Medication Nonadherence in the Geriatric Psychiatric Population: Do Seniors Take Their Pills?

  • Yun Freudenberg-HuaEmail author
  • Ryan Kaufman
  • Antonia Alafris
  • Sukriti Mittal
  • Neil Kremen
  • Erika Jakobson


The nonadherence rate to psychiatric medications among the geriatric patient population is estimated to be similar to that in the younger adult population, around 50%. Contributing factors to psychotropic medication nonadherence include patient-specific risk factors (for example, illness beliefs and cognitive function), drug-specific factors (for example, adverse effects and cost), as well as social factors (e.g., family support). Randomized controlled trials on geriatric adherence to psychiatric medications are scarce. We propose strategies that are better adapted to the geriatric population to improve medication adherence.


Geriatric Older adults Geriatric population Geriatric psychiatry Medication Nonadherence Adherence Medication compliance Vignettes 



We thank Dr. Barnett Meyers for his assistance with this manuscript.


  1. 1.
    Brown MT, Bussell JK. Medication adherence: WHO cares? Mayo Clin Proc. 2011;86(4):304–14.CrossRefGoogle Scholar
  2. 2.
    Domino EF. History of modern psychopharmacology: a personal view with an emphasis on antidepressants. Psychosom Med. 1999;61(5):591–8.CrossRefGoogle Scholar
  3. 3.
    Paulose-Ram R, Safran MA, Jonas BS, Gu Q, Orwig D. Trends in psychotropic medication use among U.S. adults. Pharmacoepidemiol Drug Saf. 2007;16(5):560–70.CrossRefGoogle Scholar
  4. 4.
    Meng X, D’Arcy C, Tempier R. Trends in psychotropic use in Saskatchewan from 1983 to 2007. Can J Psychiatr. 2013;58(7):426–31.CrossRefGoogle Scholar
  5. 5.
    Alonso J, Angermeyer MC, Bernert S, Bruffaerts R, Brugha TS, Bryson H, et al. Psychotropic drug utilization in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project. Acta Psychiatr Scand Suppl. 2004;420:55–64.Google Scholar
  6. 6.
    Taipale H, Koponen M, Tanskanen A, Tolppanen AM, Tiihonen J, Hartikainen S. Drug use in persons with and without Alzheimer’s disease aged 90 years or more. Age Ageing. 2016;45(6):900–4.CrossRefGoogle Scholar
  7. 7.
    Bartels SJ, Naslund JA. The underside of the silver tsunami – older adults and mental health care. N Engl J Med. 2013;368(6):493–6.CrossRefGoogle Scholar
  8. 8.
    Institute of Medicine. The mental health and substance use workforce for older adults: in whose hands? Washington, DC: The National Academies Press; 2012. Scholar
  9. 9.
    Forlani C, Morri M, Ferrari B, Dalmonte E, Menchetti M, De Ronchi D, et al. Prevalence and gender differences in late-life depression: a population-based study. Am J Geriatr Psychiatry. 2014;22(4):370–80.CrossRefGoogle Scholar
  10. 10.
    Licht-Strunk E, van der Kooij KG, van Schaik DJ, van Marwijk HW, van Hout HP, de Haan M, et al. Prevalence of depression in older patients consulting their general practitioner in The Netherlands. Int J Geriatr Psychiatry. 2005;20(11):1013–9.CrossRefGoogle Scholar
  11. 11.
    Colijn MA, Nitta BH, Grossberg GT. Psychosis in later life: a review and update. Harv Rev Psychiatry. 2015;23(5):354–67.CrossRefGoogle Scholar
  12. 12.
    Wetherell JL, Unutzer J. Adherence to treatment for geriatric depression and anxiety. CNS Spectr. 2003;8(12 Suppl 3):48–59.CrossRefGoogle Scholar
  13. 13.
    Sirey JA, Bruce ML, Alexopoulos GS, Perlick DA, Friedman SJ, Meyers BS. Stigma as a barrier to recovery: perceived stigma and patient-rated severity of illness as predictors of antidepressant drug adherence. Psychiatr Serv. 2001;52(12):1615–20.CrossRefGoogle Scholar
  14. 14.
    Barkhof E, Meijer CJ, de Sonneville LM, Linszen DH, de Haan L. Interventions to improve adherence to antipsychotic medication in patients with schizophrenia – a review of the past decade. Eur Psychiatry. 2012;27(1):9–18.CrossRefGoogle Scholar
  15. 15.
    Kane JM, Kishimoto T, Correll CU. Non-adherence to medication in patients with psychotic disorders: epidemiology, contributing factors and management strategies. World Psychiatry. 2013;12(3):216–26.CrossRefGoogle Scholar
  16. 16.
