# Enhancing Medication Adherence in Older Adults: A Systematic Review of Evidence‐Based Strategies

## TL;DR

This paper reviews strategies to improve medication adherence in older adults, finding that most interventions help but are often short-lived and focus on single diseases.

## Contribution

The paper systematically reviews evidence-based interventions for medication adherence in older adults, highlighting gaps in long-term effectiveness and holistic approaches.

## Key findings

- Most interventions improved adherence but effectiveness was mainly short-term.
- Educational and technical components were common in interventions.
- Few studies adopted a systemic, patient-centered approach for multiple comorbidities.

## Abstract

Medication adherence is essential for achieving favorable health outcomes, particularly in older adults with multiple chronic conditions.

This systematic review critically appraised current evidence on interventions aimed at enhancing medication adherence in older adults.

Literature searches were performed in PubMed/MedLine, EMBASE, and Web of Science for articles published up to December 31, 2024. We identified peer‐reviewed studies assessing interventions to improve medication adherence in older adults (≥ 60 years). The primary outcome was intervention effectiveness; secondary outcomes were clinical parameters, disease control, health‐related quality of life, rehospitalization rates, event rates, mortality rates, feasibility, acceptability or satisfaction levels, and overall costs or cost‐effectiveness.

A total of 128 studies was included: 96 randomized controlled trials (RCTs), 16 pre–post studies, 9 non‐RCTs, and 7 longitudinal evaluations. The majority (51.2%) was implemented in primary care. An educational component was present in 56.3% of interventions, a technical component in 47.6%, and an attitudinal component in 32.0%. Only 3.2% of interventions included rewards. Various healthcare professionals, such as pharmacists, nurses, and physicians, were involved in delivering interventions. Most studies reported improved adherence, though some factors, such as high baseline adherence, insufficient intervention intensity, and brief follow‐up limited the effectiveness. Secondary outcomes often included improvements in disease knowledge, patient satisfaction, quality of life, and clinical indicators like blood pressure and HbA1c levels.

Despite most studies showed a positive impact on adherence, a high heterogeneity was highlighted, and effectiveness was mainly observed in the short term.

Key Points
○We conducted a systematic review to describe interventions aimed at improving medication adherence in older adults, and building on the diversity of approaches and settings identified in the literature, we sought to elucidate the strengths and limitations emerging from individual studies.○Most interventions had a positive impact on adherence, though effectiveness was often limited to short‐ or medium‐term.○Most studies prioritize individual diseases over adopting a systemic, patient‐centered strategy addressing multiple comorbidities, which represents a clear limitation for patients with multimorbidity and exposed to polypharmacy.
Why does this paper matter?
○Medication adherence is crucial for managing chronic conditions in older adults. This systematic review provides a comprehensive assessment of existing interventions, identifying key factors that contribute to their success and limitations.

Key Points
○We conducted a systematic review to describe interventions aimed at improving medication adherence in older adults, and building on the diversity of approaches and settings identified in the literature, we sought to elucidate the strengths and limitations emerging from individual studies.○Most interventions had a positive impact on adherence, though effectiveness was often limited to short‐ or medium‐term.○Most studies prioritize individual diseases over adopting a systemic, patient‐centered strategy addressing multiple comorbidities, which represents a clear limitation for patients with multimorbidity and exposed to polypharmacy.

We conducted a systematic review to describe interventions aimed at improving medication adherence in older adults, and building on the diversity of approaches and settings identified in the literature, we sought to elucidate the strengths and limitations emerging from individual studies.

Most interventions had a positive impact on adherence, though effectiveness was often limited to short‐ or medium‐term.

Most studies prioritize individual diseases over adopting a systemic, patient‐centered strategy addressing multiple comorbidities, which represents a clear limitation for patients with multimorbidity and exposed to polypharmacy.

Why does this paper matter?
○Medication adherence is crucial for managing chronic conditions in older adults. This systematic review provides a comprehensive assessment of existing interventions, identifying key factors that contribute to their success and limitations.

Medication adherence is crucial for managing chronic conditions in older adults. This systematic review provides a comprehensive assessment of existing interventions, identifying key factors that contribute to their success and limitations.

Designing and implementing an intervention aimed at improving adherence in older subjects.