Purpose: Hypertension (HT) is considered to be the most common disorder in the general population. Demographic data indicate that older adults commonly suffer from HT. Older age is one of the key factors affecting the adherence of patients with HT. The main purpose was to identify demographic, socioeconomic, and clinical factors that affect adherence in older adults with HT.
Materials and methods: This cross-sectional study included 150 patients (84 women and 66 men) with mean age of 72.1 years. The Hill-Bone Compliance to High Blood Pressure Therapy Scale (Hill-Bone CHBPTS) was used to evaluate the adherence to therapeutic recommendations for HT. Results: The mean score obtained by the patients in the Hill-Bone CHBPTS was 20.19 (SD±4.05). The linear regression model showed the independent predictors of the total score (P<0.05): 1) age, each subsequent year of life raises the total score by an average of 0.2 points; 2) gender, males raise it by an average of 1.34 points compared to females; 3) education, a secondary, higher, or higher professional education lowers it by an average of 1.75 points compared to a primary education or no education; and 4) living with the family, having familial support lowers it by an average of 1.91 points compared to living alone or in an organized institution. Conclusion: Our study has shown that the variables of age, education level, and living with the family were statistically significant in explaining the adherence rates. Health care professionals should pay more attention to older HT patients who have a low level of education and who experience the lack of social support. There is a need for a tailored education among this group of patients to better understand and adhere to medication treatment.

Background: Nonadherence to medical treatment and lack of cooperation in hypertensive patients >65 years of age are believed to be caused by a number of age-related problems, such as cognitive impairment. Numerous epidemiological and prospective studies have demonstrated that hypertension that remains untreated for many years or is unsuccessfully treated for reasons such as poor compliance and adherence of the patient may lead to cognitive impairment. Objective: The objective of this study was to investigate the occurrence of cognitive impairment and its effect on treatment compliance and adherence in elderly hypertensive patients. Design: This study was an analytical cross-sectional study. Patients and methods: The study was conducted on 300 patients aged 65–91 years (mean age=71.8 years, SD=7.8 years) diagnosed with hypertension. The following research tools were used: 1) Hill-Bone High Blood Pressure Compliance Scale (HBCS) and 2) Mini–Mental State Examination (MMSE). We also analyzed medical documentation to obtain basic sociodemographic and clinical data. The study was approved by the Bioethics Committee of the Medical University of Wroclaw (no KB-144/2016). Results: Cognitive impairment occurred in 60% of the patients. A group of 63% patients complied with antihypertensive therapy, with the mean score of 20.8 points. Cognitive impairment was strongly correlated with the total score of the HBCS questionnaire (p<0.001) and two of its subscales: “appointment keeping” (p<0.001) and “medication taking” (p<0.001). Conclusion: Compliance and adherence levels are higher in patients with a higher educational level, whereas male sex adversely affects treatment adherence in elderly hypertensive patients.

Background: Hypertension is one of the most important risk factors for cardiovascular disease, which contributes to lowering the quality of life (QOL), especially in elderly patients. Recent data show that almost half of the hypertensive patients and one-third of patients with comorbidities were nonadherent to medication. Objective: To assess the association of QOL with the level of adherence and to examine the association with selected variables on the level of adherence. Design: A prospective, cross-sectional, and analytical study. Methods: This study involved 186 hypertensive elderly patients (mean age: 71.05±7.47 years). An analysis of medical records based on sociodemographic and clinical data was conducted. The World Health Organization Quality of Life Scale Brief version (WHOQOL-BREF) was used to assess the level of QOL, and the Hill-Bone Compliance to High Blood Pressure Therapy Scale (HBQ) was used to examine the level of adherence to therapeutic recommendations in hypertensive patients. Results: The average assessment of the QOL measured by the WHOQOL-BREF questionnaire was 3.36±0.84 points, which indicates a QOL at a level between average and good. The patients’ average score on the HBQ questionnaire was 20.39±4.31 points. In the “reduced sodium intake” subscale, patients had an average of 4.75±1.33 points. In the “appointment keeping” subscale, the patients scored an average of 3.45±1.07 points. In the “medication taking” subscale, the patients had an average of 12.19±3.46 points. It was shown that the total score of the HBQ questionnaire was negatively correlated with all domains of QOL assessed with the WHOQOL-BREF questionnaire (P<0.05). Conclusion: There is an association between QOL and adherence to therapeutic recommendations among hypertensive elderly patients. It has been concluded that with an increasing QOL, the level of adherence to therapeutic recommendations increases. The level of adherence is also negatively affected by: older age, longer duration of disease, worse marital status, lower education, living alone, and using polytherapy.

Background: Only 50%–75% of chronically ill patients take their medication as prescribed. The patient is found to adhere to treatment correctly and optimally if they accomplish 80% or more of the treatment plan. A questionnaire titled the Adherence to Refills and Medications Scale (ARMS) has been used in studies involving various populations and proved to be a simple instrument for measuring adherence, with good psychometric properties. Objective: The aim of this study was to develop a Polish version of the ARMS (ARMS-P), an instrument that identifies levels of adherence in the hypertensive population, and evaluate its psychometric properties. Methods: This cross-sectional study included 279 patients, including 166 females (mean age 66.5 years), hospitalized between September 2016 and March 2017 in the Department of Internal Medicine, Occupational Diseases, and Hypertension of Wroclaw Medical University, Poland. The 12-item ARMS was translated from English into Polish. The 12 items included in the final questionnaire comprise two subscales: adherence to taking medications (eight items) and adherence to refilling prescriptions (four items). Results: Patients in the good-adherence group were younger (P=0.017; P=0.048), more likely to be professionally active (P=0.041), better educated (P=0.037), and more likely to have normal blood pressure (P<0.001). They also measured their blood pressure more often (P<0.001), and took fewer pills in a day (P<0.001). Adherent patients were also more likely to take their medication on their own (P=0.016) and read information leaflets on the medication (P<0.001). The study demonstrated that the ARMS-P questionnaire has good psychometric properties that enable its use for assessing adherence in chronically ill patients, including in particular, patients with hypertension. Conclusion: The psychometric properties of the questionnaire are satisfactory (reliability measured by means of Cronbach’s α). The ARMS-P questionnaire proved to be suitable for use in the Polish population. The use of this screening tool for the assessment of adherence to treatment is recommended in this population of hypertensive patients.

Aims: The study aimed to assess the impact of self-care on adherence to treatment in patients diagnosed with type 2 diabetes and effect of complex interaction of social, lifestyle, economic, environmental and behavioural. Methods: The study was carried out between June 2018 and May 2019 on 324 patients (162 females, 162 males) with type 2 diabetes. To measure the levels of self-care, the Self-Care of Diabetes Index (SCODI) questionnaire was used. Adherence to treatment was assessed with the Adherence in Chronic Diseases Scale (ACDS). Results: The highest scores of health behaviour were on the subscale of adherence with the mean value of 68.37, and the lowest results on the subscale of blood sugar self-monitoring, with the mean of 56.05. We found that low adherence to treatment was present in 52.47% of respondents, the moderate level in 39.20%, while only 8.33% of patients showed the high level. There were significant positive correlations between the ACDS and SCODI subscales (p < 0.05): self-care maintenance (0.436), self-care management (0.413), self-care monitoring (0.384), and self-care confidence (0.453). Conclusions: Self-care affects on adherence in patients with type 2 diabetes. The higher self-efficacy in each of the areas of functioning, the higher the level of adherence to treatment. We found that demographic variables such as female sex, education and employment status can influence self-care in managing chronic illnesses such as type 2 diabetes.