Factors related to immunosuppressant medication adherence in renal transplant recipients.

Non-adherence to immunosuppressant medications (ISM) is a significant issue for transplant recipients. This study examines factors influencing ISM adherence in renal transplant recipients (RTRs). Patient-reported data were collected through a cross-sectional survey including use of ISMs, adherence behaviors, perceived adherence barriers, beliefs and attitudes toward ISMs, and patient life satisfaction. Logistic regression was conducted to examine how RTRs' beliefs about use of ISMs, life satisfaction, and ISM adherence barriers were related to adherence. A total of 512 adult commercial insurance enrollees following renal transplantation were included in the analysis. One hundred and seventy-seven RTRs were non-adherent (34.5%); the most frequently cited reason was forgetfulness. RTRs aged 18-29 yr were more likely to be non-adherent than recipients 46-64 yr old (p ≤ 0.001). Non-adherent RTRs had greater adherence barriers than adherent RTRs (p < 0.001). Adherent RTRs believed their ISMs were more necessary than non-adherent RTRs (p < 0.001), while non-adherent RTRs had greater concerns about taking ISMs (p = 0.009) and believed they had less control over their lives than adherent RTRs (p < 0.001). Non-adherent RTRs had lower life satisfaction (p < 0.001). Non-adherence is significantly associated with patients' beliefs about ISMs, perceived barriers, and lower life satisfaction. Strategies to increase ISM adherence are discussed.

When is an elder old? Effect of preexisting conditions on mortality in geriatric trauma.

BACKGROUND: As the U.S. population ages, the number of geriatric trauma victims will continue to grow. Outcomes are known to be worse for these patients, in large part because of preexisting conditions (PECs). The specific impact of various PECs on outcome in geriatric trauma has not been well studied because of heterogeneous data sets and sample sizes. METHODS: We sought to define the impact of clinical variables and PECs on mortality in geriatric trauma by analyzing a large statewide trauma database. We defined geriatric trauma patients as those age > or = 65. Isolated hip fractures were excluded. We used multiple logistic regression to determine the effect of 21 different PECs on 30-day in-hospital mortality. RESULTS: Data were abstracted from 33,781 patient records. Overall mortality was 7.6%. For each 1-year increase in age beyond age 65, odds of dying after geriatric trauma increased by 6.8% (95% confidence interval, 6.1-7.5%). When presenting vital signs, Glasgow Coma Scale score, and ISS were controlled, PECs with the strongest effect on mortality were hepatic disease (odds ratio [OR], 5.1), renal disease (OR, 3.1), and cancer (OR, 1.8). Chronic steroid use increased the odds of death after geriatric trauma (OR, 1.6), whereas Coumadin therapy did not. CONCLUSION: Considered independently, these data are insufficient to allow withdrawal of care, but this information may be a useful component to help in guiding families faced with difficult decisions after geriatric trauma.