CHAPTER ONE
INTRODUCTION
1.1 Background
Geriatrics is one of the internal medicine branches which deals with the health needs of the aged people. According Andhi, et al. (2023), geriatrics is of three categories. These are elderly people of 60-75, those of 76 to 90 years of age and the last category is of 91 years and above. Due to greater awareness about healthy lifestyle and enhanced health care facilities, the number and the proportion of people aged above 60 years is expected to be increased in the world from 900 million to two billion between 2015 and 2050 and while those aged 80 years will be increased to around 400 million in the world. In relation to global trends, Men are living shorter life when compared to women. The older people present a wide range of challenges like physical, psychological, emotional, social, economic4 and also physiological ageing changes leads to pharmacokinetic and dynamic changes in the geriatric patients, (Graf et al, 2006).
The degree to which a person's behavior complies with the prescribed medication regimen from a healthcare professional is referred to as medication adherence. It evidenced in several medical research that geriatrics usually have chronic and multiple conditions, so they need a very complex pharmacotherapy to manage their clinical conditions, so it leads to polypharmacy and increased risk for adverse drug reactions, (Nyloarg et al 2012). Hence, there is need to monitor patient’s medication regimen for complexity and adherence by taking various patient and clinical related factors for better therapeutic results.10 In general, medication complexity is commonly measured by simply counting the number of medications, which is usually considered as an inadequate method to deal with the complexity of the regimen, (Hubbard et al 2013).
There are many factors which affect the medication adherence like social, economic, health care system, condition related, therapy related and patient related. Hence, medication adherence is considered as a major responsibility for the health care professional in order to decrease morbidity and mortality.,(Murray et al 2004). Adherence can be measured either directly or indirectly. Direct method detects the presence of drugs in patient’s body using urine, blood and other body fluids. This method is high cost and do not provide feedback on patient care. Indirect methods include electronic drug monitoring, pill counts, pharmacy refills (no. of times the prescription is refilled at the pharmacy), medical record review, directly observed therapy, clinical assessment, self-reports and patient questionnaire, (Toh et ala 2013). Researchers also reveal that majority of patients usually do not communicate their concerns regarding their medication and few were uncertain about whether the medications are necessary, safe, effective or whether the disease is dangerous and also stated that educated and responsible patients are more concerned about their health and are able to manage their therapies, (Chisholn-Burns et al 2012). So, the patient’s active involvement in medication taking decision helps to improve their adherence
Geriatrics patients will have different co-morbidities this can antagonistically influence drug consistence. Older individuals are generally impacted with ongoing sickness like Hypertension, Diabetes mellitus, Osteoarthritis and so on. All these sicknesses require long haul therapy, poor compliance in this age bunch represents medicine wastage with inflated cost of medical care and significant deteriorating of the illness with handicap or passing. The majority of human and monetary misfortune related with non-adherence can be prompted by further developing drug adherence. The hindrances that influence prescription consistence in geriatrics with persistent ailment and giving measures to work fair and square of consistence in medication, (Alhabib et al 2022).
Patient medication compliance has always been a challenge. The elderly has a larger risk of polypharmacy than the younger population since they are more likely to have many comorbidities. As a result, they may have drug nonadherence issues. Adults over the age of 50 may have many chronic diseases that necessitate multiple drugs. Improved quality of life, preservation of cognitive and physical function, and decreased risks of additional illness, comorbidity, and death are all potential advantages of taking drugs. Due to the patient's worsening medical condition, more hospital and doctor visits, increasing health care costs, and diminished therapeutic benefits spending and maybe over-treating an illness. Multifactorial elements that affect adherence have been discovered by the World Health Organization (WHO), and they have been grouped into various dimensions: patient-related factors, socioeconomic factors, therapy-related factors, condition-related factors, health care team-related factors, system-related factors etc.
1.2 Problems Statement
Despite the established benefits of medication adherence for managing chronic health conditions, geriatric patients in Ghana often exhibit low adherence rates. Understanding the specific barriers associated with medication adherence in this population are crucial for developing targeted interventions and improving patient care. According to Andli et al (2023), patient-related factors: which include cognitive decline, polypharmacy (using multiple medications), complex medication regimens, limited understanding of medication purpose and side effects, and cultural beliefs about medications are some of the factors identified responsible to poor adherence to medication by elderly people .
Also, Saranya et al (2023) revealed that inadequate access to healthcare services, poor communication with healthcare providers, medication affordability, and the availability of medication reminders or dispensing systems could be contributing factors. As Andli (2023) pointed out those financial constraints, limited social support, and inadequate transportation to healthcare facilities could negatively impact adherence by aged people.
Base on the knowledge of the research, existing studies expensively focused on developing countries with little or no studies of this topic focusing on developing countries especially sub Sahara Africa. Base on this gap in knowledge, the study is required to close the gap in knowledge.
1.3 Justification/relevance
The motivation behind this study stems from wish of the researcher to make this study particularly timely. As the number of geriatric patients requiring chronic medication increases, addressing adherence becomes even more critical for ensuring their health and well-being. Furthermore, this study on medication adherence barriers in geriatric patients in Ghana holds significant value for improving public health outcomes, reducing healthcare costs, and promoting healthy aging in this population.
