Treatment adherence in elderly and senile patients with primary open-angle glaucoma

PURPOSE: To analyze the factors influencing the motivation for a long-term treatment in elderly and senile patients with glaucoma and to propose ways of increasing its level.

METHODS: A survey of patients with POAG was conducted to identify factors influencing motivation for treatment. Various models of therapeutic training were proposed: an independent study of proposed special literature (subgroup A), a lecture course on glaucoma (subgroup B), and individual in-depth consultation of a patient with glaucoma (subgroup C). The study of motivation for treatment was carried out at baseline — before conducting the therapeutic training, and then 1 month and 6 months after its completion. 366 patients with stage I-IV primary open-angle glaucoma who were treated in the Regional Ophthalmological Hospital took part in the survey and therapeutic training. During the study the patients were divided into 3 groups: Group I — 104 patients of middle age (45-59 years old), with 44 (42.3%) men and 60 (57.7%) women, Group II — 164 people of the elderly age group (60-74 years old), with 66 (40.2%) men and 98 (59.8%) women; Group III — 98 senile patients (75 years and older) — 36 (36.7%) men and 62 (63.3%) women.

RESULTS: The study helped determine the main cause for the lack of motivation for treatment, which turned out to be the underestimation of the treatment importance and the dangerous consequences of the disease. This mostly happens due to the following reasons: an asymptomatic disease (55.2%), a low level of awareness of the disease (51.9%), lack of a visible effect from the prescribed therapy (50.8%), adverse effects (47.5%), forgetfulness (36%), lack of confidence that the treatment can actually help (23.5%), lack of empathy and insufficient attention from the attending physician (63.4%), etc. When comparing the three proposed therapeutic training models, the best results were noted with an individual in-depth counselling: the level of motivation remained stable up to 6 months after the counselling was finished.

CONCLUSION: “Low” and “below average” levels of motivation for treatment are common for primary open-angle glaucoma patients. Our proposed model of therapeutic training has increased the level of motivation for treating in POAG patients, especially in the elderly and senile age groups. 

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