Making medication adherence decisions: Stories from older adults taking medications for congestive heart failure

Abstract

More than half of all CHF patients do not take medications as prescribed, resulting in substantial negative health outcomes. Research has shown that medication adherence may be more a consequence of individual decisions rather than the ability to follow prescribed regimens, yet very little is known about decision-making regarding adherence to medications for CHF. The purpose of this narrative inquiry study was to gain understanding and insight into older adults’ decision-making experiences and perceptions in choosing to take or not to take medications for CHF in the community setting. Using purposive and snowball sampling, research flyers were placed in two churches, two senior community centers, three senior living communities, one indigent care clinic, and one cardiology office. The personal narratives of 11 adults aged 65 and older who took at least two daily medications for CHF were gathered using in-depth, semistructured interviews. The data in this study were organized and analyzed using Riessman’s framework for narrative analysis. This study found that decision-making was a foundational and critical element of medication adherence to medications for CHF. This study suggests that medication nonadherence in older adults with CHF is primarily attributed to intentional decisions, based on personal values, to deviate from the prescribed regimen. For some, making decisions not to adhere to a prescribed medication regimen was a one-time event, while for others it was a lifestyle. Although participants made decisions to take medications differently than prescribed, they did not perceive themselves to be nonadherent.

The findings brought to the forefront that decisions for adherence or nonadherence to medications for CHF are based on personal goals and values. Nurses have the potential to promote adherence to medications for CHF through providing care that is patient-centered and nonjudgmental. Since patients may not view their medication decisions as nonadherent, the nurse should ask pointed questions about medication-taking routines. More research is needed to understand the influence of physical values on medication nonadherence. Future research should also focus on ways nurses can support patients’ decision-making to promote medication adherence in those taking medications for CHF.