Medication Adherence Interventions for Older Adults With Heart Failure: A Systematic Review

Background: Sleep disturbance is one of the most common symptoms among heart failure patients. Sleep disturbance reduces quality of life and leads to higher rates of mortality. It may affect the ability of patients to perform adequate self-care. Although some research has evaluated the association between sleep quality and heart failure self-care, a synthesis of the most recent available evidence is lacking. Aims: This systematic review aimed to assess the association between sleep quality and self-care in adults with heart failure. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology was used. Medline, CINAHL, PsycINFO and SCOPUS were searched. Observational, case-control and cohort studies were considered. The quality of the studies was evaluated with the Joanna Briggs Institute’s Critical Appraisal Tools. Results: Six articles were included. Association between sleep quality and self-care was reported by three studies. One of these did not find an association between sleep disturbance and heart failure self-care, while the other two studies did. An association between sleep quality and medication adherence was reported by three studies. All three of these studies found associations between these two variables. Studies have measured similar but different constructs. Two studies assessed sleep quality, while four other studies measured excessive daytime sleepiness. Half of the studies examined self-care, while the other half measured medication adherence. Conclusions: Although the evidence should be strengthened, sleep quality seems to affect self-care in heart failure patients. The mechanism underlying the effect of sleep quality on heart failure self-care remains unclear. Future longitudinal interaction analyses could be useful to clarify this mechanism.

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Medication adherence in the older adults with chronic multimorbidity: a systematic review of qualitative studies on patient’s experience

European Geriatric Medicine ◽

10.1007/s41999-020-00313-2 ◽

2020 ◽

Vol 11 (3) ◽

pp. 369-381 ◽

Cited By ~ 3

Author(s):

M. Maffoni ◽

S. Traversoni ◽

E. Costa ◽

L. Midão ◽

P. Kardas ◽

...

Keyword(s):

Systematic Review ◽

Older Adults ◽

Medication Adherence ◽

Qualitative Studies ◽

Patient’S Experience

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What are the effects of medication adherence interventions in rheumatic diseases: a systematic review

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2014-206593 ◽

2015 ◽

Vol 75 (4) ◽

pp. 667-673 ◽

Cited By ~ 42

Author(s):

Jessica S Galo ◽

Pavandeep Mehat ◽

Sharan K Rai ◽

Antonio Avina-Zubieta ◽

Mary A De Vera

Keyword(s):

Systematic Review ◽

Medication Adherence ◽

Treatment Adherence ◽

Rheumatic Diseases ◽

Inflammatory Arthritis ◽

Patient Characteristics ◽

Disease Outcome ◽

International Pharmaceutical Abstract ◽

Study Methodology ◽

Adherence Interventions

ObjectivesConsistent reports of suboptimal treatment adherence among patients with inflammatory arthritis underscore the importance of understanding how adherence can be promoted and supported. Our objectives were to identify and classify adherence interventions; and assess the evidence on the effects of adherence interventions on outcomes of patients with rheumatic diseases.MethodsWe conducted a mapped search of Medline, Embase and International Pharmaceutical Abstract databases to identify studies meeting inclusion criteria of: (1) patient population with inflammatory arthritis; (2) evaluation of an intervention or programme targeting medication adherence directly or indirectly; (3) reporting of one or more measures of medication adherence and disease outcome; (4) publication in English, French or Spanish. For our first objective, we applied a structured framework to classify interventions according target (patient vs provider), focus (educational vs behavioural vs affective), implementation (generalised vs tailored), complexity (single vs multifaceted) and provider. For the second objective, we appraised the evidence of effects of interventions on adherence and disease outcomes.ResultsWe identified 23 studies reporting adherence interventions that directly or indirectly addressed treatment adherence in rheumatic diseases and further appraised included RCTs. Interventions that were shown to impact adherence outcomes were generally interventions directed at adherence, tailored to patients and delivered by a healthcare provider. For interventions that were not shown to have impacts, reasons may be those related to the intervention itself, patient characteristics or study methodology.ConclusionsOur systematic review shows limited research on adherence interventions in rheumatic diseases with inconsistent impacts on adherence or disease outcome.

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Medication management strategies used by older adults with heart failure: A systems-based analysis

European Journal of Cardiovascular Nursing ◽

10.1177/1474515117730704 ◽

2017 ◽

Vol 17 (5) ◽

pp. 418-428 ◽

Cited By ~ 6

Author(s):

Robin S Mickelson ◽

Richard J Holden

Keyword(s):

Heart Failure ◽

Older Adults ◽

Medication Adherence ◽

Ad Hoc ◽

Qualitative Content Analysis ◽

Medication Management ◽

Management Strategies ◽

Cognitive Engineering ◽

Behavioral Adaptations ◽

Future Patient

Background: Older adults with heart failure use strategies to cope with the constraining barriers impeding medication management. Strategies are behavioral adaptations that allow goal achievement despite these constraining conditions. When strategies do not exist, are ineffective or maladaptive, medication performance and health outcomes are at risk. While constraints to medication adherence are described in literature, strategies used by patients to manage medications are less well-described or understood. Aim: Guided by cognitive engineering concepts, the aim of this study was to describe and analyze the strategies used by older adults with heart failure to achieve their medication management goals. Methods: This mixed methods study employed an empirical strategies analysis method to elicit medication management strategies used by older adults with heart failure. Observation and interview data collected from 61 older adults with heart failure and 31 caregivers were analyzed using qualitative content analysis to derive categories, patterns and themes within and across cases. Results: Data derived thematic sub-categories described planned and ad hoc methods of strategic adaptations. Stable strategies proactively adjusted the medication management process, environment, or the patients themselves. Patients applied situational strategies (planned or ad hoc) to irregular or unexpected situations. Medication non-adherence was a strategy employed when life goals conflicted with medication adherence. The health system was a source of constraints without providing commensurate strategies. Conclusions: Patients strived to control their medication system and achieve goals using adaptive strategies. Future patient self-mangement research can benefit from methods and theories used to study professional work, such as strategies analysis.

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