This is an intriguing area worthy of much debate. I work in an area that can be defined as applied research. I didn’t see it as such for several years until I looked back and realized that what I do is work in an aging lab, a CCRC that is home to 1000 older adults, and I am able to measure by observation the effects of medications in an aging population. And what this opportunity affords is the development of some insights that I don’t see in the medical literature. One area that I find intriguing is the concept that everyone who is non-adherent with their medications will be better off by becoming adherent. This intrigues me because I know that by increasing the medication burden in older adults we end up increasing the risk for adverse drug events (ADEs). Many studies validate one another with the number of drugs taken as one of the best predictors for an ADE. Hence, if I increase the medication burden, like adding more drugs, I should find more ADEs.
However, the problem is that studies that seek to find ways to improve adherence do not equally as well study the probable increase in ADEs in their study population. This is evidenced in the AHRQ analysis on medication adherence solutions. Only three studies looked at ADEs as a possible negative outcome with none documented, but there was lacking homogeneity to conclude anything, most likely because they were not looking in great enough detail with the right screening tools. Not unlike why so many studies don’t match up on ADEs in older adults: “You see what you look for and recognize only what you know”. i.e. If you have a shallow knowledge base and don’t know how to recognize probable ADEs in older adults, you will not find them. What leads me to believe that specific research needs to be done is having searched the literature and finding that in the HIV/AIDS population there is good evidence that increasing adherence increases the incidence of ADEs. Since adherence is so critical in being successful at managing HIV/AIDS, they look at this closely, where as other studies do a cursory review. So why wouldn’t that apply to other populations? Other drugs are toxic and other populations are not immune from ADEs.
But if you know that improving adherence in older adults can increase the risk for ADEs, then on a case-by-case basis you proceed with caution and monitor closely with the intent of improving adherence to achieve specific, realistic goals, but monitor for the development of ADEs. We not uncommonly find that people become dizzy from blood pressure medications after starting an adherence program, so we adjust doses downward. It then lends wisdom that a practitioner may consider lowering doses before starting an adherence program if there is documented poor adherence. Adhering to a well-designed drug regimen is probably one of the most effective forms of health care, when properly implemented.