BACKGROUND More than half of all patients with heart failure (HF) do not take medications as prescribed, resulting in negative health outcomes. Research has shown that medication adherence may be intentional rather than the ability to follow prescribed regimens, yet very little is known about medication-taking decisions in older patients with HF. OBJECTIVE The purpose of this qualitative study was to gain insight into the decision-making processes and experiences of older patients with HF by exploring the different aspects in choosing to take or not take medications as prescribed in the community setting. METHODS Using a narrative inquiry approach, the personal narratives of 11 adults 65 years or older who took at least 2 daily medications for HF were gathered using in-depth, semistructured interviews. The data in this study were organized and analyzed using Riessman's framework for narrative analysis. RESULTS Participants made intentional decisions to take particular medications differently than prescribed. A worrisome symptom prompted a naturalistic decision-making process. When a medication interfered with attaining a personal goal, participants coped by individualizing their medication regimen. Participants did not consider taking a medication differently than prescribed as nonadherence but a necessary aspect of maintaining a personal level of health, which could be seen as self-care. CONCLUSIONS The older patient with HF should be carefully assessed for nonadherence. The development of interventions that are patient specific, target medications with the greatest potential for nonadherence, and use easy-to-access resources may promote decisions for medication adherence. More research is needed to develop interventions that promote decisions for medication adherence.

中文翻译：

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药物不依从或自理？了解老年人心力衰竭的药物决策过程和经验。

背景技术在所有心力衰竭（HF）患者中，超过一半的人未按规定服用药物，导致不良的健康结果。研究表明，药物依从性可能是故意的，而不是遵循处方方案的能力，但对于老年心衰患者服用药物的决定知之甚少。目的本定性研究的目的是通过探讨社区环境中选择服药与不服药的不同方面来了解老年心衰患者的决策过程和经验。方法采用叙述性询问的方法，通过深入，半结构化的访谈收集11名65岁以上的成年人的个人叙述，这些成年人每天至少服用2种HF药物。本研究中的数据是使用Riessman的叙事分析框架进行组织和分析的。结果参与者做出了有意识的决定，以不同于处方的方式服用特定药物。令人担忧的症状促使人们进行自然主义的决策过程。当药物干扰实现个人目标时，参与者会通过个性化自己的药物治疗方案来应对。参加者并未考虑以不同于非处方药的方式服药，而是维持个人健康水平的必要方面，这可被视为自我保健。结论应仔细评估老年HF患者的不依从性。制定针对患者的干预措施，针对不依从性潜力最大的目标药物，并且使用易于访问的资源可以促进药物依从性的决策。需要开展更多研究来开发可促进药物依从性决策的干预措施。