Factors contributing to medication noncompliance in elderly emergency department patients on fixed incomes

Study objectives: The number of Americans older than 55 years is increasing, and many in this group rely solely on Medicare or Medicaid for medical coverage. Recent legislation has been passed to provide broader prescription coverage, the fastest-growing health care cost area and heretofore not covered by Medicare. Critics note that under this law, medication costs may actually increase by $600 a year and that 30% of the elderly with current gap coverage will likely lose it. Reports indicate that many elderly on limited incomes respond to high prescription costs by cutting medication dosages or by simply not taking them. There are no studies reviewing elderly emergency department (ED) patients and barriers to medication compliance. Methods: This was a prospective institutional review board–approved study in an urban ED from July to October 2003. English-speaking patients older than 55 years, without mental status changes or cardiovascular instability, consented verbally and were asked standard demographic questions and queried about medication usage and noncompliance. Main outcome measure was the number of patients noncompliant with their medications during the past year and reasons for noncompliance. Results: Three hundred twenty-four patients participated. Median age was 67 years (interquartile range 60 to 77), and 190 (59.7%) were women. Insurance types (based on 313) were 57 (18.2%) private, 94 (30%) Medicare or Medicaid, 29 (9.3%) charity-care or self-pay, and 136 (43.5%) some combination private or Medicare or Medicaid. Racial mix was 77% black, 9% white, 5% Hispanic, and 9% other. One hundred fourteen (69%) of 165 single patients and 71 (69%) of 103 married or committed-relationship patients were below the 2003 adjusted poverty level. Of 312 patients, 103 (33%) had stopped their medication(s) sometime during the past year. Reasons (based on 312) were as follows: 9 (2.8%) lack of funds, 23 (7.4%) side effects or grew tired of taking, 15 (4.8%) physician ordered or changed dose, 22 (7%) ran out, 4 (1.3%) acute illness, and 30 (9.6%) other reasons. Conclusion: Many inner-city patients older than 55 years are below poverty levels and rely on medical coverage for prescription costs. Almost 3% of patients currently lack funds to obtain their medications. The effect of new legislation on these numbers, once in place, should be studied to determine its true impact on the health care of the elderly.