Factors Associated with Non-Adherence to Drugs in Patients with Chronic Diseases Who Go to Pharmacies in Spain.

BACKGROUND: Pharmacological non-adherence in chronic diseases is 40-65%. No predictive profile of non-adherence exists in patients with multiple chronic diseases. Our study aimed to quantify the prevalence of non-adherence to pharmacological treatment and its associated factors in patients who visit pharmacies in Spain. METHODS: This observational cross-sectional study included patients with one or more chronic diseases. The variables analyzed were demographics, diseases involved, self-medication, information about disease, and lifestyle. The main variable was adherence using the Morisky-Green test. A total of 132 pharmacies collaborated, providing 6327 patients representing all Spain regions (April-December 2016). Bivariate and multivariate analyses were performed and the area under the receiver operating characteristic (ROC) curve was calculated. RESULTS: Non-adherence was 48.4% (95% confidence interval (CI): 47.2-49.7%). The variables that reached significance in the multivariate model were: difficulty in taking medication, self-medication, desire for more information, smoking, lower physical activity, younger age and number of chronic treatments. Discrimination was satisfactory (area under the ROC curve = 70%). Our study found that 50% patients was non-adherent and we obtained a profile of variables associated with therapeutic non-adherence. CONCLUSIONS: It is cause for concern that in patients with multiple diseases and taking multiple medications, there is an association between non-adherence, self-medication and worse lifestyle.

[ANTIAGING TREATMENTS: WHAT ARE WE TALKING ABOUT?]. / DE QUÉ HABLAMOS CUANDO HABLAMOS DE TERAPIAS ANTIENVEJECIMIENTO?

Antiaging medicine is nowadays an equivocal topic frequently used in geriatric medicine. It is, also, one of the most important sources of medical costs. With the words "antiaging medicine" we may express several different desires: a) to arrive at advanced age in the best possible physical and mental conditions, b) to act in order to slowing the aging process associated changes, c) to revert some of these negative changes. Prevention is the only positive successful way to achieve any of these possibilities. It means to emphasize any sort on interventions acting over health habits as physical activity, nutrition, to avoid toxic habits (tobacco) and to take primary and secondary diseases preventive measures. There is not medical evidence of effectiveness with any other measures, as hormonal therapies or reconstructive surgery.

[Geriatrics and palliative care: some reflections]. / Geriatría y cuidados paliativos: algunas reflexiones.

This article attempts to provide a framework for reflection on the relationships between 2 close specialties, such as geriatrics and palliative care. In medicine today, with the progressive ageing of the population, 80% of deaths occur at a very advanced age, and a high percentage of these are potentially likely to receive palliative care in their final stages. The reflections offered in this presentation are made from a perspective of someone who has always worked in the geriatrics field. Throughout this article, some the common points in the historic evolution of both specialities are made and discussed. The inter-relationships and common ground in other fields may be, their form of understanding medical care, clinical objectives, doctrinal bases, the work methodology, or the overlapping of some elements of training. Several aspects of where they differ on these same points are also discussed. It is concluded with a call for collaboration between the specialists of both fields, as well as in the need to demand that the health administrations introduce larger palliative teams in all hospitals in the country.

[Vitamin D. A geriatric updated perspective]. / Vitamina D. Visión actual desde la geriatría.

The aim of this review is to offer an updated survey about the relationship between old age, vitamin D and different clinical conditions. Two third of people over 65 years has insufficient serum levels of vitamin D (<30 ng/ml). Almost half of them present deficiency (<20 ng/ml), severe in many cases (<15 ng/ml). This proportion increases when we analyze non-white populations, women, and people with obesity, diabetes mellitus or diets poor in Vitamin D. Low serum vitamin D concentration has been linked to mortality, osteoporosis, falls propensity, fractures, frailty, and cardiovascular diseases, including hypertension. Several epidemiological studies open the possibility to a relationship between low levels of the vitamin D and many other diseases. Among them with different cancer, diabetes, some types of dementia, Parkinson's disease, macular degeneration or periodontitis. Also with muscle strength, mobility and physical performance. Vitamin D supplementation has beneficial clinical effects, with a significant reduction of risks, specially in subjects living in nursing-homes and in those treated with corticoids or antireabsortive drugs. These effects are doses dependent. Risk of intoxication is minimal, even with high doses of vitamin.