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

OBJECTIVE: 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. METHODS: 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. 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. CONCLUSIONS: 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.