Factors associated with medication adherence in older patients: A systematic review

Abstract

Objective Medication adherence is a major challenge in the treatment of older patients; however, they are under‐represented in research. We undertook a systematic review focused on older patients to assess the reasons underlying non‐adherence in this population. Methods We searched multiple electronic databases for studies reporting reasons for non‐adherence to medication regimens in patients aged 75 years and over. Our results were not limited to specific diseases, health‐care settings, or geographical locations. The quality of eligible studies was assessed using the Newcastle‐Ottawa Scale. A narrative synthesis of findings was performed. Results A total of 25 publications were included, all of which were in community settings. Frequent medication review and knowledge regarding the purpose of the medication were positively associated with adherence. Factors associated with poor adherence were multimorbidity, cognitive impairment, complex regimens with multiple prescribing physicians, and problems with drug storage or formulation. Conclusion These findings suggest that interventions to improve adherence could focus on medication review aimed at simplifying regimens and educating patients about their treatment. Groups with poor adherence that may benefit most from such a model include patients with multiple comorbidities and cognitive impairment.

Non‐prescription medicines may contribute to non‐adherence to prescription medicines in people living with chronic health conditions

“…This study found a weak but statistically significant correlation between the number of missed doses and the patient's age, level of education and employment status. Similar to this, reviews of non‐adherence literature have found an association with age, education and employment . In contrast, Australian studies by Laba et al and Al‐Ganmi et al found no significant correlation between non‐adherence and demographic factors .…”

“…Several systematic reviews have found medication non‐adherence to be associated with polypharmacy and complex regimens with higher dosing frequency . Interestingly, Smaje et al associated polypharmacy with non‐adherence but found differences across studies according to the definition of polypharmacy, namely greater than seven or nine drugs had the greatest correlation with non‐adherence while there was less association in studies using a continuous scale of pill burden .…”

“…However, a recent review by Gast and Mathes found the number of tablets had a negative impact on adherence in cardiovascular conditions but this impact was uncertain across other medical conditions . Similar to this, Smaje et al associated complex medication regimens with non‐adherence in four individual medical conditions (stroke, falls, sleep disturbance and chronic obstructive pulmonary disease) and also determined that higher levels of comorbidity were associated with poorer adherence . Therefore, the impact of polypharmacy caused by the presence of numerous CHCs warrants further investigation.…”

Exploring Medication Adherence Using M-Health: A Study from Veterinary Medicine

“…The gender and age of owners were not related to medication adherence in this sample. The published literature shows that women are, in general, more adherent than men [18,19], and that having a caregiver does not necessarily improve medication adherence [20]. Although the sample had a mean age below 40 years, the lack of association between adherence and owners' age might suggest an opportunity to use m-health apps independently from the age of the caregiver.…”

Polypharmacy Among Older Brazilians: Prevalence, Factors Associated and Sociodemographic Disparities (ELSI-Brazil)

“…Moreover, polypharmacy has been found to be associated with a variety of negative outcomes in older adults, such as falls, mental impairment, cognitive decline, increase of hospital length-of-stay and readmission [11][12][13]. Another important problem is the lack of therapy adherence, given that complex therapeutic regimes are di cult to manage properly [14,15].…”