1.4 Hypotheses
Ho1 There is no significant extent of medication adherence of geriatric patients in Bauilsa, Ghana
Ho2 There is no significant barriers of medication adherence of geriatric patients in Bauilsa Ghana
Ho3 There is no significant implications of the different barriers of medication adherence of geriatric patients’ health conditions in Bauilsa Ghana
Ho4 There is no significant possible solutions to the poor medication adherence of geriatric patients in Bauilsa Ghana
1.5 Aim of the Study
This research aims to investigate the key factors hindering medication adherence among geriatric patients in Ghana. By identifying the most prevalent barriers specific to the Ghanaian context, this research will contribute valuable insights to improve medication adherence strategies for geriatric patients. This, in turn, can lead to better health outcomes, reduced healthcare costs, and improved quality of life for this growing population. The study will formulate specific objectives which are;
- Measure the extent of medication adherence of geriatric patients in Bauilsa Ghana
- Explore the different barriers of medication adherence of geriatric patients in Bauilsa Ghana
- Identify the implications of the different barriers of medication adherence of geriatric patients’ health conditions in Bauilsa Ghana
- To provide solutions to the poor medication adherence of geriatric patients in Bauilsa Ghana
1.6 Research Questions
- What is the extent of medication adherence of geriatric patients in Bauilsa Ghana?
- What are the different barriers of medication adherence of geriatric patients in Bauilsa Ghana?
- What is the implications of the different barriers of medication adherence of geriatric patients’ health conditions in Bauilsa Ghana?
- What are solutions to the poor medication adherence of geriatric patients in Bauilsa Ghana?
1.7 Significance of the Study
This study on the implications of medical adherence among elderly people is significant for multiple stakeholders, including patients, healthcare providers, policymakers, and caregivers. By understanding the factors that influence medication adherence and the consequences of non-adherence, the study provides valuable insights that can lead to improved health outcomes, reduced healthcare costs, and enhanced quality of life for elderly patients.
Elderly patients are the primary beneficiaries of this research. Understanding the importance of medical adherence can help them manage their chronic conditions more effectively. Many older adults deal with multiple health issues, such as hypertension, diabetes, and arthritis, which require strict medication regimens. By identifying barriers to adherence—such as cognitive impairments, financial constraints, or lack of understanding about medication—this study can lead to the development of targeted interventions that help patients adhere to their prescribed treatments. Improved adherence can result in better disease management, reduced risk of complications, fewer hospitalizations, and a higher quality of life.
Healthcare providers, including doctors, nurses, and pharmacists, can utilize the findings of this study to enhance patient care. The study can guide healthcare professionals in identifying patients at risk of non-adherence and in developing personalized interventions. For example, providers can use educational strategies to improve patients' understanding of their medications or implement reminder systems to help patients take their medications on schedule. By promoting adherence, healthcare providers can achieve better clinical outcomes and improve the overall effectiveness of treatment plans. Additionally, understanding the reasons behind non-adherence can help providers communicate more effectively with patients, addressing concerns and misconceptions that may hinder adherence.
Policymakers can use the study's findings to inform healthcare policies and programs aimed at improving medication adherence among the elderly. The research highlights the need for supportive measures, such as affordable medication programs, enhanced access to healthcare services, and patient education initiatives. By addressing social determinants of health and reducing financial barriers to medication adherence, policymakers can implement policies that promote equitable access to healthcare for older adults. This can lead to a reduction in healthcare costs associated with hospitalizations, emergency care, and the management of complications resulting from non-adherence. Policymakers can also support the development of community-based interventions that provide social support and resources for elderly patients.
Caregivers, including family members and professional caregivers, play a crucial role in assisting elderly patients with medication management. This study provides caregivers with knowledge about the importance of adherence and the factors that may affect it. Understanding these factors enables caregivers to support elderly patients more effectively, whether by organizing medications, providing reminders, or offering emotional support. By fostering a supportive environment, caregivers can help improve adherence rates and contribute to better health outcomes for their loved ones. Additionally, this study can empower caregivers with strategies and tools to manage the challenges associated with caring for patients with complex medication regimens.
The study has broader implications for the healthcare system. Improved medication adherence among the elderly can lead to a reduction in healthcare resource utilization, such as fewer hospital admissions, reduced emergency room visits, and decreased need for long-term care services. This can result in significant cost savings for healthcare systems and improve the allocation of resources. Furthermore, by highlighting effective interventions to enhance adherence, the study contributes to the development of best practices that can be implemented in various healthcare settings, ultimately improving the quality of care for elderly patients.
1.8 Definition of Terms
Medical Adherence: Medical adherence, also known as medication adherence or compliance, refers to the degree to which a patient correctly follows medical advice, particularly with regard to taking prescribed medications. It involves taking medications at the right times, in the correct dosages, and following the prescribed duration of treatment. Adherence is crucial for achieving the desired health outcomes, particularly in managing chronic conditions such as hypertension, diabetes, and heart disease.
Geriatric Patient: Geriatric patients are individuals, typically aged 65 years and older, who may have complex health needs due to the natural aging process. As people age, they are more likely to experience multiple chronic conditions, functional impairments, and a decline in physiological resilience.
Barriers: A barrier to medication refers to any factor that prevents patients from taking their medications as prescribed. These barriers can lead to non-adherence, resulting in suboptimal treatment outcomes and potentially worsening the patient's health.
