Wearable devices for improving medication adherence in older adults with chronic conditions: A systematic review

Medication adherence remains a major public health challenge, especially among older adults managing multiple chronic conditions and complex therapeutic regimens. Poor adherence is linked to increased mortality, complications, hospital readmissions, higher healthcare costs, and reduced quality of life. Wearable devices (WDs), integrated into everyday accessories and equipped with sensors and reminder systems, may offer a practical strategy to support continuous monitoring and improve adherence. Given the still-limited evidence in this area, this review evaluates the impact of wearable devices on medication adherence among adults aged ≥ 65 years with at least one chronic condition, compared with usual care or other educational and technological interventions.

This systematic review was conducted in accordance with PRISMA 2020 guidelines and registered in PROSPERO (CRD420251045757). A comprehensive search was performed in PubMed, CINAHL, Cochrane Library, Ovid, and EBSCO. Eligible studies included quantitative intervention studies involving community-dwelling adults aged ≥ 65 years with at least one chronic condition. Risk of bias was assessed using RoB 2 and ROBINS-I tools.

A total of 1,094 records were identified, and nine studies met the inclusion criteria (seven randomized controlled trials, one quasi-experimental study, one crossover trial), with sample sizes ranging from 10 to 498 participants. WDs were classified into three categories: smartwatches (n = 4), wearable blood pressure (WBP) monitors (n = 4), and ECG monitors (n = 1). Seven of nine studies reported statistically significant improvements in medication adherence in the intervention groups compared with control conditions. Positive effects were observed in 3/4 smartwatch interventions and 3/4 WBP monitor interventions, whereas the ECG-based intervention showed no significant between-group differences.

Wearable devices may support medication adherence in older adults, particularly when integrated with reminder systems and healthcare professional involvement. These findings highlight the importance of embedding wearable technologies within digital health systems and technology-enabled care models for chronic disease management.