{"doi":"10.1111/jgs.18537","title":"Factors associated with medication adherence in older adults: The atherosclerosis risk in communities study","abstract":"Most studies of medication adherence in older adults lack comprehensive information on lifestyle, comorbidities, and socioeconomic status (SES). Little is known whether area-level SES or healthy lifestyle affects self-reported medication adherence. We examined factors associated with self-reported medication nonadherence in well-characterized community-based cohort of older adults. We performed a cross-sectional analysis in the Atherosclerosis Risk in Communities (ARIC) study, a prospective cohort study of cardiovascular risk factors in midlife conducted in four U.S. communities (Forsyth County, North Carolina; Jackson, Mississippi; Minneapolis, Minnesota; and Washington County, Maryland).1 We included 5164 participants (≥65 years) at visit 5 (2011–2013) who were taking at least one prescribed medication and had covariate data (see Table 1). Medication adherence was assessed using the Morisky Green Levine medication adherence questionnaire (0, high adherence; 1–2, intermediate adherence; and 3–4, low adherence).2 Based on the previous literature, age, sex, area deprivation index (ADI, national rank), education, smoking, heavy drinking, physical activity, depressive symptoms, and cognitive function were examined. The ADI is a measure that combines 17 area-level socioeconomic indicators into an index of disadvantage, with higher numbers representing greater disadvantage.3 The presence of depressive symptoms was defined by the 11-item Center for Epidemiological Studies-Depression (CES-D) scale using a cutoff of 9.4 The Mini-Mental State Examination (MMSE) score <24 indicated cognitive impairment.5 Multivariable logistic regression examined associations between factors and medication nonadherence. We examined reasons for nonadherence among persons with nonadherence. All statistical analyses were conducted using Stata 17 (StataCorp, Texas, United States). The mean (SD) age of the population was 75.5 (5.1) years, 58.1% were women, and 22.1% were Black. The prevalence of nonadherence was 39.7% (intermediate, 37.4%; low, 2.3%, Table 1). Younger age, physical inactivity, and depressive symptoms were significantly associated with medication nonadherence (Table 2). Neither area-level nor individual-level SES was associated with medication nonadherence. In the medication nonadherent group, 77.4% reported not taking medication as directed because of “poor memory,” 5.4% reported “ran out of medication,” and 1.2% reported “could not afford.” Our results showed that more than one-third of older adults do not take medications as directed. Younger age (66–74 years vs. ≥75 years), depressive symptoms, and physical inactivity were associated with medication nonadherence, but neither individual nor area-level SES showed any associations. Additionally, the majority reported memory as the major reason for nonadherence. In 2016, the U.S. Preventive Services Task Force (USPSTF) recommended routine depression screening for adults,6 but in 2020, the USPSTF concluded there is insufficient evidence to assess the balance of benefits and harms of screening for cognitive impairment in older adults.7 However, depression and cognitive screening are included in the Medicare Annual Wellness benefit. Depression screening remains low at 5.3% in 2018,8 whereas cognitive screening is estimated at 16%.9 Our results suggest that screening for and intervening on depressive symptoms, physical activity, and cognitive impairment merits further study to assess effects on improving medication adherence. Type of medication adherence measure may explain our null fundings with SES. Studies that found associations between SES and medication adherence often used medication possession ratio, the proportion of time a patient has access to medication. In contrast, the Morisky Green Levine medication adherence questionnaire used in our study focuses on individual's medication-taking behavior. Only 1.2% of participants reported unaffordability as a reason for not taking medications i","journal":"Journal of the American Geriatrics Society","year":2023,"id":388594,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":1,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.8854,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2023-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":331917,"name":"B. Gwen Windham","orcid":"0000-0001-6240-5044","position":1,"is_corresponding":false},{"id":402436,"name":"Anna Kucharska‐Newton","orcid":"0000-0001-9864-467X","position":2,"is_corresponding":false},{"id":250083,"name":"David Couper","orcid":"0000-0002-4313-9235","position":3,"is_corresponding":false},{"id":98923,"name":"Pamela L. Lutsey","orcid":"0000-0002-1572-1340","position":4,"is_corresponding":false},{"id":48275,"name":"Shoshana H. Ballew","orcid":"0000-0002-7547-3764","position":5,"is_corresponding":false},{"id":484667,"name":"Jung‐Im Shin","orcid":"0000-0003-0374-6927","position":6,"is_corresponding":false},{"id":1158116,"name":"Christina Y Yin","orcid":"0009-0000-5557-8633","position":0,"is_corresponding":true}],"reference_count":11,"raw_metadata":null,"created_at":"2026-07-19T01:18:18.214733Z","pmid":"37528774","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}