    Vrijens B, De Geest S, Hughes DA, Przemyslaw K, Demonceau J, Ruppar T, et al. A new taxonomy for describing and defining adherence to medications. Br J Clin Pharmacol. 2012;73(5):691–705.CrossRefGoogle Scholar
  17. 17.
    Depp CA, Lebowitz BD. Enhancing medication adherence: in older adults with bipolar disorder. Psychiatry (Edgmont). 2007;4(6):22–32.Google Scholar
  18. 18.
    Clifford S, Barber N, Horne R. Understanding different beliefs held by adherers, unintentional nonadherers, and intentional nonadherers: application of the Necessity-Concerns Framework. J Psychosom Res. 2008;64(1):41–6.CrossRefGoogle Scholar
  19. 19.
    Hartung D, Low A, Jindai K, Mansoor D, Judge M, Mendelson A, et al. Interventions to improve pharmacological adherence among adults with psychotic spectrum disorders and bipolar disorder: a systematic review. Psychosomatics. 2017;58(2):101–12.CrossRefGoogle Scholar
  20. 20.
    Chapman SC, Horne R. Medication nonadherence and psychiatry. Curr Opin Psychiatry. 2013;26(5):446–52.CrossRefGoogle Scholar
  21. 21.
    Melfi CA, Chawla AJ, Croghan TW, Hanna MP, Kennedy S, Sredl K. The effects of adherence to antidepressant treatment guidelines on relapse and recurrence of depression. Arch Gen Psychiatry. 1998;55(12):1128–32.CrossRefGoogle Scholar
  22. 22.
    Gellad WF, Grenard JL, Marcum ZA. A systematic review of barriers to medication adherence in the elderly: looking beyond cost and regimen complexity. Am J Geriatr Pharmacother. 2011;9(1):11–23.CrossRefGoogle Scholar
  23. 23.
    Arlt S, Lindner R, Rosler A, von Renteln-Kruse W. Adherence to medication in patients with dementia: predictors and strategies for improvement. Drugs Aging. 2008;25(12):1033–47.CrossRefGoogle Scholar
  24. 24.
    David Mintz M. Psychodynamic psychopharmacology: addressing the underlying causes of treatment resistance. Psychiatr Times. 2011;28(9).Google Scholar
  25. 25.
    Alfonso CA. Dynamic psychopharmacology and treatment adherence. J Am Acad Psychoanal Dyn Psychiatry. 2009;37(2):269–85.CrossRefGoogle Scholar
  26. 26.
    Wells RE, Kaptchuk TJ. To tell the truth, the whole truth, may do patients harm: the problem of the nocebo effect for informed consent. Am J Bioeth. 2012;12(3):22–9.CrossRefGoogle Scholar
  27. 27.
    Mallo CJ. ‘Nocebo’ effects: address these 4 psychosocial factors. Curr Psychiatr Ther. 2018;17(5):54–5.Google Scholar
  28. 28.
    Costa E, Giardini A, Savin M, Menditto E, Lehane E, Laosa O, et al. Interventional tools to improve medication adherence: review of literature. Patient Prefer Adherence. 2015;9:1303–14.CrossRefGoogle Scholar
  29. 29.
    Bergman-Evans B. AIDES to improving medication adherence in older adults. Geriatr Nurs. 2006;27(3):174–82.Google Scholar
  30. 30.
    Roter DL, Hall JA, Merisca R, Nordstrom B, Cretin D, Svarstad B. Effectiveness of interventions to improve patient compliance: a meta-analysis. Med Care. 1998;36(8):1138–61.CrossRefGoogle Scholar
  31. 31.
    Hughes CM. Medication non-adherence in the elderly: how big is the problem? Drugs Aging. 2004;21(12):793–811.CrossRefGoogle Scholar
  32. 32.
    Gazmararian JA, Kripalani S, Miller MJ, Echt KV, Ren J, Rask K. Factors associated with medication refill adherence in cardiovascular-related diseases: a focus on health literacy. J Gen Intern Med. 2006;21(12):1215–21.CrossRefGoogle Scholar
  33. 33.
    Shruthi R, Jyothi R, Pundarikaksha HP, Nagesh GN, Tushar TJ. A study of medication compliance in geriatric patients with chronic illnesses at a tertiary care hospital. J Clin Diagn Res. 2016;10(12):FC40–FC3.PubMedPubMedCentralGoogle Scholar
  34. 34.
    Ustun TB, Chatterji S, Bickenbach J, Kostanjsek N, Schneider M. The International Classification of Functioning, Disability and Health: a new tool for understanding disability and health. Disabil Rehabil. 2003;25(11–12):565–71.CrossRefGoogle Scholar
  35. 35.
    Johnson SG. Geriatrics, an issue of physician assistant clinics, vol. 3–4. 1st ed: Elsevier; 2018.Google Scholar
  36. 36.
    Elliott RA, Marriott JL. Standardised assessment of patients’ capacity to manage medications: a systematic review of published instruments. BMC Geriatr. 2009;9:27.CrossRefGoogle Scholar
  37. 37.
