Improving medication adherence among community-dwelling seniors with cognitive impairment: a systematic review of interventions

Abstract

Background Medication non-adherence may lead to poor therapeutic outcomes. Cognitive functions deteriorate with age, contributing to decreased adherence. Interventions have been tested to improve adherence in seniors with cognitive impairment or Alzheimer disease (AD), but high-quality systematic reviews are lacking. It remains unclear which interventions are promising. Objectives We conducted a systematic review to identify, describe, and evaluate interventions aimed at improving medication adherence among seniors with any type of cognitive impairment. Methods Following NICE guidance, databases and websites were searched using combinations of controlled and free vocabulary. All adherence-enhancing interventions and study designs were considered. Studies had to include community dwelling seniors, aged 65 years or older, with cognitive impairment, receiving at least one medication for a chronic condition, and an adherence measure. Study characteristics and methodological quality were assessed. Results We identified 13 interventions, including six RCTs. Two studies were of poor, nine of low/medium and two of high quality. Seven studies had sample sizes below 50 and six interventions focused on adherence to AD medication. Six interventions tested a behavioral, four a medication oriented, two an educational and one a multi-faceted approach. Studies rarely assessed therapeutic outcomes. All but one intervention showed improved adherence. Conclusion Three medium quality studies showed better adherence with patches than with pills for AD treatment. Promising interventions used educational or reminding strategies, including one high quality RCT. Nine studies were of low/moderate quality. High quality RCTs using a theoretical framework for intervention selection are needed to identify strategies for improved adherence in these seniors.

Appendix 1

See Table 4.

Table 4 List of websites searched

Appendix 2: PubMed search strategy

• 1. (“Patient compliance”[Mesh] OR “compliance”[TiAb] OR “compliant”[TiAb] OR “adherence”[TiAb] OR “adherent”[TiAb] OR “persistence”[TiAb] OR “persistent”[TiAb] OR “appropriate use”[TiAb] OR “concordance”[TiAb] OR “patient cooperation”[TiAb] OR “Medication therapy management”[Mesh] OR “drug therapy management”[TiAb] OR “therapy management”[TiAb] OR “treatment management”[TiAb] OR “medication management”[TiAb] OR “self-management”[TiAb] OR “patient education”[TiAb] OR “Treatment refusal”[Mesh] OR “treatment refusal”[TiAb] OR “refusal of treatment”[TiAb] OR “Patient dropouts”[Mesh] OR “Patient dropout*”[TiAb] OR “Treatment dropout*”[TiAb] OR “dropouts”[TiAb] OR “dropout”[TiAb] OR “Prescription Drug Misuse”[Mesh] OR “Self administration”[Mesh])

• 2. (“Cognition disorders”[Mesh] OR “impaired cognition”[TiAb] OR “impaired function”[TiAb] OR “impaired memory”[TiAb] OR “function impairment”[TiAb] OR “functional impairment”[TiAb] OR “memory impairment”[TiAb] OR “cognitive loss”[TiAb] OR “cognitive dysfunction”[TiAb] OR “cognitive deficit”[TiAb] OR “cognitive decline”[TiAb] OR “cognitive defect”[TiAb] OR “cognitive problems”[TiAb] OR “memory dysfunction”[TiAb] OR “memory loss”[TiAb] OR “memory deficit”[TiAb] OR “memory decline”[TiAb] OR “memory defect”[TiAb] OR “memory problems”[TiAb] OR “cognitive abilities”[TiAb] OR “executive function”[TiAb] OR “cognitively impaired”[TiAb] OR “Cognitive impairment”[TiAb] OR “cognitive disorder”[TiAb] OR “Dementia””[Mesh])

• 3. #1 AND #2

Filters activated: Humans, English, French, German, Aged: 65+ years.