MEDICATION ADHERENCE AMONG ELDERLY PATIENTS RECEIVING HEALTH CARE SERVICES IN A SELECTED HOSPITAL OF WATERBERG DISTRICT, LIMPOPO PROVINCE.

Introduction

Medication adherence among elderly patients living with chronic diseases continues to be a significant challenge in health care. Medication adherence refers to the extent to which a patient’s behaviour corresponds with taking medicine optimally, and it is a key factor in achieving therapeutic goals and improving patient outcomes (Specialist Pharmacy Service, 2023). Medication nonadherence is associated with poorer health outcomes when an individual fails to achieve the expected health benefits from medications related to a specific illness. Several studies have explored medication adherence among elderly patients with chronic diseases living in South Africa (AbdELwhab et al., 2025; Gumede et al., 2024; Hung et al., 2020). They recommended different strategies to improve medication adherence among the elderly with chronic diseases. Chronic diseases can influence your ability to work and lifestyle; they have an impact on mental, physical, social, and financial aspects, and they may be a burden to the family members who are living with a chronic patient. Therefore, it is crucial to explore medication adherence among elderly patients with chronic disease(s).

The World Health Organisation (2025) estimates that globally, the proportion of people aged 60 years or older will double by 2050. Most older people reside in low- and middle-income countries, such as South Africa. Population ageing is a public health concern that could negatively impact the South African economy and health system if the government fails to prepare for this change (Sibanda et al., 2021). There is an increasing burden of the elderly population in many countries, with an estimated total of 2.37 billion people aged 65 years or older globally by 2100 (Hung et al., 2020). The population of South Africa grew by 19,8% between 2011 and 2022. In 2022, the estimated total population of South Africa was 62,027,503 and included more than five million people aged 60 or older, which represents a 9,2% share of the overall South African population. The number of older persons increased across all provinces; Limpopo had a total population of 6,572,721, comprising 6.9% of the older population (65 years and above). The Waterberg district (Modimolle-Mookgophong municipality) had a total population of 130,113, comprising 9.8% of the elderly population (SA STATS, 2023).

The elderly face unique health challenges compared to young people; for example, noncommunicable diseases such as cardiac diseases, cancer, and diabetes are causes of morbidity among the elderly. The increased prevalence of comorbidities and the severity of diseases in old age will result in a higher demand for healthcare in the future. The decade of healthy ageing (2020-2030) provides an opportunity for a collaborative effort between the government and other stakeholders to enhance the health and well-being of the elderly (Sibanda et al., 2021). Globally, non-communicable diseases killed at least 43 million people in 2021, equivalent to 75% of non-pandemic-related deaths (World Health Organisation, 2025). South Africa is experiencing a growing proportion of the elderly population with rapid increases in the burden of non-communicable diseases. In South Africa, a significant portion of the elderly population, approximately 85%, has at least one chronic health condition, and 60% have two or more (SA STATS, 2023). Rural areas in South Africa represent a smaller fraction of the population; however, they share a relatively higher burden of non-communicable diseases. SA represents one of the most rapidly ageing countries in sub-Saharan Africa.

In South Africa, the burden of chronic diseases is significant, with deaths from cardiovascular disease, cancer, diabetes, and chronic respiratory diseases increasing by 58.7% over 20 years (SA STATS, 2023). There are deaths due to major non-communicable diseases over 20 years, from 1997 to 2018, which are the following: cardiovascular diseases increased from 54,701 in1997 to 80,133 in 2018; cancer increased from 27,052 in 1997 to 43,613 in 2018; chronic lower respiratory diseases rose from 10,829 in 1997 to 13,579 in 2018, and diabetes increased from 10,846 in 1997 to 26,880 in 2018 (SATS SA, 2023). In 2018, females accounted for 65,845 deaths due to three non-communicable diseases, while males accounted for 54,556; the median age at death in years was 65 for males and 69 for females. KwaZulu-Natal, Gauteng, Western Cape, and Eastern Cape have some of the highest mortality rates due to non-communicable diseases; this may reflect their population, as they host almost two-thirds of South Africa’s population.

About 50 % of adults struggle with medication adherence (Nguyenal et al., 2024). Taking medication correctly may seem like a personal or straightforward matter. However, nonadherence or not taking medication as prescribed is a complicated and common problem, and people do not realise the actual damage or side effects of non-adherence. There are several reasons why people may be unable to take medication as directed. Medication adherence issues are common among elderly patients, regardless of whether they are treating acute or chronic diseases. The elderly are susceptible to several comorbidities requiring polypharmacy, and it may make them more likely to adhere to medication than younger patients; they are, therefore, likely to have more hospital readmissions, increased health spending, slow healing, etc. (Varghese et al., 2024). (Kvarnstrom et al., 2021) classified factors influencing medication adherence among elderly patients as patient-specific barriers, an illness-specific situation, medication-related issues, health care and system-related issues, as well as logical and financial factors.

Several studies have explored medication adherence among elderly patients with chronic diseases and recommended strategies to improve adherence, including medication management, health education, supportive social networks, and ensuring continuity of care (AbdElwhab et al., 2025; Gumede et al., 2024; Hung et al., 2020). However, there is a lack of context-specific research addressing medication adherence among elderly patients aged 60 years and above with chronic diseases in the Waterberg district, specifically around the Modimolle-Mookgopong municipality. Furthermore, there is a limited understanding of medication adherence and the facilitators affecting medication adherence among the elderly population within the district, which hinders the development of targeted interventions, resulting in a high rate of complications of chronic diseases, a high rate of readmissions, and high mortality due to medication non-adherence among the elderly. Therefore, this study aims to explore medication adherence among elderly patients receiving health care services in a selected hospital in the Waterberg district.

Materials and methods

Discussion

Self-reported Medication nonadherence appears to be common in older adults with multimorbidity and polypharmacy. Depression, necessity and concerns should be considered when assessing medication non-adherence in practice (Felix & Henriques, 2021). (Horvat et al., 2024) indicated the barriers of medication adherence among the elderly in three categories, which are medication-related barriers where the elderly face several challenges, such as medication instructions, forgetting to renew medication supplies, taking multiple medications, changes in medication regimens, managing the timing and dosage of various drugs, The other category is patient-related barriers, wherein the elderly experience physical difficulties, decline in general fitness and cognitive abilities, health literacy, and common challenges such as vision, hearing, and understanding, The third barrier is related to the healthcare systems or personnel, where the elderly face challenges such as poor communication from healthcare providers. (Kvarnstrom et al., 2021) also highlighted the barriers to medication adherence and classified them into patient-specific barriers, medication-specific barriers, illness-specific barriers, health and system-specific barriers, social and culture-specific barriers, logical and financial barriers. (Maffoni et al., 2020) Identified barriers such as patients’ beliefs and concerns about treatment, patients’ beliefs about polypharmacy and prioritisation, patients’ experience and capabilities, prescriber-patient relationship, health literacy, treatment characteristics, and complexity.