Background: Medication mismanagement is a continuous problem particularly in older
people. Numerous interventions have been developed and tested in an attempt to improve
adherence with medication in this client group.
Objectives: This review aimed to examine the simple to complex interventions that have
been used to assess and improve adherence with medication in older people.
Design: An extensive review of the literature was performed and 20 relevant research
papers and one report were chosen.
Findings: Research papers were evaluated according to design, RCTs were analysed
using the JADAD scoring system, systematic reviews and reviews of the literature were
reviewed using the Critical Appraisal Skills Programme and subjected to a narrative
analysis. This process assisted the development to emerging themes. Four themes were
developed: patient barriers, health professional involvement, and health related outcomes
and formation giving.
Conclusions: The salient findings of the review infer that there is no clear definition of
non–adherent behavior. Quantitative interventions fail to assess patient choice in relation
to medication taking. Pharmacist-driven interventions are resource intensive. Health care outcomes and clinical effectiveness are seldom addressed in interventions. Among the
many difficulties encountered when attempting to use interventions to promote adherence
with medication in older people is their perceptions and beliefs, the appropriateness of the
medicines prescribed as well as the impact of lifestyle patterns; smoking, alcohol and
diet. Many intervention studies are of poor quality and do not include a theoretical
framework to underpin the interventions being used. More focused research is needed to
improve understanding of the theoretical knowledge that underpins the complexities of
adherence with medication in older people. In-depth qualitative studies can be used to
develop such theory. In addition, the quality of intervention research can be improved by
the inclusion of a research framework such as the Medical Research Council model
