Antiparkinson drugs use and adherence in older adults and associated factors: an integrative review

Medeiros, Géssica Cazuza de; Silva, Gabriela Avelino da; Asano, Nadja Maria Jorge; Coriolano, Maria das Graças Wanderley de Sales

doi:10.1590/1981-22562022025.220131.en

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Revista Brasileira de Geriatria e Gerontologia

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Review Articles • Rev. bras. geriatr. gerontol. 25 (1) • 2022 • https://doi.org/10.1590/1981-22562022025.220131.en copy

Antiparkinson drugs use and adherence in older adults and associated factors: an integrative review

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objectives

To identify factors associated with antiparkinson drugs use and adherence in older adults with Parkinson's disease (PD) through an integrative literature review.

Method

An integrative literature review involving a search for relevant publications in Portuguese, English, and Spanish on the electronic databases LILACS, MEDLINE - via PubMed, Web of Science and Scopus, without restriction regarding date or study design, was carried out during the period August-September 2021. The selection of studies was performed independently by two reviewers and the final validation conducted by a third reviewer.

Results

After applying the eligibility criteria, 5 of the 460 studies found were included in the review. Results showed moderate adherence rates (range 35.3-66.8%) and the main factors associated with lower adherence to antiparkinson therapy were older age, cognitive deficit, greater motor impairment, multimorbidities, change in therapy regimens, depression, polypharmacy, lower education, non-white ethnicity and male gender. Factors associated with greater adherence were younger age, white ethnicity, no change in therapy regimen, higher level of knowledge about PD, good clinical control, higher educational level, married status, higher income and greater level of awareness.

Conclusions

Non-adherence to antiparkinsonian therapy was frequent and multifactorial., Understanding this behavior is important to help inform the scientific community and devise public policies and strategic planning in health services for improving the quality of life of the older population.

Keywords
Medication adherence; Antiparkinson Agents; Cooperation and adherence to treatment; Older adults

Database	Search strategy employed to perform the search – combination of key words
LILACS MEDLINE	(“Adesão à medicação” or “cooperação e adesão ao tratamento”) and (“Antiparkinsonianos”) and (“Doença de Parkinson”)
PUBMED	("Medication Adherence" OR “Treatment Adherence and Compliance ”) AND (“Antiparkinson Agents”) AND ("parkinson" OR "parkinson disease")
WEB OF SCIENCE	(TS=((Medication Adherence) OR (Treatment Adherence and Compliance))) AND (TS=(Antiparkinson Agents)) AND (TS= parkinson) OR (parkinson disease)))
SCOPUS	(KEY (“Medication Adherence” OR “Treatment Adherence and Compliance”) AND KEY (“Antiparkinson Agents”) AND KEY (“Parkinson” OR “parkinson disease”))

Author, year, place and journal	Objective	Study design, sample	Instruments used to assess medication adherence	Main results on adherence
1) Valldeoriola et al.¹⁵15 Valldeoriola F, Coronell C, Pont C, Buongiorno MT, Câmara A, Gaig C, Compta Y. Socio-demographic and clinical factors influencing the adherence to treatment in Parkinson’s disease: the ADHESON study. 2011;18(7):980-87. Disponível em: https://doi.org/10.1111/j.1468-1331.2010.03320.x https://doi.org/10.1111/j.1468-1331.2010... , 2011, Barcelona (Spain), European Journal of Neurology	To determine demographic, social and clinical aspects modifying therapy adherence.	Cross-sectional study, N= 418 patients	Neurologist Opinion Morisky-Green Test (MGT).	According to physician´s opinion 93.6%, and on the MGT 60.4%, of patients adhered to parkinsonian therapy.
2) W.J. Yu et al.¹⁹19 Wei YJ, Palumbo FB, Simoni-Wastila L, Shulman LM, Stuart B, Beardsley R, Brown C. Antiparkinson drug use and adherence in medicare part D beneficiaries with Parkinson's disease. Clin Ther. 2013;35(10):1513-1525. Disponível em: DOI: 10.1016/j.clinthera.2013.09.001, 2013, Baltimore (Maryland), Clinical Therapeutics	To provide updated, comprehensive population-based data on antiparkinson drugs (APD) use and adherence and to examine characteristics associated with adherence behaviors.	Cross-sectional study N= 7,583; 65 years (93.6%); female (59.9%); White (89.3%)	Medication possession ratio (MPR).	Good adherence rate: 72.7% of sample.
3) Straka et al.²⁰20 Straka I.; Minár M.; Škorvánek M.; Grofik M.; Danterová K.; Benetin J.; Kurca E; Gažová A.; Boleková V.; Wyman-Chick KA; et al. Adherence to Pharmacotherapy in Patients With Parkinson's Disease Taking Three and More Daily Doses of Medication. Frontiers in neurology. 2019; (10) 799. Disponível em: doi: 10.3389 / fneur.2019.00799, 2019, Slovakia, Journal Frontiers in Neurology	To detect the extent of adherence to pharmacotherapy in PD patients who take a minimum of three daily doses of drugs and to identify factors associated with lower levels of adherence.	Cross-sectional study, 124 individuals Male (58%)	Morisky Medication Adherence Scale (MMAS). .	The MMAS identified a high level of adherence in 33.9% of sample; medium level in 29.8% and 36.3% reported low level of adherence
4) Mendorf et al.²¹21 Mendorf S, Witte OW, Grosskreutz J, Zipprich HM, Prell T. What Predicts Different Kinds of Nonadherent Behavior in Elderly People With Parkinson’s Disease? Front. Med. 2020,7:103. Disponível em: doi: 10.3389/fmed.2020.00103, 2020, Germany, Frontiers in Medicine	To describe common self-reported reasons for nonadherence. replicate the associations between different degrees of nonadherence and PD-specific clinical parameters explore the impact of PD-specific clinical parameters on distinct clusters/reasons of nonadherence.	Cross-sectional study, N=226 patients, Male (58.7%)	Self-reported German Stendal Adherence to Medication Score (SAMS).	Fully adherent: 14.2% of patients; Moderately non-adherent: 66.8%, and non-adherent: 19%.
5) Zipprich et al.²²22 Zipprich, H.M.; Mendorf, S.; Lehmann, T.; Prell, T. Self-Reported Nonadherence to Medication Is Not Associated with Health-Related Quality of Life in Parkinson’s Disease. Brain Sci. 2021, 11, 273. https://doi.org/10.3390/brainsci11020273 https://doi.org/10.3390/ brainsci1102027... , 2021, Germany, Brain Sci	To provide additional data to determine whether self-reported non-adherence is associated with HRQOL in PD	Cross-sectional, N=164 patients, Male (61%)	Self-reported German Stendal Adherence to Medication Score (SAMS).	10.4% of patients were fully adherent, 66.4% moderately nonadherent and 23.2% nonadherent.

