A cornerstone of healthy aging: do we need to rethink the concept of adherence in the elderly?

Anna Giardini,1 Marina Maffoni,2 Przemyslaw Kardas,3 Elisio Costa4 1Psychology Unit, Istituti Clinici Scientifici Maugeri Spa SB, IRCSS Montescano, Montescano (PV), Italy; 2Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy; 3Department of Family Medicine, Medical University of Lodz, Lodz, Poland; 4Elísio Costa, UCIBIO-REQUIMTE, Faculty of Pharmacy and Porto4Ageing EIP-AHA Reference Site, University of Porto, Porto, Portugal Abstract: Worldwide, the population is aging and this trend will increase in the future due to medical, technological and scientific advancements. To take care of the elderly is highly demanding and challenging for the health care system due to their frequent condition of chronicity, multimorbidity and the consequent complex management of polypharmacy. Nonadherence to medications and to medical plans is a well-recognized public health problem and a very urgent issue in this population. For this reason, some considerations to identify a new shared approach to integrated care of older people are described. The concept of adherence should be considered as a complex and continuous process where family, caregivers and patients’ beliefs come into play. Moreover, a new culture of adherence should contemplate the complexity of multimorbidity, as well as the necessity to renegotiate the medication regimen on the basis of each patient’s needs. Keywords: population aging, chronicity, multimorbidity, polypharmacy, nonadherenc