Systematic review of the barriers affecting medication adherence in older adults
Abstract
Medication adherence is a crucial part in the management of chronic diseases. As older adults form a greater proportion of the population with chronic diseases and multiple morbidities, understanding medication adherence in older adults becomes important. In the present article, we aimed to systematically review the literature for the factors associated with medication adherence in the geriatric population. We carried out a literature search using electronic databases and related keywords. 17 391 articles were reviewed in total. 65 articles were found to be relevant to our objective. A total of 80 factors of five different categories were found to be associated with medication adherence in older adults. The factors, the types of studies and the number of studies that agreed or disagreed were presented. A flower model for medication adherence was also presented to allow clinicians to better understand the complex nature of medication adherence in this population. The 80 factors reviewed were categorized into five main categories; namely, patient factors, medication factors, physician factors, system-based factors and other factors as factors affecting poor medication adherence in older adults. Clinicians need to be mindful of the complex nature of factors affecting medication adherence in this population to optimize therapeutic outcomes. Clinicians have to be more skillful to discover and to optimize the medication adherence factors in geriatric patients. The flower model is p…
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Medication adherence is influenced by numerous factors, including patient characteristics, medication-related issues, physician practices, and system-based factors.
“This highlights the complex nature of medication adherence, which is influenced by numerous factors, including patient characteristics, medication-related issues, physician practices, and system-based factors.58”
From Interventions to improve adherence to lipid-lowering drugs: a systematic review and meta-analysis (2025) · cites this paper as [58]
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“P a ti e n t s ’ und e r s t a nd i ng o f t h e c on ce p t i n c r ea s e s a dh e r e n ce [ 32 , 33 ] E xp l a i n t h e d e fi n iti on o f a n a tt ac k : it s hou l d h a v e a c l ea r b e g i nn i ng a nd e nd O n l y a tt ac k s s hou l d b e r ec o r d e d E xp l a i n t h a t t h e v e…”
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“Medication adherence depends on several socioeconomic, access to care, clinical, and health system factors.(12,13) One of the health system factors may be the type of pharmacy used by patients to refill their prescriptions.”
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“19 The more medications a patient is prescribed, the higher the risk of non-adherence to their treatment regimen.”
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“Given that Yap et al [11] identified 80 different factors shown to influence nonadherence, it seems clear that this problem is complex and multifactorial.”
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“…such as age, employment status, socioeconomic conditions, culture, educational level, geographic area, and race [14, 15]; social and familial support [16]; disease characteristics; therapeutic regimen; and healthcare system conditions, including healthcare professional characteristics [17, 18].”
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“There are many factors associated with non-adherence, one review of systematic reviews found a total of 80 factors in older individuals.(4) Another study found that primary non-adherence, defined as failure to fill one or more new prescriptions within one month of hospital discharge, has been found associated with hav…”
BackgroundLee, S.-M., Jeong, K., Lee, S., & Park, H. (2022) · Healthcare · doi:10.3390/healthcare10112322 · Cited by 9 · see citing works
“The impact of medication adherence on older adults is multifaceted, but in particular, medication factors are known to have a decisive impact on medication adherence in a variety of ways [18].”
BackgroundSanthagunam, S. N., Li, E., Buschert, K., & Davis, J. C. (2021) · Applied Nursing Research · doi:10.1016/j.apnr.2021.151493 · Cited by 9 · see citing works
Hong, S.-H., Kang, H.-R., Nam, J. H., Park, S.-K., Kim, T.-B., & Lee, E. (2019) · Journal of Allergy and Clinical Immunology: In Practice · doi:10.1016/j.jaip.2019.05.006 · Cited by 9
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Determinants of medication adherence among elderly with high blood pressure living in deprived areas
Afshari, M., Karimi-Shahanjarini, A., Tapak, L., & Hashemi, S. (2024) · Chronic Illness · doi:10.1177/17423953241241803 · Cited by 8 · see citing works
“Other studies have 15,51 The discrepancy may be attributed to demographic and cultural differences between these studies.”
