A few years ago, I took on a temporary role as my mom’s Medication Manager following her surgery. My job description included sifting through the pile of pamphlets, discharge papers, and scribbled notes from the hospital, figuring out her complicated pill dosage and timing, and enforcing it with a hand-drawn schedule, meticulous record-keeping, and several daily alarms. My job also entailed showing her I cared through hugs, homemade meals, and shared laughs.
Although I didn’t know it at the time, these kinds of support—both practical and emotional—may be keys to unlocking medication adherence and, in turn, positive health outcomes.
While my mom’s medication management was a temporary challenge, many people live with this responsibility on a daily basis. Unfortunately, that doesn’t mean it gets easier. As many as 50 percent of patients with chronic conditions do not take their medications as prescribed, leading to an estimated 125,000 avoidable deaths and $100 billion in preventable healthcare costs each year in the US.
What the Science Says
Research suggests that a lack of support, or loneliness, may contribute to this problem. Consider a new study by researchers at the University of Toronto. Analyzing data for over 15,000 adults aged 65 years or older who administered their own medications, the investigators found that loneliness was associated with polypharmacy—that is, taking more medications than are medically necessary. Lonely older adults also used more opioids and benzodiazepines on a daily basis than their more connected counterparts.
There could be multiple explanations for this finding. One is that loneliness exacerbated people’s levels of pain or anxiety, so they intentionally took extra medications to ease their symptoms. Some evidence backs up this reasoning; for instance, loneliness has previously been linked to greater depression and pain.
An alternative explanation is that the older adults were lonely because they didn’t have enough supportive relationships—and that lack of support also meant that they didn’t have the encouragement or help they needed to take their medications correctly.
This study builds on a large body of evidence for the potential harm of loneliness and the potential benefits of social support for patients with ongoing medication management. For instance, when a researcher at the Johns Hopkins School of Public Health interviewed women at an outpatient clinic about their experiences, a recurring theme was that supportive family members helped, while feeling unloved or uncared for hindered their ability to take their medications as prescribed.
To quantify this, investigators at the University of North Carolina at Chapel Hill measured social support among patients with heart failure using a validated survey, monitored their medication adherence for several months, and collected their health information over multiple years. In the end, they found that patients with lower social support and lower medication adherence had a 3.5 times higher risk of emergency department visits, hospitalizations, and death during the follow-up period.
Moreover, the researchers’ analyses revealed that social support predicted medication adherence, which in turn predicted cardiac events—but also that social support directly predicted cardiac events, even without medication adherence as a mediator. This finding illustrates that caring relationships are both directly and indirectly linked to health outcomes.
Diving Deeper into Social Support
The kind of support that patients receive matters. For instance, a review of fifty peer-reviewed studies concluded that practical help consistently aided medication adherence––more so than emotional support. As a result, the authors recommended that friends or family members help their loved ones with pragmatic tasks like buying or administering their medications, just like I did as my mom’s Medication Manager.
However, support could also come from healthcare providers. In one study, researchers implemented a program for patients to receive coordinated support from their pharmacists, primary care doctors, and cardiologists over the course of one year. This included collaborative care, education, and reminder phone calls. Patients in the program stuck to their medication protocols significantly better than patients in a comparison group who only received standard follow-ups.
To be clear, social support is not a cure-all for the challenges of medication management, nor is it effective in all cases. For example, it did not appear to help with medication adherence among transplant recipients, people experiencing their first episode of psychosis, or patients in Malaysia. There are numerous other barriers to medication adherence, not to mention individual and cultural differences, that may account for these discrepancies.
One such barrier is health literacy, or people’s ability to access, understand, and apply healthcare information. After all, how can you take your medications correctly if you can’t make sense of the instructions? One study found that various kinds of social support were insufficient for promoting medication adherence if the patients had limited health literacy; to overcome this, they needed a trusted confidante to whom they could admit comprehension difficulty and ask for assistance.
Nonetheless, the science overwhelmingly shows that social support can be a useful tool in the toolbox of medication adherence. And given how beneficial caring relationships are for physical, mental, and social well-being more generally, reducing loneliness among patients should be a priority.
This is especially important during the pandemic, particularly for older adults or people with chronic conditions who may have experienced heightened disconnection in the past year due to being physically limited or immunocompromised. Addressing loneliness is also important in the context of the ongoing opioid crisis, given that loneliness has been linked to non-prescribed opioid use and may have contributed to increased hospitalizations for overdoses during the pandemic.
How to Take Action
So how can you put this knowledge to use?
First, feel empowered to ask for help. Living with a chronic condition can be an isolating experience, but you don’t have to go through it alone. One group of researchers compared people living with HIV/AIDS who were either part of a peer support group or not and found that the former exhibited significantly better medication adherence. Consider joining an online or (post-pandemic) in-person support group to connect with others who share your condition. As a Hero member, make sure you set up caregiver notifications so that someone you trust can stay in the loop and offer assistance when needed.
Second, help others, because it turns out that giving support––not just receiving it––can be beneficial. For example, one study reported that patients who provided support to others through twice-monthly group meetings and weekly one-on-one phone calls experienced greater social acceptance, reciprocal support, and personal growth themselves. If you are a patient, consider volunteering or becoming an accountability buddy for someone who is just starting to manage their medications.
Finally, take advantage of technology that can help you simplify the process of medication adherence. Hero automates practical support, essentially serving as a full-time Medication Manager. This frees up loved ones, caregivers, and providers to focus on helping patients in other ways, like giving emotional support through hugs, homemade meals, and shared laughs. In an upcoming post, I’ll share more about the power—and science—of human connection on the healing journey.