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Interventions to Improve Medication Compliance in Older Patients Living in the Community

A Systematic Review of the Literature

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Abstract

Noncompliance affects all age groups, but older patients have specific barriers against effective medication use and can be more vulnerable to the incorrect use of medication. Some age-related barriers are vision loss and cognitive impairment. In people aged 60 years or older, noncompliance with medication regimens varies from 26–59%.

In this article we review randomised controlled trials (RCTs) on interventions aimed to improve compliance with medication regimens in older patients living in the community. It is known from other reviews that multifaceted interventions, a combination of interventions, are more often effective than single-focus interventions, probably because these address a wider range of barriers. Also, an individual approach with specifically tailored interventions is effective at improving compliance. In this review the following two hypotheses are evaluated: i) multifaceted interventions improve compliance more successfully than single interventions; and ii) interventions that are tailored to patients improve compliance more successfully than generalised interventions. A systematic literature search in four databases produced 14 suitable RCTs with 23 interventions that we categorised as single or multifaceted, and generalised or tailored.

Differences in medication compliance between the intervention group and the control group were in less than half of the comparisons in favour of the intervention group. Telephone-linked reminder systems achieved the most striking effect, looking at differences between the intervention and control group, and deserve further attention. Overall, multifaceted interventions and tailored interventions seemed to result more often in differences in compliance rates in older adults in favour of the intervention group compared with a control group than single and generalised interventions.

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Acknowledgements

This research was supported by Zorg Onderzoek Nederland. The authors would like to thank T. Lagro, M. Olde Rikkert, M. Smolders, M. Vernooy and G. Zielhuis for their contributions to this review. The authors have no conflicts of interest directly relevant to the content of this review.

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Authors and Affiliations

  1. Centre for Quality of Care Research, University Medical Centre Nijmegen, Nijmegen, The Netherlands

    Monique van Eijken, Sui Tsang, Michel Wensing & Richard P. T. M. Grol

  2. Scientific Institute of Dutch Pharmacists, The Hague, The Netherlands

    Peter A. G. M. de Smet

  3. Department of Clinical Pharmacy, University Medical Centre Nijmegen, Nijmegen, The Netherlands

    Peter A. G. M. de Smet

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  1. Monique van Eijken
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  2. Sui Tsang
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Correspondence to Monique van Eijken.

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van Eijken, M., Tsang, S., Wensing, M. et al. Interventions to Improve Medication Compliance in Older Patients Living in the Community. Drugs Aging 20, 229–240 (2003). https://doi.org/10.2165/00002512-200320030-00006

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