Asthma Beliefs Are Associated with Medication Adherence in Older Asthmatics

Abstract

BACKGROUND: Empirical research and health policies on asthma have focused on children and young adults, even though asthma morbidity and mortality are higher among older asthmatics. OBJECTIVE: To explore the relationship of asthmarelated beliefs and self-reported controller medication adherence in older asthmatics. DESIGN: An observational study of asthma beliefs and self-management among older adults. PARTICIPANTS: Asthmatics ages ≥60 years (N=324, mean age 67.4±6.8, 28 % white, 32 % black, 30 % Hispanic) were recruited from primary care practices in New York City and Chicago. MAIN MEASURES: Self-reported controller medication adherence was assessed using the Medication Adherence Report Scale. Based on the Common Sense Model of Self-Regulation, patients were asked if they believe they only have asthma with symptoms, their physician can cure their asthma, and if their asthma will persist. Beliefs on the benefit, necessity and concerns of treatment use were also assessed. Multivariate logistic regression was used to examine the association of beliefs with self-reported medication adherence. KEY RESULTS: The majority (57.0 %) of patients reported poor adherence. Poor self-reported adherence was more common among those with erroneous beliefs about asthma illness and treatments, including the "no symptoms, no asthma" belief (58.7 % vs. 31.7 %, respectively, p<0.001), "will not always have asthma" belief (34.8 % vs. 12.5 %, p<0.001), and the "MD can cure asthma" belief (21.7 % vs. 9.6 %, p=0.01). Adjusting for illness beliefs, treatment beliefs and demographics, patients with a "no symptoms, no asthma" belief had lower odds of having good self-reported adherence CONCLUSIONS: Illness and treatment beliefs have a strong influence on self-reported medication adherence in older asthmatics. Interventions to improve medication adherence in older asthmatics by modifying illness and treatment beliefs warrant study.

Strategies Used by Older Adults with Asthma for Adherence to Inhaled Corticosteroids

“…5,9-13 Demographic characteristics included age, race, education, income and English proficiency. 5,6 Other variables that might affect adherence strategies included patient birthplace and past experiences with asthma (e.g., intubation, years with asthma).…”

“…Studies framed according to the Common Sense Model of Self-Regulation 20 have found that medication adherence is associated with accurate conceptualizations (beliefs) of asthma and favorable opinions of ICS. 5,21 Three questions from the validated Brief Illness Perceptions Questionnaire and used extensively in prior research were used to measure asthma beliefs. 5,22,23 Subjects were asked whether they expected their doctors to cure their asthma and whether they thought they would always have asthma.…”

“…5,21 Three questions from the validated Brief Illness Perceptions Questionnaire and used extensively in prior research were used to measure asthma beliefs. 5,22,23 Subjects were asked whether they expected their doctors to cure their asthma and whether they thought they would always have asthma. Response options were dichotomized as definitely/probably vs. possibly/no.…”

“…1,2 However, adherence to ICS medication tends to be quite low, especially among older adults, among whom only 40 % use ICS medications as prescribed by their physicians. [2][3][4][5] Sub-optimal adherence to ICS among older adults is a major public health concern because of the large number of individuals affected and the particular vulnerability of this population to poor outcomes. Asthma affects up to 9 % of the US population over the age of 65 years.…”

“…8 Approximately two-thirds of asthma-related deaths in the U.S. occur among adults over age 55. 8 While studies of older asthmatics have identified characteristics that distinguish adherent and non-adherent patients, 5,[9][10][11][12][13] little has been published on specific mechanisms employed by patients to achieve and maintain adherence, and none have addressed strategies used by older adults who may differ in their ICS use from younger adults because of the greater prevalence of polypharmacy in this population. 14 One study of HIV-seropositive individuals found that adherence improved when pill-taking was linked to daily activities such as eating breakfast, watching a favorite television program, attending weekly meetings and sleeping at home.…”