Journal of Education and Health Promotion

The effect of comprehensive individual motivational‑educational program on medication adherence in elderly patients with bipolar disorders: An experimental study

Document Type : Original Article

Authors

. Hossein Tahghighi
. Hamed Mortazavi 1
. Ali Akhondpour Manteghi 2
. Mohammad Reza Armat 3

1 Geriatric Care Research Center, Department of Geriatric Nursing, School of Nursing, North Khorasan University of Medical Sciences, Bojnurd, Iran

2 School of Nursing, North Khorasan University of Medical Sciences, Bojnurd, Iran

3 Geriatric Care Research Center, Department of Medical‑Surgical Nursing, School of Nursing, North Khorasan University of Medical Sciences, Bojnurd, Iran

Abstract
BACKGROUND: The number of older adults with bipolar disorder is increasing and medication
non‑adherence is a major problem that negatively impacts the course of bipolar disorder. This study
aimed to determine the effect of a comprehensive individual motivational‑educational program on
medication adherence in elderly patients with bipolar disorder.
MATERIALS AND METHOD: An experimental study with pretest‑posttest repeated measures with a
control group was conducted on two groups of 62 elderly people with bipolar disorders hospitalized
at Ibn Sina Hospital in Mashhad, Northeast Iran, 2019. For the elderly in the intervention group, a
comprehensive motivational‑educational program was administered for one month (four 30–45 minute
sessions), and for the elderly in the control group, routine clinical care was performed. Medication
adherence in both elderly groups was measured before, immediately after, one and two months after
the intervention. Data were analyzed by SPSS statistical software (version 16) using descriptive
statistics and independent t‑test, Mann‑Whitney, paired t‑test, repeated measures analysis of
variance (ANOVA), and Chi‑square tests.
RESULTS: The mean age of elderlies in the intervention and control groups were 69.03 ± 5.75 and
68.50 ± 6.73 years, respectively. Regardless of the groups to which the patients were assigned, a
significant difference in medication adherence scores was observed during the study period (time
effect; P < 0.001). Also, the medication adherence score was significantly lower in the intervention
group, compared to the control group (group effect; P < 0.001). Also, there was a group time interaction
between the medication adherence score and the time of evaluation (P < 0.001).
CONCLUSION: The results of the present study confirm the positive effect of a comprehensive
educational‑motivational program on improving medication adherence in elderly patients with bipolar
disorder.

