Cited by 308Medication Adherence and CompliancePharmaceutical Practices and Patient OutcomesPharmacy and Medical Practices

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Systematic review of the barriers affecting medication adherence in older adults

Yap, Angela Frances, Thirumoorthy, Thiru, Kwan, Yu Heng·2016·Geriatrics & Gerontology International

DOI 10.1111/ggi.12616

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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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Design and validation of a new questionnaire with a gender perspective to measure medication adherence for secondary prevention of ischaemic heart disease: study protocol
López-Pineda, A., Cordero, A., Nouni-García, R., Quesada, J., Castellano-Vázquez, J. M., Orozco-Beltrán, D., Nolasco, A., Carratalá-Munuera, C., & Guillen, V. G. (2024) · BMJ Open · doi:10.1136/bmjopen-2023-077982 · Cited by 2
A Survey of Medication Management in Occupational Therapy Practice
Allen, D., & Jaffe, L. (2023) · Occupational Therapy in Health Care · doi:10.1080/07380577.2023.2243516 · Cited by 2
“This may be because mild cognitive impairment (MCI) is often missed by many health care professionals and can occur in diagnoses not normally associated with cognitive loss (Hain et al., 2012; Hawkins et al., 2012; Smith et al., 2017; Weintraub et al., 2018; Yap et al., 2016).”
Adherence therapy for adults with type 2 diabetes: a feasibility study of a randomized controlled trial
Alenazi, F., Peddle, M., Bressington, D. T., Mahzari, M. M., & Gray, R. J. (2023) · Pilot and Feasibility Studies · doi:10.1186/s40814-023-01294-2 · Cited by 1
Comparison of primary care prescriptions for old and very old hypertensive patients Selcan
Çolak, T., Vızdıklar, C., Kaşkal, M., Aydın, V., Ataç, Ö., & Akıcı, A. (2023) · Turkish Journal of Medical Sciences · doi:10.55730/1300-0144.5618 · Cited by 2
“Aside from potential issues such as drug interactions, altered drug elimination and intolerance to adverse events, several drugs may interfere with the treatment of hypertension, interrupting control, and provoking any complications [1,5].”
Background
The feasibility of an inter‐professional transitions of care service in an older adult population
Southerland, L., Porter, B. L., Newman, N., Payne, K., Hoyt, C., & Rodis, J. (2019) · American Journal of Emergency Medicine · doi:10.1016/j.ajem.2018.07.047 · Cited by 2
“Older adults are at especially high risk of post-ED visit complications; those with low socioeconomic status may experience difficulties with transportation to obtain medications [7].”
Background
Committed to Weight Loss: an IPA Analysis Into the Experiences of Individuals Who Lost Weight Through Nutritional Intervention
Miles, H., & Barrow, M. (2018) · Current Research in Nutrition and Food Science Journal · doi:10.12944/crnfsj.6.1.06 · Cited by 2
Characterization of Usage Patterns of Drugs Suspected to Cause Adverse Drug Reactions in Older Hospitalized Patients
Katsuhisa, M., Hamada, S., Hamaie, C., Takeshita, Y., Ikuta, K., Saizen, Y., Koujiya, E., Takami, Y., Yamamoto, K., & Takeya, Y. (2026) · Geriatrics & Gerontology International · doi:10.1111/ggi.70661 · Cited by 1
Introducing the Adherence Promotion with Person-Centered Technology (Appt) Trial Rationale, Methods, and Baseline Characteristics
Zhang, S., Dieciuc, M., Dilanchian, A. T., Lustria, M. L. A., Carr, D. C., Terracciano, A., He, Z., Chakraborty, S., Charness, N. H., & Boot, W. R. (2025) · Contemporary Clinical Trials · doi:10.1016/j.cct.2025.108056 · Cited by 1
Identifying Dimensions and Items for a Questionnaire to Assess Medication Adherence in Men and Women with Ischemic Heart Disease: Insights from the GENADHECAR Study
Carbonell-Soliva, Á., Nouni-García, R., Quesada, J., González-Llopis, F., Cordero, A., Bertomeu-González, V., Orozco-Beltrán, D., Verdú-Soriano, J., Nolasco, A., Pérez-Jover, V., et al. (2025) · Patient Preference and Adherence · doi:10.2147/ppa.s516285 · Cited by 1
Assessing Accessibility of Health Care for the Oldest Old
Kartseva, M., & Rogozin, D. (2025) · Population and Economics · doi:10.3897/popecon.9.e146947 · Cited by 1
Validation and Cross-Cultural Adaptation of Treatment Satisfaction Questionnaire for Medication Version 2 Among Older Adult Patients in Malaysia: A Psychometric Testing Study.
Yunus, M. A. A. H. M., & Akkawi, M. E. (2025) · Value in Health Regional Issues · doi:10.1016/j.vhri.2025.101128 · Cited by 1
Management of pain and other palliative needs in older people with HIV
Neupane, N., Mehta, M., & Robinson-Papp, J. (2025) · Current Opinion in HIV and AIDS · doi:10.1097/coh.0000000000000940 · Cited by 1
Healthcare related costs associated with donepezil use in patients with very mild dementia due to Alzheimer's disease: A retrospective observational study
Hsieh, S.-W., Hsiao, C.-Y., Yang, Y.-H., & Hsieh, H.-M. (2025) · Journal of Alzheimer's disease reports · doi:10.1177/25424823251356233 · Cited by 1
“29,30 In our study, the majority appear to have an MMSE assessment that would suggest mild or moderate dementia despite a CDR of 0.5.”
Influential
The indirect effect of nonadherence on health-related quality of life in older adults with neurological disorders: implications for clinical endpoints and interventions
