Systematic review of the barriers affecting medication adherence in older adults

Abstract

Medication adherence is a crucial part in the management of chronic diseases. As older adults form a greater proportion of the population with chronic diseases and multiple morbidities, understanding medication adherence in older adults becomes important. In the present article, we aimed to systematically review the literature for the factors associated with medication adherence in the geriatric population. We carried out a literature search using electronic databases and related keywords. 17 391 articles were reviewed in total. 65 articles were found to be relevant to our objective. A total of 80 factors of five different categories were found to be associated with medication adherence in older adults. The factors, the types of studies and the number of studies that agreed or disagreed were presented. A flower model for medication adherence was also presented to allow clinicians to better understand the complex nature of medication adherence in this population. The 80 factors reviewed were categorized into five main categories; namely, patient factors, medication factors, physician factors, system-based factors and other factors as factors affecting poor medication adherence in older adults. Clinicians need to be mindful of the complex nature of factors affecting medication adherence in this population to optimize therapeutic outcomes. Clinicians have to be more skillful to discover and to optimize the medication adherence factors in geriatric patients. The flower model is presented as a framework for clinicians to better understand the various factors affecting medication adherence in older adults. Geriatr Gerontol Int 2016; 16: 1093-1101.

Bibliometric analysis of global publications in medication adherence (1900–2017)

“…The keywords used in the search strategy were obtained from several previous systematic reviews in the field of medication adherence . The search strategy was based on two queries that were combined together to perform the search.…”

“…The keywords used in the search strategy were obtained from several previous systematic reviews in the field of medication adherence. [21][22][23][24] The search strategy was based on two queries that were combined together to perform the search. The first search query was based on the title search using phrases such as 'medication adherence' or 'adherence to medication'.…”

Cost‐Related Medication Nonadherence Among Older Adults: Findings From a Nationally Representative Sample

“…7 Further, medication nonadherence, along with suboptimal prescribing and drug administration, results in $290 billion in avoidable medical spending annually in the United States. 8 Older adults, aged 65 years or older, with multiple chronic conditions face medication nonadherence, 9,10 and such nonadherence is associated with potentially avoidable health services use. 8,11 For example, previous studies found that medication adherence rates among patients with at least one chronic condition can be as low as 50%, 12,13 and nearly 15% of chronically ill Americans specifically stated that costs were the main reason for medication underuse.…”

EpxMedTracking: Feasibility Evaluation of an SMS-Based Medication Adherence Tracking System in Community Practice

“…In terms of thinking about how an SMS-based system could be optimized to address medication nonadherence, it may be helpful to consider the problem in the context of the framework proposed in the systematic review by Yap et al [11] on the barriers to medication adherence in older adults, in which they organize the reasons for nonadherence that have been proven to date into 5 categories: patient factors, medication factors, physician factors, system-based factors, and other factors. Many of the factors they identified include situations and patient beliefs that could conceivably be identified and addressed by an SMS- or phone call–based system (see Textbox 1).…”

“…Given that Yap et al [11] identified 80 different factors shown to influence nonadherence, it seems clear that this problem is complex and multifactorial. While forgetfulness is often cited as a reason for medication nonadherence, Saberi et al [10] found that interventions relying solely on reminding HIV patients to take their antiretroviral therapy were largely not effective, leading them to speculate that the attributed forgetfulness was a simple excuse for more complex underlying reasons like stigma, depression, drug abuse, and lack of social support.…”