Interventions to Improve Medication Adherence Among Older Adults

Meta-Analysis of Adherence Outcomes Among Randomized Controlled Trials

Conn, Vicki S. PhD, RN, FAAN
Hafdahl, Adam R. PhD
Cooper, Pamela S. PhD
Ruppar, Todd M. PhD, APRN, BC
Mehr, David R. MD, MS
Russell, Cynthia L. PhD, RN

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

¹Address correspondence to Vicki S. Conn, PhD, RN, FAAN, S317 Sinclair School of Nursing, University of Missouri, Columbia, MO 65211. E-mail: [email protected]

Received March 20, 2008; Accepted July 21, 2008

Decision Editor: William J. McAuley, PhD

Gerontologist 49(4):p 447-462, August 2009.

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Meta-analysis was used to synthesize results of 33 published and unpublished randomized controlled trials.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.