Considerations for long-acting antiretroviral therapy in older persons with HIV
O'Shea, J. G., Cholli, P. A., Heil, E. L., & Buchacz, K. (2023) · AIDS (London) · doi:10.1097/qad.0000000000003704 · Cited by 8 · see citing works
Besel, J., Insel, K. C., & Williams, G. C. (2023) · Journal of Cardiovascular Nursing · doi:10.1097/jcn.0000000000001052 · Cited by 8 · see citing works
Self-Reported Medication Adherence Among Older People Admitted to Hospital: A Descriptive Study
Irshaidat, S., Gustafsson, M., & Norberg, H. (2023) · Drugs - Real World Outcomes · doi:10.1007/s40801-023-00352-8 · Cited by 8 · see citing works
“Because previous literature has shown that poor medication adherence is prevalent among the growing population of older people, it is important to learn more about the underlying factors affecting adherence in order to optimize the management of chronic diseases [10].”
BackgroundData on medication adherence in adults with neurological disorders: The NeuroGerAd study
Prell, T., Schönenberg, A., Mendorf, S., Mühlhammer, H. M., Grosskreutz, J., & Teschner, U. (2022) · Scientific Data · doi:10.1038/s41597-022-01847-9 · Cited by 8 · see citing works
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Hedna, K., Fastbom, J., Jonson, M., Wilhelmson, K., & Wærn, M. (2022) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.5684 · Cited by 10 · see citing works
“Further, LTCF offer many factors promoting medication adherence.(49) Another consideration is that our regression analyses conducted in men and women should be interpreted with caution due to the low number of suicides in women and therefore low power.”
BackgroundSchönenberg, A., & Prell, T. (2021) · Healthcare · doi:10.3390/healthcare9121752 · Cited by 8
“Polypharmac is lso associated with increased age, depression, memory loss, and poor physical functioning [40] and it can be regarded as an in icator of general poorer health [14,41].”
BackgroundResultInfluentialZhao, C. F., Batio, S., Lovett, R. M., Pack, A. P., Wolf, M., & Bailey, S. (2021) · Patient Preference and Adherence · doi:10.2147/ppa.s310613 · Cited by 8
Aplicaciones móviles para mejorar la adherencia a la medicación: revisión y análisis de calidad
de León, B. G., Salas, B. L., del Pino-Sedeño, T., Rodríguez-Álvarez, C., Bejarano-Quisoboni, D., & Trujillo-Martín, M. (2021) · Atención Primaria · doi:10.1016/j.aprim.2021.102095 · Cited by 8 · see citing works
Older Peoples’ Adherence and Awareness of Changes in Drug Therapy after Discharge from Hospital
Norberg, S., & Gustafsson, M. (2018) · Pharmacy · doi:10.3390/pharmacy6020038 · Cited by 8 · see citing works
“Previous studies have shown that there are several factors that might affect patient adherence, for example, old age, female sex, civil status, and multiple drugs [4].”
BackgroundMcLoughlin, A., Bennett, K., & Cahir, C. (2019) · Annals of Behavioral Medicine · doi:10.1093/abm/kaz004 · Cited by 7 · see citing works
Liquori, G., Dionisi, S., Giannetta, N., di Simone, E., Leo, A. D., Panattoni, N., Ricciardi, F., Grieco, A., Orsi, G. B., & Muzio, M. D. (2023) · European Review for Medical and Pharmacological Sciences · doi:10.26355/eurrev_202310_33951 · Cited by 7
“Yap et al 18 , considering the adverse health events of the elderly nonadherent to therapy, conducted a major study to identify and classify factors influencing adherence and proposed a flower model to facilitate the understanding of the complex nature of adherence and to optimize treatment…”
BackgroundInfluentialDonhauser, F. J., Zimmermann, M., Steinkirchner, A. B., Wiegrebe, S., Dietl, A., Brandl, C., Burkhardt, R., Gessner, A., Schweda, F., Bergler, T., et al. (2023) · Journal of Clinical Medicine · doi:10.3390/jcm12062102 · Cited by 7 · see citing works
“This is related to challenges in conducting population-based studies in the elderly [24].”
