What’s New about Medication Adherence?

Medication adherence is the foundation of effective drug therapy. It is defined as the extent to which a person takes his or her medications according to the agreed upon instructions. Adherence is a health-related behavior that is prerequisite to achieving desired outcomes: drugs cannot be effective if they are not taken.

Yet we know that approximately 50% of older adults are nonadherent or have poor adherence to their drug therapy. We also know that nonadherence is associated with 125,000 deaths per year in the US and $300 billion dollars per year in healthcare expenditures (direct and indirect costs).

What drives medication adherence? Why do you adhere to certain health behaviors and not others? Some patients have stellar adherence and routinely take their medications on time and every day. More commonly, though, patients stumble with adherence for various reasons. Over the past several months, I have pondered not only what makes the patients I work with take their medications, but what drives my medication- or supplement-taking behavior.

Adherence may not be a stimulating topic, but it is an essential one. Health outcomes depend on it. In this article, I want to re-look at medication adherence with a 20-year look back on progress we have made in health care regarding adherence and where we have fallen short. It is a good time for you to think about your own or your clients’ adherence to medications and other health-related choices—daily exercise, getting more fiber, or limiting alcohol intake, anyone?—and consider what drives you.

A is for Advocate, C is for Communicate

In a healthcare world where excessive and unnecessary use of medications is common among older adults, one key strategy to push back against this trend is to self-advocacy. There is no doubt that patients who participate more actively in their healthcare—by asking questions and expressing concerns, for example—will achieve better outcomes and be more satisfied with their care. Thus, anyone who takes medications and caregivers of those individuals need to be confident to advocate for themselves regarding day-to-day decisions about medication use.

In 2019, the Lown Institute published a report Medication Overload: America’s Other Drug Problem. It states that for most patients, there is no single healthcare professional that is assigned responsibility for a person’s overall healthcare, who can keep track of all of a person’s medications and protect them from medication overload. This means that patients must be prepared to step up to the plate and be the connector between the different settings where care is received, including doctor offices and pharmacies,.

While some people might feel intimidated to question if a medicine is needed, double check if one doctor has spoken with another doctor, or admit they are not following healthcare instructions at home (such as taking a medication every day or getting more physical activity), honest and open communication is a necessary step toward better health outcomes. In fact, physicians have expressed frustration that patients often are not honest about their lifestyle, perceptions about treatments, and preferences, for example (Wall Street Journal, 3/22/25 “Doctors are just as frustrated as you by our messed up healthcare system”).

In our efforts to reduce unnecessary and harmful medication use, why is communication so important? In many instances, if you do not bring it up, it may not be discussed at all. My focus here is on medication issues, but these principles apply to all aspects of your healthcare. How do you feel about taking medications? Are you a drug “minimalist” (you would prefer to try non-drug therapies first) or are you okay with trying a medication? Have you stopped taking a medication because it is too expensive or causing a side effect? Or perhaps you don’t think the medicine is helping, but the doctor never specifically asked about it and you didn’t think to bring it up. One of the barriers to “deprescribing” is that neither doctors nor patients make it a regular part of office visit conversations.

Duration of Drug Therapy: What do omeprazole, zolpidem, and alendronate have in common?

Use of unnecessary medications is one of 8 categories of medication-related problems that I describe in my book, “Maybe It’s Your Medications.” This article focuses on a specific aspect of unnecessary medication use, namely, duration of drug therapy. Continuing medications beyond a recommended or intended duration contributes to the risk of adverse drug reactions, interactions, unnecessary costs, and other more serious consequences associated with medication use.

Taking a medication “beyond the recommended duration,” where the duration is well-defined, has been identified as a signal of potentially inappropriate medication use among older adults.¹ This means geriatric experts agree it is an important issue. Recommended duration can be a complex topic, though, and does not apply to every medication. When treating chronic health conditions, for example, medications typically are prescribed with the intent that the patient will take them ongoing for many years, until the patient’s condition or other circumstances change. Think about drugs to treat chronic conditions like high blood pressure, asthma, or rheumatoid arthritis, for example. In contrast, some medications have a well-defined duration of therapy, based on research or expert consensus, depending on the health condition being treated. While there is no specific list of these medications, it is important to recognize that duration of therapy is an important safety concept. In turn, individuals can feel comfortable to ask questions and start a conversation with their doctors.

