Improving medication adherence among community-dwelling seniors with cognitive impairment: a systematic review of interventions
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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.
KeywordsAdherence Alzheimer disease Cholinesterase inhibitors Cognitive impairment Community-dwelling seniors Systematic review
The authors wish to thank the research professionals who worked on this review, Ms Martine Marcotte and Ms Laura Finken, as well as a resident in geriatric medicine who participated in the article selection, Dr Pierre Molin. They also wish to thank Dr. André Tourigny from the CEVQ who was instrumental in initiating this research, and Ms Zorica Djordjevic, librarian at the Hôpital St-Sacrement du CHU de Québec, who contributed to the database search strategy.
Chair on adherence to treatments, Université Laval (EKröger) and from the Centre d’excellence sur le vieillissement de Québec (CEVQ) and the Réseau québécois de recherche sur le vieillissement du Fonds de recherche du Québec—santé (E Kröger)
Conflicts of interest
None of the authors have any conflict of interest to declare.
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