Keywords

Aged
bipolar disorder
medication adherence
motivational interviewing
patient education
  1. Chang ES, Kannoth S, Levy S, Wang SY, Lee JE, Levy BR. Global
    reach of ageism on older persons’ health: A systematic review.
    PLoS One 2020;15:e0220857.
    2. Luo Y, Su B, Zheng X. Trends and challenges for population and
    health during population aging ‑ China, 2015‑2050. China CDC
    Wkly 2021;3:593‑8.
    3. Farokhnezhad Afshar P, Asgari P, Shiri M, Bahramnezhad F.
    A Review of the Iran’s elderly status according to the census
    records. Galen Med J 2016;5:1‑6.
    4. Aldrich N, Benson WF. Disaster preparedness and the chronic
    disease needs of vulnerable older adults. Prev Chronic Dis
    2008;5:A27.
    5. Ljubic N, Ueberberg B, Grunze H, Assion HJ. Treatment of
    bipolar disorders in older adults: A review. Ann Gen Psychiatry
    2021;20:45.
    6. Arnold I, Dehning J, Grunze A, Hausmann A. Old Age
    Bipolar Disorder‑Epidemiology, Aetiology and Treatment.
    Medicina (Kaunas) 2021;57:587.
    7. McIntyre RS, Berk M, Brietzke E, Goldstein BI, López‑Jaramillo C,
    Kessing LV, et al. Bipolar disorders. Lancet 2020;396:1841‑56.
    8. Dome P, Rihmer Z, Gonda X. Suicide risk in bipolar disorder:
    A brief review. Medicina (Kaunas) 2019;55:403.
    9. Plans L, Barrot C, Nieto E, Rios J, Schulze TG, Papiol S,
    et al. Association between completed suicide and bipolar
    disorder: A systematic review of the literature. J Affect Disord
    2019;242:111‑22.
    10. Havermans R, Nicolson NA, Devries MW. Daily hassles, uplifts,
    and time use in individuals with bipolar disorder in remission.
    J Nerv Ment Dis 2007;195:745‑51.
    11. Hakkaart‑van Roijen L, Hoeijenbos MB, Regeer EJ, Ten Have M,
    Nolen WA, Veraart CP, et al. The societal costs and quality of life
    of patients suffering from bipolar disorder in the Netherlands.
    Acta Psychiatr Scand 2004;110:383‑92.
    12. McMorris BJ, Downs KE, Panish JM, Dirani R. Workplace
    productivity, employment issues, and resource utilization in
    patients with bipolar I disorder. J Med Econ 2010;13:23‑32.
    13. Chakrabarti S. Treatment‑adherence in bipolar disorder:
    A patient‑centred approach. World J Psychiatry 2016;6:399‑409.
    14. Sanchez‑Moreno J, Martinez‑Aran A, Tabarés‑Seisdedos R,
    Torrent C, Vieta E, Ayuso‑Mateos JL. Functioning and disability
    in bipolar disorder: An extensive review. Psychother Psychosom
    2009;78:285‑97.
    15. Bauer M, Glenn T, Alda M, Bauer R, Grof P, Marsh W, et al.
    Trajectories of adherence to mood stabilizers in patients with
    bipolar disorder. Int J Bipolar Disord 2019;7:19.
    16. Jin H, Kim Y, Rhie SJ. Factors affecting medication adherence in
    elderly people. Patient Prefer Adherence 2016;10:2117‑25.
    17. Crowe M, Whitehead L, Wilson L, Carlyle D, O’Brien A, Inder M,
    et al. Disorder‑specific psychosocial interventions for bipolar
    disorder‑‑A systematic review of the evidence for mental health
    nursing practice. Int J Nurs Stud 2010;47:896‑908.
    18. Stang P, Frank C, Ulcickas Yood M, Wells K, Burch S. Impact of
    bipolar disorder: Result from a screening study. J Clin Psychiatry
    2007;9:42‑7.
    19. Jonsdottir H, Opjordsmoen S, Birkenaes AB, Engh JA, Ringen PA,
    Vaskinn A, et al. Medication adherence in outpatients with severe
    mental disorders: Relation between self‑reports and serum level.
    J Clin Psychopharmacol 2010;30:169‑75.
    20. Haynes RB, Ackloo E, Sahota N, McDonald HP, Yao X.
    Interventions for enhancing medication adherence. Cochrane
    Database Syst Rev 2008;Cd000011.
    21. Gholizadeh B, Ebrahimi S, Zakerimoghadam A, Shahsavari H,
    Naboureh A. Effects of self‑management program and telephone
    follow up on medical adherence in patients with ischemic heart
    disease. Koomesh 2017;19:213‑9.
    22. Ghoshchian Cheshmehshadi S, McWanted Hosseini S, Najafi M,
    Bigdeli I. Comparison of the effectiveness of complementary
    therapies of psychosocial education and psychosocial‑family
