Approaches to Enhance Medication Adherence in Older People With Cognitive Impairment: A Systematic Review

Older people with cognitive impairment face challenges in adhering to medication regimes, resulting in a risk of adverse events. The aim of this systematic review was to determine the effectiveness of interventions to increase medication adherence in older people with cognitive impairment.

MEDLINE, CINAHL and PsycInfo databases were searched in December 2024. The protocol was registered using Open Science Framework (https://doi.org/10.17605). Inclusion criteria were randomised, controlled trials involving community-dwelling older adults with cognitive impairment testing an intervention, which aimed to improve medication adherence. Exclusion criteria were articles written in a language other than English. Risk of bias was assessed using the Cochrane Risk of Bias Tool. Meta-analysis was not undertaken due to clinical heterogeneity, and therefore, narrative analysis was used to synthesise results.

Seven studies with 350 participants were included. Sample sizes of the included studies were relatively small, ranging from 16 to 101 participants, and the average age of participants was mid-70 years. Level of cognitive impairment varied but most studies focused on those with mild impairment. Intervention types were reminder systems (n = 3), educational interventions (n = 3) and health professional supported behaviour change interventions (n = 2). One study was a three-armed trial, including two intervention types.

All intervention types reported positive outcomes, but most were not statistically significant. Reminder systems appeared to show the most promise of the intervention types. Further high-quality studies with larger sample sizes, including commonly used medication administration aids and approaches are recommended.