Illness perception, medication beliefs associated with ICS adherence among older adults
Adherence to inhaled corticosteroids (ICS) among older adults with asthma is relatively low at 40.9 percent, according to a study presented at the recently concluded Singapore Health and Biomedical Congress (SHBC) 2018. Perceived illness timeline and medication beliefs correlate with adherence.
A total of 323 participants (mean age 71.5 years; 43 percent females; 51.2 percent had secondary school education and above; 73.6 percent Chinese) were included, of which 58.8 percent were on combined ICS–long-acting beta agonist (LABA) therapy and 41.2 percent on ICS monotherapy. Four in 10 of the participants (40.9 percent) had good adherence to ICS. [Liu CW, et al, SHBC 2018]
In logistic regression analysis, good ICS adherence correlated with asthma perception as an illness with a longer timeline (odds ratio [OR], 1.22; 95 percent CI, 1.10–1.35; p<0.001) and with ICS belief as a being a necessity (OR, 2.67; 1.76–4.06; p<0.001). There was less concern on taking asthma medications among patients with good ICS adherence (OR, 0.39; 0.26–0.60; p<0.001).
Furthermore, those on combined ICS-LABA therapy were more adherent to their treatment than those on ICS monotherapy (OR, 2.50; 1.41–4.44; p=0.02).
In correlations tests, longer timeline and higher necessity scores positively correlated with higher adherence scores (ρ, 0.40; p<0.001 and ρ, 0.35; p<0.001, respectively), whereas higher concerns scores negatively correlated with adherence (ρ, –0.27; p<0.001).
“This is the first Singapore study that explored beliefs and adherence to ICS among older adults,” researchers said.”
“Our study results mirror research that has examined beliefs with adherence in younger adults. The stronger the belief on the necessity of ICS, the better the adherence. The greater the concerns that patients have with regard to their ICS, the lower the adherence,” they added.
Moreover, researchers argue that the results infer a consistency of association between adherence to ICS with perceived illness timeline and medication beliefs across a broad age spectrum.
“Further research can look into interventions aimed at addressing these factors to improve adherence to ICS,” they said.
In this cross-sectional study, patients attending primary care clinics completed interviewer-administered questionnaires. Medication Adherence Report Scale for asthma was used to determine adherence to ICS. The Brief-Illness Perception Questionnaire and Beliefs about Medications Questionnaire were used to assess illness perceptions and medication beliefs, respectively.
“Being a cross-sectional study, only associations can be established. There was under-representation of the Malay and Indian population in the sample; hence, caution should be exercised when generalizing the findings to these ethnic groups,” researchers said.
“Poor adherence to ICS or controller medication is a prevalent problem which leads to poor asthma outcomes and increased healthcare costs especially among older adults. Few studies have explored the illness perceptions and medication beliefs in older adults, which are potentially modifiable factors of poor adherence,” they noted.