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Meeting the needs of older adults with diabetes mellitus requires understanding the multiple factors that interact to influence patient adherence to the prescribed regimen and adjustment to the disease. Herein, we propose a conceptual framework to explain patient adherence and to discuss practical strategies for enhancing adherence. The conceptual framework is based on the cycle of care and is expanded to incorporate major theories in health-behavior change. Based on this review, numerous factors were identified that can affect patient adherence. First, features of the regimen, such as complexity, duration, and extent of behavioral change, can negatively influence patient adherence. Second, psychosocial and environmental barriers to patient adherence are described. A major area of importance is patient-provider relationships. Specifically, patients' and professionals' attitudes, beliefs, communication processes, and subsequent reactions to the consultation can affect adherence. Suggestions are made regarding strategies to enhance adherence, including the need to assess and monitor the patient's beliefs and practices, enhance the communicative skills of health-care professionals and patients, and develop programs specifically targeted at promoting professional and patient problem-solving skills. The problem of generalizing from current research is that few empirical studies have focused on diabetes management among older adults.
Lynda A. Anderson (Thu,) studied this question.