Improving Medication Adherence and Health Outcomes in Older Adults: An Evidence-Based Review of Randomized Controlled Trials

Abstract

Background Poor medication adherence is a major public health problem in older adults often resulting in negative health outcomes. Objective The objective of this review was to provide an updated summary of evidence from randomized controlled studies to determine whether interventions aimed at improving medication adherence also improve the health outcomes of older adults residing in community-based settings. Methods Articles that assessed medication adherence interventions and related health outcomes in elderly individuals were identified through searches of MEDLINE (1970–June 2016), the Cochrane Database of Systematic Reviews (through to June 2016), and Google Scholar. Across the 12 included studies, interventions were grouped into three main categories: behavioral/educational (n = 3), pharmacist-led (n = 7), and reminder/simplification (n = 2). Results Among the behavioral/educational intervention studies, two showed improvements in both adherence and related health outcomes, whereas one found no changes in adherence or health outcomes. Among the pharmacist-led studies, three showed improvements in both adherence and related health outcomes, while three reported no changes in adherence or health outcomes. One found an improvement in adherence but not health outcomes. Among the reminder/simplification studies, both studies reported improvements in adherence without a significant impact on related health outcomes. Conclusion This evidence-based review of medication adherence interventions in older adults revealed promising strategies in the larger context of a largely mixed body of literature. Future patient-centered and multidisciplinary interventions should be developed and tested using evidence-based principles to improve medication adherence and health outcomes in older adults.

Anticholinergic burden and dry mouth among Finnish, community‐dwelling older adults

“…There was, on average, a six‐month time interval between the collection of drug information and the clinical oral examinations, and this should be taken in to account when interpreting the results. Yet, it is not unreasonable to assume that the time interval had only a minor influence on the results because of its short duration and because medication for chronic diseases is relatively permanent . Another limitation related to drugs is the xerostomic effects that are unrelated to anticholinergicy.…”

“…Yet, it is not unreasonable to assume that the time interval had only a minor influence on the results because of its short duration and because medication for chronic diseases is relatively permanent. 36 Another limitation related to drugs is the xerostomic effects that are unrelated to anticholinergicy. Because the innervations of the salivary glands are complex and it is not clearly known how concomitant use of multiple drugs affects the salivary glands at the receptor-level, 1 it is difficult to distinguish the main pathways of the xerostomic effect.…”

Pharmacotherapy in Older Adults with Cardiovascular Disease: Report from an American College of Cardiology, American Geriatrics Society, and National Institute on Aging Workshop

“…44 In general, studies of adherence interventions in older adults have yielded mixed results, with some showing favorable effects on adherence rates and outcomes, some showing greater adherence rates with no effect on outcomes, and some showing no apparent benefit in adherence or outcomes. 45 Individuals with multiple chronic conditions are the least likely to show improvement despite multifaceted interventions. 41 In contrast, there is moderate-strength evidence that policy interventions that lower out-of-pocket expenses reduce but do not eliminate nonadherence to cardiovascular medications.…”

“…A recent nationwide randomized trial in individuals with myocardial infarction that incorporated electronic pill bottles, lottery incentives, and social support without direct involvement of physicians or pharmacists did not improve medication adherence or reduce cardio vascular readmissions or costs . In general, studies of adherence interventions in older adults have yielded mixed results, with some showing favorable effects on adherence rates and outcomes, some showing greater adherence rates with no effect on outcomes, and some showing no apparent benefit in adherence or outcomes . Individuals with multiple chronic conditions are the least likely to show improvement despite multifaceted interventions .…”

Educational intervention on medication reviews aiming to reduce acute healthcare consumption in elderly patients with potentially inappropriate medicines—A pragmatic open‐label cluster‐randomized controlled trial in primary care

“…General practitioners (GPs) feel overwhelmed by the management of polypharmacy in their elderly patients, emphasizing the need for education on PIMs. Some of the evidence‐based educational strategies that successfully improve professional practice and prescribing patterns are educational outreach visits and feedback on performance . Health care data from electronic medical records may be collected with relative ease and have previously been used both to create feedback on prescribing to physicians and in interventions targeting primary health care practices (hereafter called practices) .…”