Difficulty in taking medication and stroke among older adults with systemic arterial hypertension: the Fibra Study

Torres, Juliana Lustosa; Neri, Anita Liberalesso; Ferrioli, Eduardo; Lourenço, Roberto Alves; Lustosa, Lygia Paccini

doi:10.1590/1413-812320212611.3.29292019

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Sumário

HEALTH AND VULNERABILITY AMONG THE ELDERLY • Ciênc. saúde coletiva 26 (suppl 3) • 2021 • https://doi.org/10.1590/1413-812320212611.3.29292019 copy

Difficulty in taking medication and stroke among older adults with systemic arterial hypertension: the Fibra Study

Dificuldade em tomar medicamentos e acidente vascular encefálico em idosos com hipertensão arterial sistêmica: Estudo Fibra

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

This article aims to investigate whether difficulty in taking medication is associated with stroke among older adults with Systemic Arterial Hypertension (SAH) and to explore their association with living arrangements. Cross-sectional study was based on 3,502 older adults with SAH from the four universities pole of Frailty in Brazilian Older People (Fibra) Study, Brazil, including 14 municipalities of the five Brazilian regions. We used the medical diagnosis of stroke and difficulty in taking medications (self-reported difficulty and financial difficulty affording prescribed medications). Multivariate analysis was performed using logistic regression. Differently from women, older men with SAH, which report difficulty in taking medication (unintentional non-adherence), have higher odds of stroke. When stratified by living arrangements, those living with a partner have even higher odds of stroke compared to those without difficulty in taking medication and living alone. None association was found for difficulty affording prescribed medication for both men and women. Unintentional difficulty in taking medication plays a role in SAH treatment among men. Primary care strategies for controlling blood pressure should not be focus only on patients but targeting spouses as well.

Key words:
Activities of daily living; Aged; Hypertension; Medication adherence; Stroke

Variables	Total	Stroke		P value
Variables		No	Yes
Sex, (%)				<0.001
Male	30.0	29.2	39.4
Female	70.0	70.8	60.6
Age, mean (SD)	73.1 (6.1)	73.0 (6.1)	73.7 (6.2)	0.084
Years of education, mean (SD)	4.3 (4.2)	4.4 (4.2)	3.9 (3.8)	0.039
Living arrangement (%)				0.292
Living alone	14.2	14.4	11.9
Living with a partner	32.1	31.8	35.4
Other living arrangements	53.7	53.8	52.6
Body mass index, mean (SD)	27.8 (5.1)	27.9 (5.1)	27.7 (5.2)	0.591
Number of medical diagnosis of chronic diseases, mean (SD)	1.3 (1.1)	1.2 (1.1)	1.6 (1.2)	< 0.001
Medical diagnosis of depression (%)	20.5	19.9	27.2	0.003
Cognitive impairment^b (%)	30.7	30.2	35.6	0.051
IADL Disability^c (%)	42.2	40.2	63.3	< 0.001
Number of medications, mean (SD)	3.2 (2.3)	3.1 (2.3)	3.7 (2.6)	< 0.001
Difficulty in taking medications (%)	8.5	7.5	18.5	< 0.001
Difficulty affording prescribed medications (%)	24.7	24.1	30.5	0.015
Total	3,502	3,200	302

Variables	Men		Women
Variables	OR	95% CI	OR	95% CI
Age	1.00	0.96; 1.03	0.99	0.97; 1.02
Years of education	1.03	0.99; 1.08	0.91	0.91; 0.99*
Living arrangement (versus living alone)
Living with a partner	2.06	0.90; 4.73	0.82	0.49; 1.39
Other living arrangements	1.20	0.51; 2.84	1.05	0.68; 1.63
Body mass index	0.93	0.89; 0.98*	1.01	0.98; 1.04
Number of medical diagnosis of chronic diseases	1.11	0.90; 1.37	1.32	1.15; 1.52**
Medical diagnosis of depression	1.17	0.68; 1.99	1.34	0.95; 1.88
Cognitive impairment	1.43	0.90; 2.26	0.92	0.66; 1.29
IADL disability^a	2.29	1.47; 3.55**	2.27	1.59; 3.22**
Number of medications	1.08	0.99; 1.16	1.05	0.99; 1.12
Difficulty in taking medication	1.96	1.13; 3.39*	1.52	0.95; 2.42
Difficulty affording prescribed medication	0.86	0.51; 1.43	1.35	0.97; 1.88

Variables	Men			Women
	Prevalence	Stroke		Prevalence	Stroke
		OR^a	95% CI		OR^a	95% CI
No difficulty and living alone	7.1	1.00		7.2	1.00
No difficulty and living with a partner	12.5	1.92	0.79; 4.66	6.1	0.83	0.48; 1.44
No difficulty and other living arrangements	8.1	1.17	0.46; 2.98	7.5	1.04	0.66; 1.65
Difficulty in taking medication and living alone	9.3	1.37	0.13; 14.19	10.2	1.48	0.39; 5.64
Difficulty in taking medication and living with a partner	23.5	4.31	1.43; 12.96*	8.0	1.13	0.39; 3.25
Difficulty in taking medication and other living arrangements	13.5	2.10	0.73; 6.07	11.1	1.64	0.85; 3.16

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[1] Collaborators

JL Torres contributed to idea and design; JL Torres, AL Neri, E Ferrioli and RA Lourenço contributed to acquisition of data, analysis and interpretation of findings; writing - original draft: JL Torres and LP Lustosa; writing - review and editing: JL Torres, AL Neri, E Ferrioli, RA Lourenço and LP Lustosa.