Brain Healthy Behaviors

In March 2023, I attended the American Society on Aging conference in Atlanta. Sanjay Gupta, MD was one of the keynote speakers, talking about his book, Keep Sharp. In addition, AARP was one of the sponsors at the meeting, and I came home with a neat postcard that summarized “6 Pillars of Brain Health.” These 6 pillars, along with videos about each one, are available on the AARP website. Here is a quick overview. These 6 Pillars are something we should all pay attention to, to keep our brains healthy as we age.

A Day I’ll Always Remember: St. Louis Pharmacist Publishes a Go-To Guide for Healthy Aging

As seen on Fox 2 Now I describe myself as kind of intense. I am very goal oriented. I want to get things done and get them done well. “Maybe It’s Your Medications” is now a published book. It has been my focus for quite some time. Finally, the hard work has paid off; it is published and available for purchase. My friends and colleagues know that this moment is the culmination of many years of focusing on a goal and working steadily to achieve it.

My experience in working with older adults in their homes to review and evaluate drug therapy—touching hundreds if not thousands of patients and family members over the years—has informed me of the many types of errors and issues that can occur. This includes issues surrounding the use of both prescription and nonprescription medications.

Advocating for Safe Medication Use

I had the honor in June 2023 to speak to caregivers on the topic of Advocating for Safe Medication Use, courtesy Aging Advantage in St. Louis, as part of their Family Caregiver Education program. The program was livestreamed on Facebook (the first time I’ve done something like that!), and you can access the full recording here.

Per Merriam-Webster, to advocate means “to support or argue for” a cause or policy, for example. In this case, the cause is safe medication use for yourself or a loved one. Why is this an important topic?

PrevenTable: A PreventEd Podcast

"Do you have any questions for the pharmacist?"

PrevenTable May 2022

Dr. Hedva Barenholtz Levy explains her role as a geriatric specialist pharmacist and the complexities that accompany working with older adults. Listen as she describes the risks that alcohol, cannabis, and opioids can pose to seniors and as she urges consumers to become an active part of their healthcare team.

Medications for Alzheimer’s, Urinary Incontinence, and the Prescribing Cascade

Medications commonly used to treat Alzheimer’s Disease (AD), from a drug class known as the “cholinesterase inhibitors,” also can increase the risk of developing urinary incontinence (referred to as overactive bladder). There are three cholinesterase inhibitors available in the US:

donepezil (Aricept®)
galantamine (Razadyne ®)
rivastigmine (Exelon®)

This adverse drug effect of cholinesterase inhibitors became well-documented after the medications were approved and more widely prescribed. It is important to be aware of and recognize this potential effect because it often leads to the addition of another medication to control the incontinence. Adding a drug to manage the side effects of another drug is referred to as a “prescribing cascade” and is one of the several causes of polypharmacy.

Be Aware of Brand Name Extensions: All Zantac is Not the Same

The other night I saw a television advertisement that caught my eye. It was for a heartburn product, “Zantac 360⁰.” It drew my attention because Zantac is the brand name for the generic drug ranitidine, which was withdrawn from the market in April 2020 because of contamination concerns. The easy work-around when ranitidine was withdrawn was to switch to famotidine (brand name Pepcid). Ranitidine and famotidine are in the same drug class of “H2-receptor antagonists.” They are comparable agents and both are available as over-the-counter (OTC) products for treating heartburn. It was an easy substitution.

In late April 2021, however, the manufacturer of Zantac introduced a new product, Zantac 360⁰, to the market The catch is that this new Zantac product contains famotidine, not ranitidine. Adjusting the name from Zantac to Zantac 360⁰ is an example of what is called “brand name extension.” It is a marketing tool commonly used by manufacturers of OTC products to capitalize on consumer familiarity with brand names. Unfortunately, brand name extensions can be misleading to the unassuming consumer.