BackgroundSollazzo, F., Nitto, M. D., Rosito, L., Torino, F., Alvaro, R., Lacarbonara, F., Vellone, E., & Durante, Á. (2023) · European Journal of Oncology Nursing · doi:10.1016/j.ejon.2023.102327 · Cited by 7 · see citing works
Majd, Z., Mohan, A., Johnson, M. L., Essien, E., Barner, J., Serna, O., Gallardo, E., Fleming, M., Ordonez, N., Holstad, M., et al. (2022) · Patient Preference and Adherence · doi:10.2147/ppa.s360461 · Cited by 7 · see citing works
Cossart, A., Staatz, C., Isbel, N., Campbell, S., & Cottrell, W. (2022) · Drugs & Aging · doi:10.1007/s40266-022-00975-6 · Cited by 7 · see citing works
“Although older adult patients who receive a transplant are considered to be ‘robust’, barriers to medication taking are likely to be compounded by advancing age [10, 11].”
BackgroundMedication Management, Mild Cognitive Impairment and Occupational Therapy: A Scoping Review
Allen, D., Jaffe, L., & Pfleghaar, A. (2022) · Physical & Occupational Therapy In Geriatrics · doi:10.1080/02703181.2022.2079800 · Cited by 7 · see citing works
Vatcharavongvan, P., & Puttawanchai, V. (2022) · Pharmacy in practice · doi:10.18549/pharmpract.2022.1.2600 · Cited by 7 · see citing works
Molist-Brunet, N., Sevilla-Sánchez, D., Puigoriol-Juvanteny, E., Espaulella-Ferrer, M., Amblàs-Novellas, J., & Espaulella-Panicot, J. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph182111310 · Cited by 7 · see citing works
“Additionally, it is essential to remark that polypharmacy is also a risk factor for inappropriate pharmacological treatment adherence [15].”
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Alcântara, L., Figueiredo, T., & Costa, E. (2025) · Patient Preference and Adherence · doi:10.2147/ppa.s496707 · Cited by 6 · see citing works
Usability of an automated medication dispensation device and adherence dashboard: A study protocol
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Efficacy and Safety of Fixed-Dose Combinations for Pain in Older Adults
Zhang, Q., Chan, D., & Ho, K. (2024) · Drugs & Aging · doi:10.1007/s40266-024-01156-3 · Cited by 6 · see citing works
“Polypharmacy and complex dosing regimen were also found to be among the most important factors affecting medication adherence [22].”
Alomar, A. O., Khushaim, R. H., Al-Ghanem, S. K., Jumaiah, A. T. B., Albaqami, S. M., Alleft, L., & Abahussain, E. A. (2024) · Cureus · doi:10.7759/cureus.69418 · Cited by 6 · see citing works
- Authors
- Yap, A. F., Thirumoorthy, T., & Kwan, Y. H.
- Affiliations
- Duke-NUS Medical School (SG)
- Corresponding author
- Kwan, Yu Heng
- ORCID
- Kwan, Yu Heng
- Venue
- Geriatrics & Gerontology International
- Publisher
- Wiley
- Published
- 2015-10-20
- Volume
- 16
- Issue
- 10
- Pages
- 1093-1101
- ISSN
- 1444-1586 (ISSN-L)
- 1447-0594
- OpenAlex
- W2116716283
- Cited by
- 308
- References
- 0
- Citations by year
- 2026: 20 · 2025: 25 · 2024: 35 · 2023: 40 · 2022: 63 · 2021: 41 · 2020: 24 · 2019: 22 · 2018: 23 · 2017: 11 · 2016: 3 · 2013: 1
- FWCI
- 2.05
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Geriatrics and gerontology international/Geriatrics & gerontology international (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmacology › Pharmacy and Medical Practices
- Keywords
- medication adherence, older adults, barriers to adherence, chronic disease management, patient factors, physician characteristics, elderly patients
- MeSH terms
- Aged, Aged, 80 and over, Chronic Disease, Cognition Disorders, Dementia, Humans, Socioeconomic Factors, Geriatric Assessment, Incidence, Drug Monitoring, Risk Assessment, Needs Assessment, Medication Adherence
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