Thursday, July 12, 2007
This presentation is part of : Issues in Healthcare of the Aging
Medication Adherence in Older Adults
Cynthia Russell, PhD, RN, Sinclair School of Nursing, University of Missouri, Columbia, MO, USA, Catherine Ashbaugh, MSN, RN, Transplant Department, University of Missouri Health Care, Columbia, MO, USA, Vicki Conn, PhD, RN, School of Nursing, University of Missouri, Columbia, MO, USA, Richard Madsen, PhD, Biostatistics, University of Missouri, Columbia, MO, USA, Karen Hayes, PhD, APRN, BC, FNP, ACNP, School of Nursing, Wichita State University & Ashley Clinic, Wichita, KS, USA, and Gilbert Ross, MD, Deparment of Surgery, University of Missouri, Columbia, MO, USA.
Learning Objective #1: At the completion of this session the learner will be able to describe medication non-adherence rates in older renal transplant recipients.
Learning Objective #2: At the completion of this session the learner will be able to recongize the risks associated with medication non-adherence in older renal transplant recipients.

Background: As chronic renal disease increases in those aged 60 and over, renal transplantation is concurrently increasing as a life-saving therapy that enhances quality of life, prolongs the lifespan, and reduces care costs. Renal transplantation in those aged 65 and older has risen from 3% in 1990 to 14% in 2006. Immunosuppressive medication adherence is crucial to survival of the transplant. Expensive, complex and persistent immunosuppressive regimens with undesirable side effects make medication adherence a challenge. Older renal transplant recipients are at additional risk for poor medication adherence due to cognitive and physical changes associated with aging.
Purpose: This is the first descriptive, longitudinal study in older renal transplant recipients to empirically examine immunosuppressive medication adherence of two simultaneously scheduled, twice-daily immunosuppressive medications.
Methods: Adherence to immunosuppressive medications was electronically monitored using the Medication Event Monitoring System (MEMS V) and a diary for 6 months in 12 renal transplant recipients aged 60 years or older.
Results: Mean age was 65 years, 58% (n = 7) were females, and 83% (n = 10) were Caucasian. The most prevalent etiology of kidney disease was diabetes mellitus 41% (n = 5). Nine (75%) had received deceased donor kidney transplants. Monitored medications included cyclosporine 58% (n = 7) and tacrolimus 42% (n = 5). The median percent of prescribed doses taken on time was 83.90% (M = 67.84, SD = 34.10, range = 3.3-97.9). Seven (58%) of subjects achieved >/= 90% adherence to prescribed doses, two (17%) had 80-89% adherence, and three (25%) had <79% adherence.
Implications/Future Research: Preliminary findings indicate that older renal transplant recipients are a sub-group at substantial risk for undesirable outcomes due to poor medication adherence. Future study of predictors and outcomes of immunosuppressive medication non-adherence in this growing population is warranted.