Introduction
Medication non-adherence is a major issue that correlates with a variety of risks depending on the condition that is not being appropriately addressed, the patient, and the measures in which the diagnosis is handled. The current case study highlights a situation in which an elderly woman abruptly stops taking her antihypertensive medication, which has led to the occurrence of new symptoms that would otherwise be prevented. Namely, avoiding the medication for approximately two weeks has caused the patient’s blood pressure to be 230/160 mm Hg, the pulse rate to be 112 beats per minute, and has generated overall incoherence. The current paper argues that the patient would benefit from addressing memory issues, a lack of efficient medication management, and a lack of knowledge to enhance adherence to the prescribed treatment.
Causes
There are a variety of reasons why the elderly patient may have stopped taking the prescribed medication, which ultimately led to adverse consequences. On the one hand, it is important to acknowledge the age factor. Research highlights that as individuals age and their cognitive abilities naturally decrease, medication adherence becomes less prominent (Cho et al., 2018).
The case study highlights that the senior patient has memory problems, and the fact that the husband noticed the incoherence after the medication was stopped highlights an even more critical condition issue. Hence, it is certain that one of the reasons why the patient has not been adhering to the treatment for approximately two weeks may have, to a certain extent, been influenced by her cognitive impairment. However, additional causes may have also impacted the degree to which the treatment was implemented.
Another reason that may have influenced adherence is education. Specifically, researchers highlight that patients are either unaware of the importance of the medication or the outcomes correlating with their condition, in case treatment is not implemented (Kardas et al., 2022). Furthermore, it is essential to consider the state of the patient. Hypertension is often asymptomatic in its less severe stages (Oliveros et al., 2019). Hence, the patient did not experience the immediate effects of the treatment and did not realize the importance of medication.
The lack of instant relief becomes even more critical when the patient may not be aware of the negative consequences of hypertension. Hence, on the one hand, taking the pills is not an experience that brings physical changes, while not taking the pills is not considered negative for short—or long-term effects. In this case, adherence is minimized due to a lack of knowledge of hypertension, its consequences, and how the treatment mitigates the barriers mentioned above.
An additional reason can be ineffective medication management. For example, a schedule is not implemented, or additional measures are not taken to ensure the patient takes the pills according to the recommended dose and timing. The lack of support can impede the patient’s willingness to comply with the treatment (Stewart et al., 2022). As a result, the husband noticed the lack of adherence after the adverse consequences had been generated.
Consequences
Needless to say, the EMS was called because the husband had acknowledged one consequence that had been generated after the patient had stopped medication for two weeks. The elderly woman was incoherent, which was one of the effects of non-adherence to the treatment. However, there are additional consequences that are to be discussed.
When the EMS team measured the blood pressure, it was 230/160 mm Hg, which is exceptionally high. Moreover, as it was established that the pills were avoided for roughly two weeks, it is safe to assume that the high blood pressure has been maintained for a certain amount of time. Long-term hypertension has been linked to major heart problems, including heart failure, strokes, and myocardial infarction (Oliveros et al., 2019). This occurs as a result of damage to the arteries.
The damage to blood vessels causes more extensive issues that go beyond heart disease. Researchers mention that long-term hypertension leads to kidney disease (Lee et al., 2022). This occurs due to the narrowing of the vessels, ultimately damaging certain organs. The same research mentions the risk that prolonged high blood pressure has on developing dementia (Lee et al., 2022). This, once again, is generated due to blood vessel damage, which, in turn, facilitates reduced blood flow to all organs, including the brain.
While high blood pressure is often asymptomatic, its long-term effects are well-documented. The issue becomes more critical, considering the patient is well within seniority. The mortality rate increases drastically under the condition that the elderly individual suffers from hypertension (Oliveros et al., 2019). As highlighted previously, the damaging effects are experienced on multiple levels, and most organs can experience damage due to the condition. Hence, the most critical effect is premature death.
Questions for the Patient and Family Members
Patient-centered care is an important consideration when determining questions that would help guide the individual and family members through the treatment of hypertension. The first area of concern is non-adherence due to dissatisfaction with the medication or its results. Hence, the first question would be, “Is the current treatment plan effective in helping you reach your current health goals?” In this case, the patient may report having certain side effects or wanting to transition to a different medication for a specific reason.
Feedback can also include comments on inconvenience, allowing for better medication management. An example would be a health goal that includes ameliorating side effects generated by blood pressure medication. In this case, the answer would allow for a better understanding of potential changes that would create an environment in which medication adherence is higher than it currently is.
