaction with the home living environment	0.169	0.004	0.897	0.007

Notes: Data in bold indicates statistical significance (P<0.05).

Abbreviations: Rho, Spearman’s rank correlation coefficients; Beta, regression coefficient; P, significance level.

MoriskyDEAngAKrousel-WoodMWardHJPredictive validity of a medication adherence measure in an outpatient settingJ Clin Hypertens (Greenwich)200810534835418453793

 PubMed Web of Science ®Google Scholar

MoriskyDEDiMatteoMRImproving the measurement of self-reported medication nonadherence: Final responseJ Clin Epidem201164258263

 Web of Science ®Google Scholar