    education on the symptoms of depression and mania of bipolar
    patients Type I that contrlo with drug treatment. Quarterly Clin
    Psychol Stud 2017;7:179‑201.
    23. Fakhri A, Morshedi H, Mohammadi Zeidi I. Effectiveness of
    theory based education on medication adherence in older adults
    with hypertension. Jundishapur Sci Med J 2017;16:161‑74.
    24. Mohebi P, Fallahi‑Khoshknab M, Rahgoue A, Tabriz KN,
    Ardakan MRK. Effect of the community re‑entry program on
    medication adherence in patients with bipolar disorder type I.
    Iran Rehabilitation J 2017;3:58‑65.
    25. Watson AC, Corrigan P, Larson JE, Sells M. Self‑stigma in people
    with mental illness. Schizophr Bull 2007;33:1312‑8.
    26. Kooshyar H, Shoorvazi M, Dalir Z, Hosseini M. Motivational
    factors and its relationship with medical adherence and
    healthrelated quality of life in diabetic community‑residing
    elderly. J Mazandaran Univ Med Sci 2014;24:134‑43.
    27. Tolouei M. Motivational factors of nurses in the education of
    patients. Hayat 2006;12:43‑51.
    28. Patricia J, Neafsey R, Olga J, Surheil L. Self medication practice in
    spanish speaking older adults. Hispanic Health Care International
    2007;5:169‑78.
    29. Taibanguay N, Chaiamnuay S, Asavatanabodee P,
    Narongroeknawin P. Effect of patient education on medication
    adherence of patients with rheumatoid arthritis: A randomized
    controlled trial. Patient Prefer Adherence 2019;13:119‑29.
    30. Ayodapo AO, Elegbede OT, Omosanya OE, Monsudi KF. Patient
    education and medication adherence among hypertensives in a
    Tertiary Hospital, South Western Nigeria. Ethiop J Health Sci
    2020;30:243‑50.
    31. Morisky DE, Green LW, Levine DM. Concurrent and predictive
    validity of a self‑reported measure of medication adherence. Med
    Care 1986;24:67‑74.
    32. Sinan O, Akyuz A. Effects of home visits on medication adherence
    of elderly individuals with diabetes and hypertension. East J Med
    2019;24:8‑14.
    33. Bahredar MJ, Asgharnejad Farid AA, Ghanizadeh A, Birashk B.
    The efficacy of psycho‑educational group program on medication
    adherence and global functioning of patients with bipolar disorder
    type I. Int J Community Based Nurs Midwifery 2014;2:12‑9.
    34. Sookhak F, Zolfaghari M, Asadi Noghabi AA, Haghani H. Effect
    of a cognitive‑behavioral intervention on medication adherence
    in patients’ undergoing hemodialysis. J Hayat 2014;20:85‑94.
  2. 35. Eftekhar Ardebili H, Fathi S, Moradi H, Mahmoudi M,
    Mahery AB. Effect of educational intervention in blood pressure
    control in hypertensive women. J Mazandaran Univ Med Sci
    2014;24:62‑71.
    36. Lam DH, Hayward P, Watkins ER, Wright K, Sham P. Relapse
    prevention in patients with bipolar disorder: Cognitive therapy
    outcome after 2 years. Am J Psychiatry 2005;162:324‑9.
    37. Varming AR, Hansen UM, Andrésdóttir G, Husted GR, Willaing I.
    Empowerment, motivation, and medical adherence (EMMA):
    The feasibility of a program for patient‑centered consultations to
    support medication adherence and blood glucose control in adults
    with type 2 diabetes. Patient Prefer Adherence 2015;9:1243‑53.
    38. Yazdanpanah Y, Saleh Moghadam AR, Mazlom SR, Haji Ali
    Beigloo R, Mohajer S. Effect of an educational program based on
    health belief model on medication adherence in elderly patients
    with hypertension. Evid Based Care J 2019;9:52‑62.
    39. Miklowitz DJ, George EL, Richards JA, Simoneau TL, Suddath RL.
    A randomized study of family‑focused psychoeducation and
    pharmacotherapy in the outpatient management of bipolar
    disorder. Arch Gen Psychiatry 2003;60:904‑12.
    40. Alhalaiqa F, Deane KH, Nawafleh AH, Clark A, Gray R.
    Adherence therapy for medication non‑compliant patients with
    hypertention: A randomized controlled trial. J Hum Hypertens
    2012;26:117‑26.
Journal of Education and Health Promotion
Volume 13, Issue 2
February 2023
Pages 1-9

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