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The Gerontologist Advance Access originally published online on May 21, 2009
The Gerontologist 2009 49(4):447-462; doi:10.1093/geront/gnp037
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© The Author 2009. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org.

Interventions to Improve Medication Adherence Among Older Adults: Meta-Analysis of Adherence Outcomes Among Randomized Controlled Trials

Vicki S. Conn, PhD, RN, FAAN1,2, Adam R. Hafdahl, PhD3, Pamela S. Cooper, PhD2, Todd M. Ruppar, PhD, APRN, BC2, David R. Mehr, MD, MS4 and Cynthia L. Russell, PhD, RN2

2 Sinclair School of Nursing, University of Missouri, Columbia
3 Department of Mathematics, Washington University, St. Louis, Missouri
4 Department of Family and Community Medicine, School of Medicine, University of Missouri, Columbia

1 Address correspondence to Vicki S. Conn, PhD, RN, FAAN, S317 Sinclair School of Nursing, University of Missouri, Columbia, MO 65211. E-mail: conn{at}missouri.edu


  Abstract

Purpose: This study investigated the effectiveness of interventions to improve medication adherence (MA) in older adults. Design and Methods: Meta-analysis was used to synthesize results of 33 published and unpublished randomized controlled trials. Random-effects models were used to estimate overall mean effect sizes (ESs) for MA, knowledge, health outcomes, and health services utilization. Results: Data were synthesized across 11,827 participants. Interventions significantly improved MA (ES = 0.33), knowledge (ES = 0.48), and diastolic blood pressure (ES = 0.19). Nonsignificant effects were found for systolic blood pressure (ES = 0.21), other health outcomes (ES = 0.04), and health services utilization (ES = 0.16). Moderator analyses showed larger adherence ESs for interventions employing special medication packaging, dose modification, participant monitoring of medication effects and side effects, succinct written instructions, and standardized (not tailored) interventions. Larger effects were found when a moderate proportion of participants were women, for participants taking 3–5 medications, and when pill count adherence was measured. Implications: The findings document that interventions increase MA in older adults. The considerable heterogeneity in the magnitude of effects across studies and results of the moderator analyses demonstrate the need for additional empirical research to optimize interventions.

Keywords: Medication adherence, Patient compliance, Meta-analysis, ,

Received March 20, 2008; Accepted July 21, 2008

Decision Editor: William J. McAuley, PhD


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