Critique of Holt et al.’s “Health-related quality of life and antihypertensive medication adherence among older adults”

The title of the report was brief and contained enough words to help the reader understand what the study was all about. It contained the primary topic, ‘Health-Related Quality of Life (HRQOL)’ and antihypertensive medication adherence.   It further communicates the nature of the analysis, which states the effects of adhering to the medication specifically for older people. If the report were published in a different journal, it probably would have indicated that it was quantitative research. It would be easy to find this paper using the keywords ‘HRQOL,’ ‘medication adherence,’ ’hypertension,’ ‘older adults,’ and ‘elderly.’  However, it would be challenging to locate the paper in a search for quantitative studies.


The report contained an informative abstract. It does not critique nor evaluate but provides more than just a description. It was brief with less than 300 words and contained subheadings. It included the significant aspects of the research to help the reader quickly determine whether the paper would be useful. It summarized the purpose of the study, had a succinct presentation of the methods, and the measures of assessing HRQOL. The results were also highlighted briefly to inform the reader of what to expect. The abstract ends with a concluding sentence which confirms to the reader the importance of adequate HRQOL in achieving high medication adherence.    


The introduction to the study was brief and well-written. The first paragraph describes hypertension as a significant chronic disease, states its prevalence in the United States and how low antihypertensive medication adherence impacts the control of hypertension control.  The first paragraph portrayed the significance of the topic. The rest of the introduction focuses on factors associated with medication adherence and the results from prior studies. Based on the factors presented, a quantitative approach seems appropriate for the study.


The methods section was divided into six subsections, each giving a thorough and detailed description of how the researchers conducted the study.

Study population and timeline

Elizabeth Holt and colleagues used a mixed design methodology to investigate the factors that influenced adherence to antihypertensive medication in older adults. The study design and baseline features were obtained from previous studies. The participants came from a care organization in Southeastern Louisiana and were selected at random. The researchers used common terminologies used in the textbook. The citation was to a paper prepared by Krousel-Wood and colleagues. The design study was longitudinal. The recruitment occurred over an extended period to allow for proper analysis of patients. The team selected a wide team before choosing a reasonable number which they believed were suitable for the study. This was the best possible sampling design for the purpose of the study and nature of the condition under study. Sampling biases were minimized as much as possible hence the long period in which sampling occurred. The sample also gave a good representation of the actual population of older adults with chronic diseases and the possible barriers they encountered.   

Study Measures

The researchers set suitable conditions in place to ensure the data collected was relevant. They used trained officers to administer the baseline CoSMO survey, and each interview lasted between 30 and 45 minutes to provide adequate time for the respondents to answer questions. They focused on evaluating socio-demographic and clinical factors, medication adherence, HRQOL, and reduction in the use of prescribed antihypertensive medication, which resulted from high cost. The team obtained information from administrative and pharmacy databases of the managed care organization to ensure they had reliable data.

Patient characteristics

Elizabeth and colleagues defined clearly the characteristics that they were looking for from eligible participants in the study. They wanted to know the marital status of individuals, their race, age, the highest level of education achieved, co-morbid conditions, height and weight, and the length of time under which patients were under hypertension.  To be eligible, participants had to be adults of age 65 years and above, and have essential hypertension. The identified candidates were then screened over a telephone interview after which the researchers selected a suitable number to work with. Of the 7020 participants identified, only 3545 passed the telephone interview and only 2194 were enrolled. 14 individuals who were neither whites nor African Americans were also excluded from the study. The features helped to determine which other barriers could hinder a patient’s adherence to medication other than costs. They also asked all the patients whether they had missed on medication due to high cost in the previous one year period counting from the date of the interview. Picking individuals from the organization could be judged as convenient sampling. However, the procedures employed and the team followed appropriate ways of obtaining a good representation of the population.


This section presented substantial information which assisted in data collection. It began by defining HRQOL measured the level of at which patients lives were affected by their health and it entails the physical, emotional, social impact of the disease. The researchers described how they used the Rand Medical Outcomes study which comprised of 36 questions which measured physical functioning, inability to perform roles as a result of physical health problems, possibility and level of body pain, and the general state of health f an individual. It also involved testing mental problems like social functioning, inability to perform roles due to emotional challenges, and mental health. The questions were structured in admirable detailed and the interviewers started with the easies question and progressed on to those that were a bit challenging.

Medication adherence

The main outcome of the study was self-reported medication adherence and it was assessed using the eight-item Morisky Medication Adherence Scale.

Statistical analysis

The study used the Chi-square method to analyze the data obtained. They calculated the mean of the HRQOL values on the physical and mental subscales for every MMAS-8 antihypertensive medication adherence group using analysis of covariance to modify covariates. The researchers also used various other methods like multinomial logistic regression models to assess the relationship between MMAS-8 levels and the physical component summary and Mental component summary. Considering the huge number of the population and distribution and the number of groups being compared, the researchers used appropriate statistical methods for the analysis.


The results began by presenting the findings from the analysis. The results were presented using a table for easy comparison. The table showed the characteristics of CoSMO participants by PCS and MCS. All the key findings were interpreted and discussed within the context of the study. However, the report ignores the issue of generalizability. The results are also presented in a manner that is easily accessible by future nurses. The presentation is well-organized and has sufficient details. In my opinion, I find the results valid, and the study will contribute significantly in nursing practice.  Elizabeth Holt is a scholar which makes the finding more credible. Besides, the study had adequate strengths, given that the results were observational, and the data was self-reported. Moreover, the analysis was cross-sectional which reduced the chances of creating errors. The implications of the researchers are in tandem with previous which indicated that physical HRQOL increased with decreased in prevalence of chronic diseases among older adults. They therefore seem reasonable and completed enough that they may not require further research. 

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