Perceptions of dementia drive medication noncompliance among AD patients
While majority of Alzheimer’s disease (AD) patients are adherent to medication, perceptions about dementia among caregivers and patients remain an important barrier to better compliance, a recent Singapore study has found.
“[T]he present study, being the first such study in Singapore, provides a good descriptive overview of factors leading to noncompliance to AD medications. It may serve to inform future practice in Singapore, catering to the needs generated by the unique socio-cultural background of Singaporeans,” said researchers.
The study included 144 AD patients (mean age 76.9±7.9 years; 66.0 percent female), of whom 74.3 percent (n=107) renewed AD medication prescriptions at 1 year, while 25.7 percent (n=37) did not and were thus identified as noncompliant. [Singapore Med J 2018;doi:10.11622/smedj.2018076]
The mean duration of persistent medication was 10.3±3.5 months, such that all compliant patients persisted for >12 months while 60 percent of the noncompliant participants discontinued medication within the first 6 months of the first visit to the memory clinic.
The main reason for noncompliance to treatment was the patients’ and caregivers’ view that memory decline is a phenomenon that comes naturally ageing and is thus of a lower priority than other comorbidities. This was reported by 32.4 percent of participants (n=12), many of whom were taking medications for concomitant cardiovascular conditions such as atrial fibrillation, heart failure and hypertension.
“As these cardiovascular comorbidities were considered more critical than the memory loss experienced in AD, these patients and their caregivers inevitably neglected AD treatment and compliance to AD medications,” explained researchers.
Seven patients (18.9 percent) reported therapy-associated side effects as strong drivers of noncompliance to treatment. Six of these patients were taking donepezil, which led to side effects such as nausea, bloatedness and diarrhoea. One patient was using a rivastigmine patch and experienced headaches.
Other main contributors to treatment noncompliance were the perception that the treatment was ineffective (n=6; 16.2 percent) and patient death (n=9; 24.3 percent).
“The results showed no association between demographic characteristics and compliance to medication use, whereas the perceptions about dementia among patients and their caregivers played a major role,” researchers noted.
This is supported by a previous review by Cipriani and Borin, which reported that among Singaporeans, dementia is viewed as part of normal ageing and is a “stigmatized mental illness.” [Int J Soc Psychiatry 2015;61:198-204]
Thus, “[a] multidisciplinary approach in educating patients and their caregivers about the importance of treatment and medication use is crucial, and the involvement of pharmacists should be considered,” said researchers.
For the study, researchers retrospectively reviewed hospital records of patients seeking care at the General Memory Clinic of the National University Hospital in Singapore. Telephone calls to corresponding caregivers were placed to identify reasons for medication noncompliance. Participants were followed-up for at least 1 year.
Factors for noncompliance to medication were classified into five dimensions in accordance with the World Health Organization: social and economic factors, healthcare team-related factors, condition-related factors, therapy-related factors and patient-related factors.“Moving forward, this study may also provide a strong foundation for future behavioural and needs assessment of caregivers of AD patients, as well as for evaluation of the clinical, humanistic and economic outcomes of noncompliant AD patients,” researchers said.