Restricted accessResearch articleFirst published online 2025-1
Medication Management Difficulty,Medication Nonadherence,and Risk of Hospitalization Among Cognitively Impaired Older Americans: A Nationally Representative Study
Effective disease management in older adults relies on medication adherence to prevent adverse outcomes like hospitalization, particularly among those with cognitive impairment. In this study, we examined the impact of cognitive impairment on medication management, adherence, and hospitalization risk across levels of cognitive function. Analyzing data from 28,558 community-dwelling older adults, we found that those with dementia had the most difficulty managing medications (13.12%), followed by cognitive impairment without dementia (5.80%), and intact cognition (1.96%). Only persons with dementia showed a significant association between medication management difficulty and hospitalization risk (Odds Ratio [OR] = 1.71; 95% Confidence Intervals: 1.08, 2.70; p = .02). Cost-related medication nonadherence was associated with hospitalization risk solely among those with intact cognition (OR = 1.25; 95% CI: 1.07, 1.45; p = .004). Dementia was associated with higher odds of medication management difficulty and subsequently hospitalization risk, underscoring the need for resources to support medication use for this population.
AustinJ.KleinK.MattekN.KayeJ. (2017). Variability in medication taking is associated with cognitive performance in nondemented older adults. Alzheimer’s and Dementia, 6, 210–213. https://doi.org/10.1016/j.dadm.2017.02.003
2.
BorahB.SaccoP.ZarotskyV. (2010). Predictors of adherence among Alzheimer's disease patients receiving oral therapy. Current Medical Research and Opinion, 26(8), 1957–1965. https://doi.org/10.1185/03007995.2010.493788
3.
BreitnerJ. C.WelshK. A.GauB. A.McDonaldW. M.SteffensD. C.SaundersA. M.MagruderK. M.HelmsM. J.PlassmanB. L.FolsteinM. F. (1995). Alzheimer’s disease in the national Academy of sciences-national research Council registry of aging twin veterans. III. Detection of cases, longitudinal results, and observations on twin concordance. Archives of Neurology, 52(8), 763–771. https://doi.org/10.1001/archneur.1995.00540320035011
4.
BriesacherB.Ross-DegnanD.AdamsA.WagnerA.GurwitzJ.SoumeraiS. (2009). A new measure of medication affordability. Social Work in Public Health, 24(6), 600–612. https://doi.org/10.1080/19371910802672346
5.
Cantarero-PrietoD.LeonP. L.Blazquez-FernandezC.JuanP. S.CoboC. S. (2020). The economic cost of dementia: A systematic review. Dementia, 19(8), 2637–2657. https://doi.org/10.1177/1471301219837776
6.
CrimminsE. M.KimJ. K.LangaK. M.WeirD. R. (2011). Assessment of cognition using surveys and neuropsychological assessment: The health and retirement study and the aging, demographics, and memory study. Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 66(Suppl 1), i162–i171. https://doi.org/10.1093/geronb/gbr048
7.
DusetzinaS. B.BesawR. J.WhitmoreC. C.MattinglyT. J. I. I.SinaikoA. D.KeatingN. L.EversonJ. (2023). Cost-related medication nonadherence and desire for medication cost information among adults aged 65 Years and older in the US in 2022. JAMA Network Open, 6(5), Article e2314211. https://doi.org/10.1001/jamanetworkopen.2023.14211
8.
El-SaifiN.MoyleW.JonesC.TuffahaH. (2018). Medication adherence in older patients with dementia: A systematic literature review. Journal of Pharmacy Practice, 31(3), 322–334. https://doi.org/10.1177/0897190017710524
9.
FriedL. P.TangenC. M.WalstonJ.NewmanA. B.HirschC.GottdienerJ.SeemanT.TracyR.KopW. J.BurkeG.McBurnieM. A.Cardiovascular Health Study Collaborative Research Group. (2001). Frailty in older adults: Evidence for a phenotype. The journals of gerontology. Series A, Biological sciences and medical sciences, 56(3), M146–M156. https://doi.org/10.1093/gerona/56.3.m146
10.
Health and Retirement Study. (2018). Public survey data (p. 2018). Health and Retirement Study.
11.
