Approaches to enhance medication adherence among older people
An umbrella review
DOI:
https://doi.org/10.14528/snr.2026.60.3.3255Keywords:
older people, medication, chronic disease, interventionsAbstract
Introduction: Increased life expectancy has led to a higher prevalence of chronic diseases that require long-term treatment and sustained medication adherence. As medication non-adherence represents a major challenge in health care and society at large, the aim of this literature review was to identify effective approaches that promote medication adherence in older people.
Methods: Following PRISMA guidelines, we conducted an umbrella literature review in March 2023. The literature search was performed in the PubMed, CINAHL Ultimate, Cochrane Library, ScienceDirect and Web of Science databases. We used the Joanna Briggs Institute assessment tool to assess the quality of the included articles.
Results: Of the 242 records retrieved, seven articles were included in the content analysis, synthesis and compilation. Four subcategories contributing to medication adherence in older people were identified: 1) health education for older people; 2) medication monitoring; 3) use of medication dispensers; and 4) instruments for assessing medication adherence.
Discussion and conclusion: The analysis revealed several approaches to improving medication adherence in older people. Key approaches include health education, medication monitoring, dispensers, and instruments for assessing medication adherence. These approaches offer valuable insights into improving older people’s health status and quality of life.
Downloads
References
Al Bawab, A. Q., Al-Qerem, W., Abusara, O., Alkhatib, N., Mansour, M., & Horne, R. (2021). What are the factors associated with nonadherence to medications in patients with chronic diseases? Healthcare, 9(9), Article 1237. https://doi.org/10.3390/healthcare9091237 PMid:34575011; PMCid
Alnijadi, A. A., Yuan, J., Wu, J., Li, M., & Lu, Z. K. (2021). Cost-Related Medication Nonadherence (CRN) on healthcare utilization and patient-reported outcomes: Considerations in managing medicare beneficiaries on antidepressants. Frontiers in Pharmacology, 12, Article 764697. https://doi.org/10.3389/fphar.2021.764697 PMid:34950029; PMCid
Anderson, L. J., Nuckols, T. K., Coles, C., Le, M. M., Schnipper, J. L., Shane, R., Jackevicius, C., Lee, L., Pevnick, Members of the PHARM-DC Group (2020). A systematic overview of systematic reviews evaluating medication adherence interventions. American Journal of Health-System Pharmacy, 77(2), 138–147. https://doi.org/10.1093/ajhp/zxz284 PMid:31901098; PMCid
Bertolazzi, A., Quaglia, V., & Bongelli, R. (2024). Barriers and facilitators to health technology adoption by older adults with chronic diseases: An integrative systematic review. BMC Public Health, 24(1), Article 506. https://doi.org/10.1186/s12889-024-18036-5 PMid:38365698; PMCid
Campbell, N. L., Boustani, M. A., Skopelja, E. N., Gao, S., Unverzagt, F. W., & Murray, M. D. (2012). Medication adherence in older adults with cognitive impairment: A systematic evidence-based review. American Journal of Geriatric Pharmacotherapy, 10(3), 165–177. https://doi.org/10.1016/j.amjopharm.2012.04.004 PMid:22657941
Chew, S. M., Lee, J. H., Lim, S. F., Liew, M. J., Xu, Y., & Towle, R. M. (2021). Prevalence and predictors of medication nonadherence among older community-dwelling people with chronic disease in Singapore. Journal of Advanced Nursing, 77(10), 4069–4080. https://doi.org/10.1111/jan.14913 PMid:34061364
Costa, E., Giardini, A., Savin, M., Menditto, E., Lehane, E., Laosa, O., Pecorelli, S, Monaco, A., & Marengoni, A. (2015). Interventional tools to improve medication adherence: Review of literature. Patient Preference and Adherence, 9, 1303–1314. https://doi.org/10.2147/PPA.S87551 PMid:26396502; PMCid
Cross, A. J., Elliott, R. A., Petrie, K., Kuruvilla, L., & George, J. (2020). Interventions for improving medication-taking ability and adherence in older adults prescribed multiple medications. Cochrane Database of Systematic Reviews, 5(5), Article Cd012419. https://doi.org/10.1002/14651858.CD012419.pub2 PMid:32383493; PMCid
Elo, S., & Kyngäs, H. (2008). The qualitative content analysis process. Journal of Advanced Nursing, 62(1), 107–115. https://doi.org/10.1111/j.1365-2648.2007.04569.x PMid:18352969
Félix, I. B., & Henriques, A. (2021). Medication adherence and related determinants in older people with multimorbidity: A cross-sectional study. Nursing Forum, 56, 834–843 https://doi.org/10.1111/nuf.12619 PMid:34076260
