Leader: Enrica Menditto; Other collaborator(s): Lara Perrella, Valentina Orlando, Sara Mucherino
Medication adherence is a critical issue affecting older adults. On average, 30-50% of prescribed medications are not taken as directed. Non-adherence to medications negatively impacts patient health, leads to increased healthcare utilization, and represents a significant barrier to realizing the full benefits of evidence-based therapies. The economic consequences of non-adherence are also considerable. In Europe alone, non-adherence is linked to nearly 200,000 deaths annually and accounts for €125 billion in potentially preventable direct and indirect costs. To address this societal challenge, interventions to improve medication adherence, including the use of innovative technologies, must be integrated into routine clinical practice to enhance health outcomes and healthcare system efficiency. As the population ages, a growing proportion of individuals are affected by multiple chronic conditions, a phenomenon known as multimorbidity, which consumes 70% of healthcare costs. The treatment of these comorbidities often results in polypharmacy. It is estimated that 11% of unplanned hospital admissions are due to medication-related harm, with over 70% of these admissions involving elderly patients on polypharmacy. To investigate medication-taking behaviors in real-world scenarios, we will employ drug utilization approaches, utilizing various health-related automated databases as tools in the research outlined in WP3.
Brief description of the activities and of the intermediate results:
Addresses the secondary use of data to develop targeted interventions in specific health domains, focusing primarily on medication adherence among older adults, which is a critical issue due to its negative impact on health outcomes and healthcare costs. Activities have included the monitoring of rational medication use and the development of an AI-based algorithm to identify adherence trajectories. Key results include the successful application of the AI algorithm to heart failure treatments. The research has provided valuable insights into adherence patterns and their association with polypharmacy and multimorbidity.
Main policy, industrial and scientific implications
From a policy perspective, this research is vital for addressing the issue of non-adherence among patients older than 65 years of age, which contributes to preventable healthcare costs and hospital admissions. Implementing data-driven interventions can improve medication management and patient outcomes, reducing the strain on healthcare systems. Industrially, the development of AI-based tools for monitoring medication adherence presents opportunities for innovation in health technology, enhancing healthcare efficiency. Scientifically, the task advances the understanding of adherence patients’ patterns and factors associated with them in patients with heart failure (HF).
Brief description of the activities and of the intermediate results
A multi-faceted approach and the interdisciplinary collaboration among researchers, healthcare providers, policymakers, and technology developers are needed to address the growing challenge of polypharmacy in aging populations. Key results include a systematic review on polypharmacy management in Italy. Ultimately, such efforts will contribute to more sustainable healthcare systems and better outcomes for elderly patients.
Main policy, industrial and scientific implications
From a clinical perspective, the understanding of polypharmacy in older adults provides crucial insights into the challenges associated with managing frailty patients. Scientifically, the task advances the understanding of polypharmacy by providing the fundamentals for implementing personalized interventions for treatment optimization in patients over 65 of age with multimorbid conditions and implementing knowledge and appropriateness of prescription and use of medicines.
Brief description of the activities and of the intermediate results:
Addresses the secondary use of data to identify crucial gaps in poor medication adherence among older adults. Activities have included the monitoring of rational medication use and analysis of specific factors involved. Key results include ongoing studies on the correlation between falls and specific medications. The research has provided valuable insights into adherence patterns and their association with polypharmacy and multimorbidity.
Main policy, industrial and scientific implications:
From a policy perspective, this research provides a solid scientific basis for managing factors that negatively impact the healthcare system by addressing the issue of non-adherence among patients over the age of 65. A multi-faceted approach underscores the need for interdisciplinary collaboration among researchers, healthcare providers, policymakers, and technology developers to address the growing challenge of polypharmacy in aging populations. Ultimately, such efforts will contribute to more sustainable healthcare systems and better outcomes for older patients. Scientifically, the task advances the understanding of specific patterns of more-at-risk patients, as drugs that increase the risk of falls.
Brief description of the activities and of the intermediate results:
Falls are a leading cause of hospitalization among older adults, strongly affecting quality of life. Fall-Risk-Increasing Drugs (FRIDs) represent a key modifiable risk factor, yet their role in fall-related hospitalizations requires further investigation. Drug Utilization approaches represent a unique opportunity to improve understanding of the complexity of FRIDs prescribing in frail patients, leading to risk minimization measures.
Main policy, industrial and scientific implications:
From a policy perspective, this research provides findings to implement strategies that optimize prescribing and reduce fall-related hospitalizations, improving healthcare sustainability. Scientifically, the study advances understanding of fall-risk-increasing drugs (FRIDs), showing their strong link to hospitalizations. It underscores the need for interdisciplinary collaboration to refine prescribing guidelines and manage polypharmacy effectively. These insights support evidence-based policies and innovation in medication safety, ultimately enhancing health outcomes for aging populations while reducing healthcare system burdens.
Pubblications:
Mucherino S, Lelia Dima A, Coscioni E, Vassallo MG, Orlando V and Menditto E. Longitudinal trajectory modeling to assess adherence to Sacubitril/Valsartan among patients with Heart Failure. 2023. Pharmaceutics (MDPI). (Published on 1 November 2023)
Oral at Conferences:
Perrella L, Mucherino S, Casula M, Illario M, Orlando V, Menditto E. Management of polypharmacy in Italy: a systematic literature review. Age-It Conference, Venezia, 20-22 May 2024
Perrella L, Mucherino S, Casula M, Illario M, Orlando V, Menditto E. Polypharmacy management in chronic conditions: a systematic literature review of Italian interventions. ESPACOMP Annual Meeting – Napoli, 21-22 November 2024.
Poster at Conferences:
Perrella L, Mucherino S, Casula M, Illario M, Orlando V, Menditto E. Polypharmacy management in chronic conditions: a systematic literature review of Italian interventions. SIF Conference, Sorrento 13-16 November 2024.
Perrella L, Mucherino S, Casula M, Illario M, Orlando V, Menditto E. Polypharmacy management in chronic conditions: a systematic literature review of Italian interventions. ESPACOMP Annual Meeting, Napoli, 21-22 November 2024.