Document Type : Original Article
Authors
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
- 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. - 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.