Ferdinand, K. C., Senatore, F. F., Clayton-Jeter, H., Cryer, D. R., Lewin, J. C., Nasser, S. A., Fiuzat, M., & Califf, R. M. (2017). Improving medication adherence in cardiometabolic disease: Practical and regulatory implications. Journal of the American College of Cardiology, 69(4), 437–451. https://doi.org/10.1016/j.jacc.2016.11.034 PMid:28126162; PMCid
Foley, L., Larkin, J., Lombard-Vance, R., Murphy, A.W., Hynes, L., Galvin, E., & Molloy, G. J. (2021). Prevalence and predictors of medication non-adherence among people living with multimorbidity: A systematic review and meta-analysis. BMJ Open, 11, Article e044987. https://doi.org/10.1136/bmjopen-2020-044987 PMid:34475141; PMCid
Holbrook, A. M., Wang, M., Lee, M., Chen, Z., Garcia, M., Nguyen, L., Ford, A., Manji, S., & Law, M. R. (2021). Cost-related medication nonadherence in Canada: A systematic review of prevalence, predictors, and clinical impact. Systematic Reviews, 10(1), 1–13. https://doi.org/10.1186/s13643-020-01558-5 PMid:33407875; PMCid
Hyvert, S., Yailian, AL., Haesebaert, J., Emmanuelle, V., Chapurlat, R., Dussart, C., De Freminville, H., & Janoly-Dumenil, A. (2023). Association between health literacy and medication adherence in chronic diseases: A recent systematic review. International Journal of Clinical Pharmacy, 45, 38–51. https://doi.org/10.1007/s11096-022-01470-z PMid:36369411
Jetha, S. (2015). Polypharmacy, the elderly, and deprescribing. The Consultant Pharmacist, 30(9), 527–532. https://doi.org/10.4140/TCP.n.2015.527 PMid:26350893
Kaveh, M. H., Kaveh, S., & Faradonbeh, M. R. (2023). Mobile health-based interventions in self-care and treatment adherence in older people: A review study. International Journal, 1, Article e6. https://doi.org/10.34172/ija.2023.e6
Kim, J., & Parish, A. L. (2017). Polypharmacy and medication management in older adults. Nursing Clinics of North America, 52(3), 457–468. https://doi.org/10.1016/j.cnur.2017.04.007 PMid:28779826
Kleiven, H. H., Ljunggren, B., & Solbjør, M. (2020). Health professionals’ experiences with the implementation of a digital medication dispenser in home care services: A qualitative study. BMC Health Services Research, 20, Article 320. https://doi.org/10.1186/s12913-020-05191-9 PMid:32299431; PMCid
Krause, O., Picksak, G., & Junius-Walker, U. (2017). Polypharmazie: Lösungswege für eine verbesserte Arzneimitteltherapiesicherheit. Deutsche Medizinische Wochenschrift, 142, 1046–1053. https://doi.org/10.1055/s-0043-100125 PMid:28728199
Li, Y., Schoufour, J., Wang, D. D., Dhana, K., Pan, A., Liu, X., Song, M., Liu, G., Shin, H. J., Sun, Q., Al-Shaar, L., Wang, M., Rimm, E. B., Hertzmark, E., Stampfer, M. J., Willett, W. C., Franco, O. H., & Hu, F. B. (2020). Healthy lifestyle and life expectancy free of cancer, cardiovascular disease, and type 2 diabetes: Prospective cohort study. BMJ, 368, Article l6669. https://doi.org/10.1136/bmj.l6669
Macrotrends (2024, February 24). Slovenia Life Expectancy 1950–2024. Macrotrends. https://www.macrotrends.net/global-metrics/countries/SVN/slovenia/life-expectancy
McGrattan, M., Ryan, C., Barry, H. E., & Hughes, C. M. (2017). Interventions to improve medicines management for people with dementia: A systematic review. Drugs and Aging, 34(12), 907–916. https://doi.org/10.1007/s40266-017-0505-3 PMid:29177770
Moßhammer, D., Haumann, H., Mörike, K., & Joos, S. (2016). Polypharmazie: Tendenz steigend, folgen schwer kalkulierbar. Deutsches Arzteblatt international, 113, 627–633. https://doi.org/10.3238/arztebl.2016.0627 PMid:27743469; PMCid
Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., … Moher, D. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ, 372, Article n71. https://doi.org/10.1136/bmj.n71
Pereira, F., Meyer-Massetti, C., del Río Carral, M., Von Gunten, A., Wernli, B., & Verloo, H. (2023). Development of a patientcentred medication management model for polymedicated home-dwelling older adults after hospital discharge: Results of a mixed methods study. BMJ open, 13(9), Article e072738. https://doi.org/10.1136/bmjopen-2023-072738 PMid:37730411; PMCid
Pietrzykowski, Ł., Michalski, P., Kosobucka, A., Kasprzak, M., Fabiszak, T., Stolarek, W., Siller-Matula, J. M., & Kubica, A. (2020). Medication adherence and its determinants in patients after myocardial infarction. Scientific Reports, 10, Article 12028. https://doi.org/10.1038/s41598-020-68915-1 PMid:32694522; PMCid
Polit, D. F., & Beck, T. C. (2021). Nursing research: Generating and assessing evidence for nursing practice (11th ed.). Wolters Kluwer.