Another question would be, “Do you understand what your condition entails and how the medications affect it?” As highlighted previously, one of the possible reasons why non-adherence was high was the fact that hypertension is often asymptomatic (Oliveros et al., 2019). Hence, the patient may lack information about the condition, its effects, and ways to minimize risks that are imposed long-term.
Furthermore, the argument correlates with the importance of asking how medication affects high blood pressure. As the patient potentially expresses a lack of knowledge in this regard, the healthcare provider can comprehensively explain the mechanism by which the pills affect health risks. The discussion can also be approached as an illustration of the importance of consistency in treatment adherence.
Another question is, “Do you ever forget to take your medications, and if so, what are the ways to remind you to do so?” This question will help determine whether the patient has stopped taking the pills because of side effects and personal decision-making or simply because of forgetfulness, which becomes a risk once the patient is older. The answer may determine the pill management techniques that can be implemented to minimize the risks. Needless to say, patients who forget about medications and how to take them can be assisted both through a social system and through technological measures. They would decrease the likelihood that the treatment will not be consistently followed and, as a result, generate better health outcomes overall.
Additionally, the family member who lives with the patient can be asked, “Can you help her adhere to the medication prescribed by the doctor?” The patient’s husband called the emergency medical services in the first place. However, since the support system was not set in place initially, non-adherence was only noticed two weeks after the patient abruptly stopped taking the pills. The question would help determine the extent to which the husband is involved in the treatment and establish ways to address adherence engagement.
Intervention to Improve Adherence
While a prominent issue, medication adherence can be addressed through evidence-based practice. As highlighted previously, one of the first questions that can be asked is regarding the information on the condition and the treatment. Researchers highlight that information management is one of the most widely applied adherence interventions (Kardas et al., 2022). The patient is to be informed on the condition, its damaging long-term and short-term effects, the symptoms correlating with hypertension, and ways in which the medicine helps minimize negative consequences.
Another intervention is implementing technological measures that would address medication management. Since the patient is older and has memory issues, a simple solution would be to set a pill alarm as a daily reminder. However, additional measures can be applied. For example, researchers mention electronic pill boxes that identify how many pills are left and how many times the box has been opened (Lee et al., 2022). The pill can send a signal to the healthcare provider or husband in case the patient forgets to take a pill.
Last but not least, involving the husband in the treatment is essential. Social support has been linked to lower risks of non-adherence to prescribed medication (Stewart et al., 2022). The husband can manage the patient’s treatment by being aware of the necessary measures and supervising and assessing whether all the steps are being followed. As a result, cases in which pills are being avoided for two weeks and blood pressure is high for days in a row are avoided.
Conclusion
Medication adherence is a complex topic that depends on a variety of factors, including knowledge, cognitive abilities, and support systems. In the current case study, the possible causes for non-adherence to hypertension medication, including the lack of initial symptoms of the condition, inefficient pill management, and memory issues, have resulted in adverse health outcomes. It is argued that informing the patient and her husband of the condition and how the medication works, employing technology for reminders and adherence assessment, potentially changing the medication itself, and involving family members would reduce the risks of similar consequences being experienced again.
References
Cho, M. H., Shin, D. W., Chang, S.-A., Lee, J. E., Jeong, S.-M., Kim, S. H., Yun, J. M., & Son, K. (2018). Association between cognitive impairment and poor antihypertensive medication adherence in elderly hypertensive patients without dementia. Scientific Reports, 8(1). Web.
Kardas, P., Bago, M., Barnestein-Fonseca, P., Garuolienė, K., Granas, A. G., Gregório, J., Hadžiabdić, M. O., Kostalova, B., Leiva-Fernández, F., Lewek, P., Mala-Ladova, K., Schneider, M. P., van Boven, J. F., Volmer, D., Ziampara, I., & Ágh, T. (2022). Reimbursed medication adherence enhancing interventions in 12 European countries: Current state of the art and future challenges. Frontiers in Pharmacology, 13. Web.
Lee, E. K., Poon, P., Yip, B. H., Bo, Y., Zhu, M., Yu, C., Ngai, A. C., Wong, M. C., & Wong, S. Y. (2022). Global burden, regional differences, trends, and health consequences of medication nonadherence for hypertension during 2010 to 2020: A meta‐analysis involving 27 million patients. Journal of the American Heart Association, 11(17). Web.
Oliveros, E., Patel, H., Kyung, S., Fugar, S., Goldberg, A., Madan, N., & Williams, K. A. (2019). Hypertension in older adults: Assessment, management, and challenges. Clinical Cardiology, 43(2), 99–107. Web.
Stewart, S.-J. F., Moon, Z., & Horne, R. (2022). Medication nonadherence: Health impact, prevalence, correlates, and interventions. Psychology & Health, 38(6), 726–765. Web.