It means taking the medication consistently and accurately, including at times and in the dosage as directed. It also means following special instructions such as taking with food or not cutting or crushing.

According to one recent study, medication adherence is actually fairly high in older adults when they first start taking a medication. However, the authors noted that adherence may decline over time. Another study presented a less optimistic image, observing that medication non-adherence may happen in up to half of older adults. Whatever the numbers, there are many reasons for non-adherence. These include people’s lack of knowledge about their illnesses and the complications associated with them, physical problems that keep them from getting or taking their medications, and financial/cost issues. Additionally, people may stop taking their medications once they feel better and their symptoms have eased or been resolved.

Not surprisingly, financial issues are a key reason that people don’t take or stop taking their medications. One study noted that people 65 and older reported two types of cost-related non-adherence issues. One was not getting prescriptions filled because of costs, and the other was not taking medication as prescribed (e.g., skipping doses or cutting pills in half) to save money. The authors said that “cost-related non-adherence was six times higher among older adults who were food insecure compared with those who were food secure, and more than twice as likely among older adults reporting fair or poor health or with disabilities compared with those in excellent, very good, or good health, or without disabilities.”

While non-adherence numbers may vary, there is no question about the negative consequences associated with non-adherence. One literature review concluded that medication non-adherence may be associated with all-cause hospitalization and mortality in older adults. Not taking medications as prescribed also may lead to avoidable complications related to a specific medical condition, and/or symptoms such as anxiety, headaches, sleep problems, fatigue, mood changes, cognitive changes, nausea, and pain or other physical discomfort.

Non-adherence is particularly dangerous for older adults. As Arif Nazir, MD, CMD, chief medical officer of Abode Care Partners, said, “Many of them need their medications for day-to-day survival, which is different than younger people.” Older adults often have multiple chronic conditions, he said, and the impact of non-adherence can lead to serious complications.