Porritt, K., Gomersall, J., & Lockwood, C. (2014). JBI's Systematic reviews: Study selection and critical appraisal. American Journal of Nursing, 114(6), 47–52. https://doi.org/10.1097/01.NAJ.0000450430.97383.64 PMid:24869584
Schönfeld, M. S., Pfisterer-Heise, S., & Bergelt, C. (2021). Selfreported health literacy and medication adherence in older adults: A systematic review. BMJ Open, 11, Article e056307. https://doi.org/10.1136/bmjopen-2021-056307 PMid:34916329; PMCid
Scott, I. A., Hilmer, S. N., Reeve, E., Potter, K., Le Couteur, D., Rigby, D., Gnjidic, D., Del Mar, C. B., Roughead, E. E., Page, A., Jansen, J., & Martin, J. H. (2015). Reducing inappropriate polypharmacy: The process of deprescribing. JAMA Internal Medicine, 175(5), 827–834. https://doi.org/10.1001/jamainternmed.2015.0324 PMid:25798731
Tasai, S., Kumpat, N., Dilokthornsakul, P., Chaiyakunapruk, N., Saini, B., & Dhippayom, T. (2021). Impact of medication reviews delivered by community pharmacist to elderly patients on polypharmacy: A meta-analysis of randomized controlled trials. Journal of Patient Safety, 17(4), 290–298. https://doi.org/10.1097/PTS.0000000000000599 PMid:30920431
Teixeira, S. M. A., Coelho, J. C. F., Sequeira, C., Lluch, I. C. M. T., & Ferré-Grau, C. (2019). The effectiveness of positive mental health programs in adults: A systematic review. Health & Social Care in the Community, 27(5), 1126–1134. https://doi.org/10.1111/hsc.12776 PMid:31144395
Terp, R., Kayser, L., & Lindhardt, T. (2021). Older patients’ competence, preferences, and attitudes toward digital technology use: Explorative study. JMIR Human Factors, 8(2), Article e27005. https://doi.org/10.2196/27005 PMid:33988512; PMCid
Tomlinson, J., Cheong, V. L., Fylan, B., Silcock, J., Smith, H., Karban, K., & Blenkinsopp, A. (2020). Successful care transitions for older people: A systematic review and metaanalysis of the effects of interventions that support medication continuity. Age and ageing, 49(4), 558–569. https://doi.org/10.1093/ageing/afaa002 PMid:32043116; PMCid
Ulley, J., Harrop, D., Ali, A., Alton, S., & Fowler Davis, S. (2019). Deprescribing interventions and their impact on medication adherence in community-dwelling older adults with polypharmacy: A systematic review. BMC Geriatrics, 19(1), Article 15. https://doi.org/10.1186/s12877-019-1031-4 PMid:30658576; PMCid
Verloo, H., Chiolero, A., Kiszio, B., Kampel, T., & Santschi, V. (2017). Nurse interventions to improve medication adherence among discharged older adults: A systematic review. Age and Ageing, 46(5), 747–754. https://doi.org/10.1093/ageing/afx076 PMid:28510645
Wilson, T. E., Hennessy, E. A., Falzon, L., Boyd, R., Kronish, I. M., & Birk, J. L. (2020). Effectiveness of interventions targeting self-regulation to improve adherence to chronic disease medications: A meta-review of meta-analyses. Health Psychology Review, 14(1), 66–85. https://doi.org/10.1080/17437199.2019.1706615 PMid:31856664; PMCid
Yang, C., Zhu, S., Lee, D. T. F., & Chair, S. Y. (2022). Interventions for improving medication adherence in community-dwelling older people with multimorbidity: A systematic review and meta-analysis. International Journal of Nursing Studies, 126, Article 104154. https://doi.org/10.1016/j.ijnurstu.2021.104154 PMid:34953373
Zafari Nobari, S., Vasli, P., Hosseini, M., & Nasiri, M. (2021). Improving health-related quality of life and adherence to health-promoting behaviors among coronary artery bypass graft patients: A non-randomized controlled trial study. Quality of Life Research, 30, 769–780. https://doi.org/10.1007/s11136-020-02675-3 PMid:33064290
Zelko, E., Klemenc-Ketis, Z., & Tusek-Bunc, K. (2016). Medication adherence in elderly with polypharmacy living at home: A systematic review of existing studies. Materia Socio-Medica, 28(2), 129–132. https://doi.org/10.5455/msm.2016.28.129-132 PMid:27147920; PMCid
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Slovenian Nursing Review

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
As the author undersigned hereby, I transfer, assign, or otherwise convey the following authorship rights as comprised in the Copyright and Related Rights Act (CRRA) to the Slovenian Nursing Review, Ob železnici 30A, 1000 Ljubljana: the right of reproduction - the exclusive right to fix the work in a material medium or in another copy directly or indirectly, temporarily or permanently, by any means and in any digital form, in whole or in part (CRRA, Article 23); the right of distribution (CRRA, Article 24); the right of making a work available and accessible through the internet (CRRA, Article 32a); the right of transformation, especially the exclusive right to translate a pre-existing work (CRRA, Article 33). The transfer of author rights applies to the article in its entirety, including pictorial and/or graphic works and possible supplements. The transfer of rights is exclusive and unlimited in duration or territory.













