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Rising medication costs prompt many rural elders to take fewer medicines and smaller doses than prescribed

Men and women 65 years of age and older consume over 30 percent of all prescription medications in the United States, with many taking several medications daily for multiple chronic conditions. According to a recent study, rising medication costs prompted nearly half (44 percent) of elderly men and women in North Carolina to take less medicine than prescribed by their doctors at the risk of maintaining their health or recovering from illness. About 30 percent of rural elders said they had a little or some difficulty and 14 percent said they had a great deal of difficulty paying for their prescription medicines or paying the annual deductible required for the Medicaid prescription drug benefit ($250 deductible and a four-drug benefit cap in the study region).

These adults used several strategies to manage the cost of their prescription drugs. About 17 percent bought part of a prescription instead of all of it, 15 percent took less medicine than prescribed to make it last, and 19 percent asked their doctors for free samples. However, difficulty paying for medication was not the only factor prompting medication mismanagement. Rural elderly people also were more likely to mismanage their medication regimens if they were black, younger, in poorer mental health, or had more acute-care doctor visits, regardless of income. Neither income nor income adequacy had much effect.

While the addition of a prescription drug benefit to Medicare may help the 44 percent of the sample who had trouble affording medications, it will not completely solve the problem of medication noncompliance among the elderly, conclude Jim Mitchell, Ph.D., and colleagues at East Carolina University. With support from the Agency for Healthcare Research and Quality (HS08779), they interviewed 499 community-dwelling elders in rural Eastern North Carolina who were taking one or more prescription medications.

See "Mismanaging prescription medications among rural elders: The effects of socioeconomic status, health status, and medication profile indicators," by Dr. Mitchell, Holly F. Mathews, Ph.D., Lisa M. Hunt, R.Ph., and others, in the June 2001 issue of The Gerontologist 41(3), pp. 348-356.

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