Older adults and their caregivers perceive patient-centered communication improves medication adherence

Medication management and adherence is a growing health concern among older adults. Approximately 70% of older adults take 5 or more medications a day. Annually, medication non-adherence is a major contributor to emergency hospitalization and nursing home placement and it is estimated that medication non-adherence in older adults costs between $7-21 billion annually in preventable healthcare and nursing home expenditures. Patient-centered communication (PCC), characterized by empathy, understanding the patient as a whole, and patient-physician partnerships in decision-making, power, and responsibility, has been found to improve patient trust, knowledge, and motivation to self-manage medications. The present study explored older adult and caregiver experiences with medication management. We conducted 9 focus groups with older adults or caregivers (N=65), representing 5 northeastern urban and rural communities. Participants were identified by key informants with snowball sampling. The focus groups were audio-recorded and transcripts were coded using an inductively derived codebook. Thematic analysis was used to identify patterns that emerged across focus groups. Individuals in every focus group spontaneously identified components of PCC as positively influencing medication adherence. Specifically, participants who described experiencing more PCC with providers (e.g. physicians willing to take time, listen, and address concerns) described themselves as being adherent to physician recommendations, engaged in healthcare decision making, and comfortable communicating issues with medications and working towards mutually acceptable solutions with providers. Participants who described encounters with physicians who did not use a PCC approach (e.g. physicians described as abrupt and unwilling to listen or answer questions) felt more comfortable consulting pharmacists about medication issues than their physicians, and described scenarios where they stopped taking medications without consulting their physicians. In many cases, participants attributed their reluctance to inform their providers about their non-adherence to poor patient-physician communication experiences. Additionally, participants from each focus group believed that a subset of older adults would be willing, but may be less comfortable or experienced asking questions, challenging, or advocating for PCC with their physicians. These findings indicate the importance of incorporating PCC into medical training, as the implications for medication management, including among older adults, may be substantial. The identification of a subset of older adults who may not be comfortable initiating an active role in decision-making, and may not be forthcoming about their medication management practices, indicates that additional efforts (e.g., physician training, patient education) may be needed to activate some older patients.