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Does Retirement Affect Adherence to Medications?

There is a decline in adherence to medication after retirement among men and women with hypertension and men with type 2 diabetes….

Cardiovascular diseases are the leading cause of death worldwide, and diabetes is projected to be in the top 4 most common causes of death in high-income countries by 2030. Medications can substantially reduce the risk of complications from these diseases; however, poor adherence to a medication regimen is common and substantially hampers the effectiveness of these therapies. In this study, Kivimäki et al examined whether retirement is associated with a change in adherence to medication in patients with hypertension or type 2 diabetes.

A total of 3468 adult patients with hypertension and 412 adult patients with type 2 diabetes were identified and followed for medication adherence for the 3 years before their retirement and the 4 years after their retirement (mean follow-up 6.8 yr). Participants were censored at death. Of the 3880 included participants, 2720 (70.1%) were female and median age at retirement for the participants were 61 years. The primary outcome was proportion of patients with poor adherence to medication, which we defined as less than 40% of days covered by treatment.

The preretirement prevalence of poor adherence to medication was 6% in men and women with hypertension, 2% in men with diabetes and 4% in women with diabetes. Among men, retirement was associated with an increased risk of poor adherence to both antihypertensive agents and antidiabetic drugs. Among women, an increased risk of poor adherence was seen only for antihypertensive agents.

For men and women with hypertension and men with type 2 diabetes, retirement was linked to 1.3- to 2.4-fold increases in poor medication adherence. The researchers saw no significant difference in this adherence pattern between age groups, socioeconomic strata, or patients with and without depression or comorbid cardiovascular disease. Given that hypertension and type 2 diabetes are often asymptomatic, a perception of reduced symptoms of ill health after retirement may result in a sense of false security encouraging reduced medication use.

Practice Pearls:

  • Retirement is linked to 1.3- to 2.4-fold increases in poor medication adherence.
  • A perception of reduced symptoms of ill health after retirement may result in a sense of false security encouraging reduced medication use.
  • Among men, retirement was associated with an increased risk of poor adherence to both antihypertensive agents and antidiabetic drugs

Canadian Medical Association Journal, October 2013