    Haynes RB, Ackloo E, Sahota N, McDonald HP, Yao X. Interventions for enhancing medication adherence. Cochrane Database Syst Rev. 2008;2:CD000011.
  38. 38.
    Zedler BK, Kakad P, Colilla S, Murrelle L, Shah NR. Does packaging with a calendar feature improve adherence to self-administered medication for long-term use? A systematic review. Clin Ther. 2011;33(1):62–73.CrossRefGoogle Scholar
  39. 39.
    Kishimoto T, Nitta M, Borenstein M, Kane JM, Correll CU. Long-acting injectable versus oral antipsychotics in schizophrenia: a systematic review and meta-analysis of mirror-image studies. J Clin Psychiatry. 2013;74(10):957–65.CrossRefGoogle Scholar
  40. 40.
    Barry MJ, Edgman-Levitan S. Shared decision making – pinnacle of patient-centered care. N Engl J Med. 2012;366(9):780–1.CrossRefGoogle Scholar
  41. 41.
    Elwyn G, Frosch D, Thomson R, Joseph-Williams N, Lloyd A, Kinnersley P, et al. Shared decision making: a model for clinical practice. J Gen Intern Med. 2012;27(10):1361–7.CrossRefGoogle Scholar
  42. 42.
    Briesacher BA, Gurwitz JH, Soumerai SB. Patients at-risk for cost-related medication nonadherence: a review of the literature. J Gen Intern Med. 2007;22(6):864–71.CrossRefGoogle Scholar
  43. 43.
    Madden JM, Graves AJ, Zhang F, Adams AS, Briesacher BA, Ross-Degnan D, et al. Cost-related medication nonadherence and spending on basic needs following implementation of Medicare Part D. JAMA. 2008;299(16):1922–8.CrossRefGoogle Scholar
  44. 44.
    Morrow DG, Leirer VO, Andrassy JM, Tanke ED, Stine-Morrow EA. Medication instruction design: younger and older adult schemas for taking medication. Hum Factors. 1996;38(4):556–73.CrossRefGoogle Scholar
  45. 45.
    Wong-Anuchit C, Chantamit OPC, Schneider JK, Mills AC. Motivational interviewing-based compliance/adherence therapy interventions to improve psychiatric symptoms of people with severe mental illness: meta-analysis. J Am Psychiatr Nurses Assoc. 2018. 1078390318761790.Google Scholar
  46. 46.
    Viswanathan M, Golin CE, Jones CD, Ashok M, Blalock SJ, Wines RC, et al. Interventions to improve adherence to self-administered medications for chronic diseases in the United States: a systematic review. Ann Intern Med. 2012;157(11):785–95.CrossRefGoogle Scholar
  47. 47.
    Bruce ML, Ten Have TR, Reynolds CF 3rd, Katz II, Schulberg HC, Mulsant BH, et al. Reducing suicidal ideation and depressive symptoms in depressed older primary care patients: a randomized controlled trial. JAMA. 2004;291(9):1081–91.CrossRefGoogle Scholar
  48. 48.
    Alexopoulos GS, Reynolds CF 3rd, Bruce ML, Katz IR, Raue PJ, Mulsant BH, et al. Reducing suicidal ideation and depression in older primary care patients: 24-month outcomes of the PROSPECT study. Am J Psychiatry. 2009;166(8):882–90.CrossRefGoogle Scholar
  49. 49.
    Smith GE, Lunde AM, Hathaway JC, Vickers KS. Telehealth home monitoring of solitary persons with mild dementia. Am J Alzheimers Dis Other Demen. 2007;22(1):20–6.CrossRefGoogle Scholar
  50. 50.
    Campbell NL, Boustani MA, Skopelja EN, Gao S, Unverzagt FW, Murray MD. Medication adherence in older adults with cognitive impairment: a systematic evidence-based review. Am J Geriatr Pharmacother. 2012;10(3):165–77.CrossRefGoogle Scholar
  51. 51.
    Insel KC, Cole L. Individualizing memory strategies to improve medication adherence. Appl Nurs Res. 2005;18(4):199–204.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Yun Freudenberg-Hua
    • 1
    • 2
    • 3
    Email author
  • Ryan Kaufman
    • 1
    • 4
  • Antonia Alafris
    • 1
    • 5
  • Sukriti Mittal
    • 1
    • 6
  • Neil Kremen
    • 1
    • 6
  • Erika Jakobson
    • 1
    • 6
  1. 1.Donald and Barbara Zucker School of Medicine at Hofstra/NorthwellHempsteadUSA
  2. 2.Center for Alzheimer’s Disease, Feinstein Institute for Medical ResearchManhassetUSA
  3. 3.Division of Geriatric PsychiatryZucker Hillside HospitalGlen OaksUSA
  4. 4.Psychiatry Residency Program, Zucker Hillside HospitalGlen OaksUSA
  5. 5.Pharmacy and Clinical Services (Behavioral Health), Zucker Hillside HospitalGlen OaksUSA
  6. 6.Division of Geriatric PsychiatryZucker Hillside HospitalGlen OaksUSA

Personalised recommendations