Psychotropic medications adherence status and its determinants among older adults with severe affective and psychotic disorders: a multicenter cross-sectional study

Abstract

Background: Nonadherence jeopardizes treatment outcomes in the psychiatric care continuum. However, there was a paucity of data in the resource-limited life trajectories. Objectives: This study sought to uncover the psychotropic medications adherence behavior of older adults with severe mental disorders and its modeling predictors. Design: A hospital-based cross-sectional study was conducted in selected hospitals of the South Gondar Zone from March 1 to August 30, 2024. Methods: A multistage sampling technique followed by stratified and systematic random sampling methods was employed. Data were collected via interviewer-administered semistructured questionnaire and medical record review. A medication adherence rating scale, medication regimen complexity index instrument, Oslo social support scale, drug attitude inventory scale, and internal stigma monitoring index scale were utilized to assess adherence, treatment regimen complexity, social/family support, attitudes toward treatment, and internal stigma, respectively. Ordinal logistic regression deciphered key predictors using adjusted odds ratios (AORs) with a 95% confidence interval at p < 0.05. Results: The study sample comprised 423 patients with severe psychiatric disorder (mean (SD) age, 67.3 (±11.9) years; 56.03%, 237 male). Among the participants 255 (60.28%, (95% CI: 58.86–62.11)) had suboptimal adherence behavior. Age, education status, adherence counseling, attitude toward treatment, memory aids, internal stigma, insight, social support, illicit drug use, comorbidity, ADRs, patient-level medication regimen complexity index, and polypharmacy were the predictors identified in the final model. Conclusion: Despite multiple methodological limitations, this study suggests that suboptimal psychotropic medications adherence behavior was a critical challenge among older adults with severe mental disorders in geriatric mental healthcare in the Ethiopian hospital settings. We urge policymakers to devise evidence-based policies and strategies focusing on the identified predictors early on and intervene accordingly. Special attention should be given to individuals with low literacy levels, negative attitudes toward treatment, high internalized stigma, poor insight into their condition, substance use, comorbidities, adverse drug reactions, high levels of medication regimen complexity score, and those on polytherapy.