Cost‐Related Medication Nonadherence Among Older Adults: Findings From a Nationally Representative Sample

OBJECTIVES To estimate the rate of and risk factors associated with cost‐related medication nonadherence among older adults. DESIGN Cross‐sectional analysis of the 2017 National Health Interview Survey (NHIS). SETTING Nationally representative health interview survey in the United States. PARTICIPANTS Survey respondents, aged 65 years or older (n = 5701 unweighted) in the 2017 wave of the NHIS. MEASUREMENTS Self‐reported, cost‐related medication nonadherence (due to cost: skip dose, reduce dose, or delay or not fill a prescription) and actions taken due to cost‐related medication nonadherence (ask for lower‐cost prescription, use alternative therapy, or buy medications from another country) were quantified. We used a series of multivariable logistic regression analyses to identify factors associated with cost‐related medication nonadherence. We also reported analyses by chronic disease subgroups. RESULTS In 2017, 408 (6.8%) of 5901 older adults, representative of 2.7 million older adults nationally, reported cost‐related medication nonadherence. Among those with cost‐related medication nonadherence, 44.2% asked a physician for lower‐cost medications, 11.5% used alternative therapies, and 5.3% bought prescription drugs outside the United States to save money. Correlates independently associated with a higher likelihood of cost‐related medication nonadherence included: younger age, female sex, lower socioeconomic levels (eg, low income and uninsured), mental distress, functional limitations, multimorbidities, and obesity ( P  < .05 for all). Similar patterns were found in subgroup analyses. CONCLUSION Cost‐related medication nonadherence among older adults is increasingly common, with several potentially modifiable risk factors identified. Interventions, such as medication therapy management, may be needed to reduce cost‐related medication nonadherence in older adults. J Am Geriatr Soc 67:2463–2473, 2019