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Strategies to Improve Medication Adherence in Older Persons: Consensus Statement from the Senior Italia Federanziani Advisory Board

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Abstract

Poor adherence to treatment regimens has long been recognized as a substantial roadblock to achieving better outcomes for patients. Non-adherence to medications affects the quality and length of life and has been associated with negative health outcomes and increasing healthcare costs. The problem of non-adherence is particularly troublesome in older patients who are affected by multiple chronic diseases and for this reason receive multiple treatments. To date, no single intervention strategy has been shown to be effective in improving adherence across all patients, conditions, and settings. Between September and October 2014, a group of experts in geriatrics, pharmacology, epidemiology, and public health applied a modified RAND appropriateness method to reach a consensus on the possible best interventions to improve adherence in older individuals. Seven interventions were identified, classified based on their target (patient, therapy, and public health/society): (1) Comprehensive Geriatric Assessment, (2) patient (and caregiver) education to improve patient empowerment, (3) optimization of treatment, (4) use of adherence aids, (5) physician and other healthcare professionals’ education, (6) adherence assessment, (7) facilitating access to medicine by service integration. For each intervention, experts assessed (a) target population, (b) health professionals potentially involved in the intervention, (c) strategies/instruments needed for implementation, and (d) time of the intervention. Interventions that target adherence must combine different approaches targeting the complex aspects of older adults in a holistic approach. Tackling non-adherence, with its complexity, requires a multi-stakeholder patient-centred approach acting in a defined framework of interactions in which the different players may provide different services but are integrated with one another.

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Author information

Authors and Affiliations

  1. Department of Clinical and Experimental Sciences, University of Brescia, Viale Europa 11, 25123, Brescia, Italy

    Alessandra Marengoni

  2. Italian Medicines Agency, Rome, Italy

    Alessandro Monaco

  3. UCIBIO, REQUIMTE and Faculty of Pharmacy, University of Porto, Porto, Portugal

    Elisio Costa

  4. Geriatrics and Geriatric Emergency Care, IRCCS-INRCA, Ancona, Italy

    Antonio Cherubini

  5. IIS Aragón, Aragon Health Sciences Institute (IACS), Zaragoza, Spain

    Alexandra Prados-Torres

  6. Institute of General Practice, Johann Wolfgang Goethe University, Frankfurt, Germany

    Christiane Muth

  7. Department of Geriatric Medicine/Radboud Alzheimer Centre, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands

    Renè J. F. Melis

  8. Laboratory for Quality Assessment of Geriatric Therapies and Services, Department of Neuroscience, IRCCS-Istituto di Ricerche Farmacologiche “Mario Negri”, Milan, Italy

    Luca Pasina

  9. Section of Geriatric Medicine, Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands

    Tischa J. M. van der Cammen

  10. Faculty of Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands

    Tischa J. M. van der Cammen

  11. San Camillo IRCCS, Venice, Italy

    Katie Palmer

  12. University of Brescia, Brescia, Italy

    Sergio Pecorelli

  13. Department of Geriatrics, Centro Medicina dell’Invecchiamento, Università Cattolica del Sacro Cuore, Rome, Italy

    Graziano Onder

Authors
  1. Alessandra Marengoni
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  2. Alessandro Monaco
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  3. Elisio Costa
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  4. Antonio Cherubini
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  5. Alexandra Prados-Torres
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  6. Christiane Muth
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  7. Renè J. F. Melis
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  8. Luca Pasina
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  9. Tischa J. M. van der Cammen
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  10. Katie Palmer
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  11. Sergio Pecorelli
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  12. Graziano Onder
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Corresponding author

Correspondence to Alessandra Marengoni.

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Funding

Senior Italia Federanziani sponsored the meeting of the experts. The funder had no role in study design, data collection, decision to publish, or preparation of the manuscript.

Conflict of interest

Alessandra Marengoni, Alessandro Monaco, Elisio Costa, Antonio Cherubini, Alexandra Prados-Torres, Christiane Muth, Renè J.F. Melis, Luca Pasina, Tischa J.M. van der Cammen, Katie Palmer, Sergio Pecorelli, and Graziano Onder declare they have no conflicts of interest relevant to the content of this article.

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Marengoni, A., Monaco, A., Costa, E. et al. Strategies to Improve Medication Adherence in Older Persons: Consensus Statement from the Senior Italia Federanziani Advisory Board. Drugs Aging 33, 629–637 (2016). https://doi.org/10.1007/s40266-016-0387-9

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  • DOI: https://doi.org/10.1007/s40266-016-0387-9

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