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Interventions to improve adherence in older people

Clinical bottom line

There is no consistent evidence that any method improved adherence to medicines or medication regimens in older people.


Background

At least half of people do not take medicines as prescribed. Older people are more likely to have chronic conditions that require medication, and are likely to have more, and more complicated, medication regimens. Interventions that would help them to take medicines as prescribed would be beneficial, particularly as increasing age and medicine numbers increases the chance of adverse events.

Reference

N Higgins, C Regan. A systematic review of the effectiveness of interventions to help older people adhere to medication regimes. Age and Ageing 2004 33: 224-229.


Systematic review

Six electronic databases were used to find papers, plus bibliographies and reviews, and experts were contacted for additional material. Inclusion criteria were controlled studies published in English, examining adherence to medicines in people aged 65 or more, up to 2002.

Results

Seven studies were found, of which five were randomised and two were blind. Only one defined what it mean by adherence, and none gave an intention to treat analysis. The setting was hospital patients in six studies (inpatients in five, outpatients in one), and general practice in another. Pharmacy (five trials) and nursing (two) were the disciplines involved, and duration was one to six months.

Two of the randomised and one of the non-randomised trials claimed statistical improvements in adherence, but the size of the effect was not great.

Comment

These studies were of no great quality, so were liable to bias. There were few of them, and the effects they found were limited or non-existent. None looked at outcomes.