KuzuyaM.HirakawaY.SuzukiY.IwataM.EnokiH.HasegawaJ.IguchiA. (2008). Association between unmet needs for medication support and all-cause hospitalization in community-dwelling disabled elderly people. Journal of the American Geriatrics Society, 56(5), 881–886. https://doi.org/10.1111/j.1532-5415.2008.01676.x
12.
LangaK. M.LarsonE. B.CrimminsE. M.FaulJ. D.LevineD. A.KabetoM. U.WeirD. R. (2017). A comparison of the prevalence of dementia in the United States in 2000 and 2012. JAMA Internal Medicine, 177(1), 51–58. https://doi.org/10.1001/jamainternmed.2016.6807
13.
LangaK. M.PlassmanB. L.WallaceR. B.HerzogA. R.HeeringaS. G.OfstedalM. B.BurkeJ. R.FisherG. G.FultzN. H.HurdM. D.PotterG. G.RodgersW. L.SteffensD. C.WeirD. R.WillisR. J. (2005). The aging, demographics, and memory study: Study design and methods. Neuroepidemiology, 25(4), 181–191. https://doi.org/10.1159/000087448
14.
LauD. T.MercaldoN. D.ShegaJ. W.RademakerA.WeintraubS. (2011). Functional decline associated with polypharmacy and potentially inappropriate medications in community-dwelling older adults with dementia. American Journal of Alzheimer's Disease and Other Dementias, 26(8), 606–615. https://doi.org/10.1177/1533317511432734
NeilsenR. B.SeayM. C. (2012). HRS complex sample specification for SAS, Stata, and WesVar.
17.
NekuiF.GalbraithA. A.BriesacherB. A.ZhangF.SoumeraiS. B.Ross-DegnanD.GurwitzJ. H.MaddenJ. M. (2021). Cost-related Medication Nonadherence and Its Risk Factors Among Medicare Beneficiaries. Medical care, 59(1), 13–21. https://doi.org/10.1097/MLR.0000000000001458
18.
OfstedalM. B.FisherG. G.HerzogA. R. (2005) Documentation of cognitive functioning measures in the Health and Retirement Study (10). University of Michigan.
19.
ReinhardS. (2019). Home alone revisited: Family caregivers providing complex care. Innovation in Aging, 3(Supplement_1), S747–S748. https://doi.org/10.1093/geroni/igz038.2740
20.
SchallerS.MauskopfJ.KrizaC.WahlsterP.Kolominsky‐RabasP. L. (2015). The main cost drivers in dementia: a systematic review. International Journal of Geriatric Psychiatry, 30(2), 111–129. https://doi.org/10.1002/gps.4198
21.
SmithD.LovellJ.WellerC.KennedyB.WinboltM.YoungC.IbrahimJ. (2017). A systematic review of medication non-adherence in persons with dementia or cognitive impairment. PLoS One, 12(2), Article e0170651. https://doi.org/10.1371/journal.pone.0170651
22.
SnowdenM. B.SteinmanL. E.BryantL. L.CherrierM. M.GreenlundK. J.LeithK. H.LevyC.LogsdonR. G.CopelandC.VogelM. (2017). Dementia and co-occurring chronic conditions: a systematic literature review to identify what is known and where are the gaps in the evidence?International Journal of Geriatric Psychiatry, 32(4), 357–371.
23.
SokolM. C.McGuiganK. A.VerbruggeR. R.EpsteinR. S. (2005). Impact of medication adherence on hospitalization risk and healthcare cost. Medical Care, 43(6), 521–530. https://doi.org/10.1097/01.mlr.0000163641.86870.af
24.
SonnegaA.FaulJ. D.OfstedalM. B.LangaK. M.PhillipsJ. W.WeirD. R. (2014). Cohort Profile: the Health and Retirement Study (HRS). International Journal of Epidemiology, 43(2), 576–585. https://doi.org/10.1093/ije/dyu067
25.
YoungE. H.PanS.YapA. G.RevelesK. R.BhaktaK. (2021). Polypharmacy prevalence in older adults seen in United States physician offices from 2009 to 2016. PLoS One, 16(8), Article e0255642. https://doi.org/10.1371/journal.pone.0255642
26.
ZhaoY.KuoT.-C.WeirS.KramerM. S.AshA. S. (2008). Healthcare costs and utilization for Medicare beneficiaries with Alzheimer's. BMC Health Services Research, 8(1), 108. https://doi.org/10.1186/1472-6963-8-108
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