Author, year	Assessment Instruments	Factors associated with adherence	Factors associated with non-adherence	Measures of statistical association/Level of evidence
1) Valldeoriola et al,¹⁵15 Valldeoriola F, Coronell C, Pont C, Buongiorno MT, Câmara A, Gaig C, Compta Y. Socio-demographic and clinical factors influencing the adherence to treatment in Parkinson’s disease: the ADHESON study. 2011;18(7):980-87. Disponível em: https://doi.org/10.1111/j.1468-1331.2010.03320.x https://doi.org/10.1111/j.1468-1331.2010... 2011	Physician´s subjective perception and Morisky–Green Test (MGT).	High level of knowledge about the disease, good clinical control, spouse or life partner, and higher income.	Psychiatric symptoms	95% CI/2b
2) W.J. Yu et al.¹⁹19 Wei YJ, Palumbo FB, Simoni-Wastila L, Shulman LM, Stuart B, Beardsley R, Brown C. Antiparkinson drug use and adherence in medicare part D beneficiaries with Parkinson's disease. Clin Ther. 2013;35(10):1513-1525. Disponível em: DOI: 10.1016/j.clinthera.2013.09.001, 2013	1. Medicare records; 2. Chronic Condition Data Warehouse 2006–2007	Younger age, white ethnicity, receipt of financial support, early enrollment, intact cognitive function, fewer comorbidities, no change in drugs regimen, and longer long-term care stay.	Older age, non-white race, cognitive impairment, high comorbidity, and patients switching therapy and/or augmentation.	Prevalence ratio and 95% CI/ 2b
3) Straka et al.²⁰20 Straka I.; Minár M.; Škorvánek M.; Grofik M.; Danterová K.; Benetin J.; Kurca E; Gažová A.; Boleková V.; Wyman-Chick KA; et al. Adherence to Pharmacotherapy in Patients With Parkinson's Disease Taking Three and More Daily Doses of Medication. Frontiers in neurology. 2019; (10) 799. Disponível em: doi: 10.3389 / fneur.2019.00799, 2019	8-Item Morisky Medication Adherence Scale (MMAS-8)	Factors associated with adherence not assessed.	Male gender, longer PD duration, worse quality of life, frequency and severity of non-motor symptoms and more severe motor and non-motor symptom fluctuations.	Spearman’s rank correlation coefficient (r _s) and correlation ratio eta (η)/ 2b)
4) Mendorf et al.²¹21 Mendorf S, Witte OW, Grosskreutz J, Zipprich HM, Prell T. What Predicts Different Kinds of Nonadherent Behavior in Elderly People With Parkinson’s Disease? Front. Med. 2020,7:103. Disponível em: doi: 10.3389/fmed.2020.00103, 2020	German Stendal Adherence with Medication Score (SAMS)	Factors associated with adherence not assessed.	Lower educational level, higher rate of motor impairment in activities of daily living, higher number of medications per day and higher rate of motor complications of PD	Regression coefficient for cluster/ 2b
5) Zipprich et al.²²22 Zipprich, H.M.; Mendorf, S.; Lehmann, T.; Prell, T. Self-Reported Nonadherence to Medication Is Not Associated with Health-Related Quality of Life in Parkinson’s Disease. Brain Sci. 2021, 11, 273. https://doi.org/10.3390/brainsci11020273 https://doi.org/10.3390/ brainsci1102027... , 2021	Self-reported German Stendal Adherence with Medication Score (SAMS).	Factors associated with adherence not assessed.	Male gender, lower Montreal Cognitive Assessment (MoCA) score, higher non-motor symptoms questionnaire (NMS-Quest) score, greater number of medications per day (indicator of comorbidity), and higher Beck Depression Inventory (BDI) score	Correlation/ 2b

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[1] Correspondence Géssica Cazuza de Medeiros gessicamedeirosnutricionista@hotmail.com

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Antiparkinson drugs use and adherence in older adults and associated factors: an integrative review

Abstract

﻿Objectives

Method

Results

Conclusions

Objectives