Schönenberg, A., Mendorf, S., & Prell, T. (2024) · Frontiers in Neurology · doi:10.3389/fneur.2024.1462478 · Cited by 1
“This again points to the strong influence of depressive symptoms on both nonadherence and HRQoL (9, 12).”
Influential
Navigating the Paradox: Challenges and Strategies of University Students Managing Mental Health Medication in Real-World Practices
Li, J., Steinberg, J., Mynatt, E. D., & Mishra, V. (2024) · arXiv.org · doi:10.48550/arxiv.2408.07784 · Cited by 1
“Most prior works on medication management strategies focused on older adults [14, 61] and individuals with disabilities [53], often categorizing younger populations as ‘healthier.”
Background
Factors Influencing Insulin Adherence among Outpatients with Type 2 Diabetes Mellitus and the Impact of Pharmaceutical Intervention: A Randomized Clinical Trial
He, T., Wang, H., Sun, W., Li, L.-T., Li, L., & Ji, C. (2024) · Journal of Clinical Pharmacy and Therapeutics · doi:10.1155/2024/5518977 · Cited by 1
Estimating Type 2 Diabetes Prevalence: A Model of Drug Consumption Data
Oliveira, R., Monteiro-Soares, M., Guerreiro, J., Pereira, R., & Teixeira-Rodrigues, A. (2024) · Pharmacy · doi:10.3390/pharmacy12010018 · Cited by 1
“Pasina et al. obtained a non-adherence rate reported (n = 100) in 55.1% of the patients at the first follow-up and 69.6% 3 months from hospital discharge in elderly patients receiving polypharmacy, confirming that age is a predictor of increased non-adherence [53,54].”
BackgroundInfluential
Nebenwirkungen einer medikamentösen Osteoporosetherapie und Konsequenzen für die Sequenztherapie: Fokus Arzt-Patient Kommunikation
Thomasius, F., Siggelkow, H., & Obermayer-Pietsch, B. (2023) · Osteologie/Osteology · doi:10.1055/a-2270-3406 · Cited by 1
“…werden und betreffen individuelle Grundvoraussetzun - gen des Patienten/der Patientin (wie geringe kognitive Funktion, Depression und eigene Überzeugung zu den Medikamenten), die Arzt-Patient Kommunikation, Grad der Umsorgung und andere Faktoren wie Vorhandensein einer Betreuungsperson [3].”
Family Size Effect on Mental Health and medication Adherence on a Sample of Copd Patients. The Moderating Role of Financial Strain
Article, R. H., Gouva, M., Mazetas, D., Gouva, M., Economou, A., Gerogianni, I., & Gourgou, K. I. (2023) · International Journal of Psychiatry · doi:10.33140/ijp.08.05.03
“Accordingly, a great effort has been devoted to enlightening the factors that affect the adherence of patients with chronic illnesses and several dozens of factors have been highlighted, categorized as either patient factors, therapy factors, clinical condition factors, healthcare system factors, or socio-economic fac…”
Background
Barriers and facilitators for implementation of automated home medication dispensers in home care from Dutch professionals’ perspective: a qualitative study
Mostert, C., Ginkel, J. D. D. M.-V., van Dijk, M., & Ista, E. (2023) · JBI evidence implementation · doi:10.1097/xeb.0000000000000366 · Cited by 1
Using a generic quality of life measure to determine adherence thresholds: a cross-sectional study on older adults with neurological disorders in Germany
Mühlhammer, H. M., Schönenberg, A., Lehmann, T., & Prell, T. (2023) · BMJ Open · doi:10.1136/bmjopen-2022-067326 · Cited by 2
BTKi-Therapie bei CLL: Die MFA als Förder:innen der Adhärenz
der Adhärenz, F. (2022) · CNE Pflegemanagement · doi:10.1055/a-1954-7431 · Cited by 1
The impact of SMS reminders on adherence to medication and care plans after coronary artery bypass graft surgery
Bikmoradi, A., Omidvar, S., Roshanaei, G., Khatiban, M., & Harorani, M. (2022) · British Journal of Cardiac Nursing · doi:10.12968/bjca.2022.0103 · Cited by 1
The complex issue of medication management in older persons: a challenge for nurses
Vitiello, C., Longobucco, Y., Tofalos, S. E., & di Bari, M. (2022) · infermieristica journal · doi:10.36253/if-1714 · Cited by 1
Patterns and Predictors of Medication Change after Discharge from Hospital: An Observational Study in Older Adults with Neurological Disorders
Schwarzkopf, A., Schönenberg, A., & Prell, T. (2022) · Journal of Clinical Medicine · doi:10.3390/jcm11030563 · Cited by 2
“In general, adherence patterns may vary depending on the underlying diagnosis [36–38], as different diagnoses may come with varying levels of chronicity, restrictions and burden [9].”
Background
Guidelines for Medication Education for Occupational Therapists
Schwartz, J. K. (2022) · The Open Journal of Occupational Therapy · doi:10.15453/2168-6408.1851 · Cited by 3
“While there are many reasons that people fail to take their medications, lack of medication knowledge is one factor known to impact medication adherence (Yap et al., 2016).”
Polypharmacy simulation and pharmacotherapy perceptions among students from a university in Ceará: a pilot study
Bezerra, Y. M., Pereira, I. D. S., Sarubbi, R. D., Viana, A. B., & Quidute, A. (2021) · Revista Brasileira de Educação Médica · doi:10.1590/1981-5271v45.3-20210026.ing · Cited by 1
Difficulties in reporting purpose and dosage of prescribed medications are associated with poor cognition and depression
Zipprich, H. M., & Prell, T. (2021) · PLoS ONE · doi:10.1371/journal.pone.0251374 · Cited by 1
“Medication adherence is a crucial part of chronic disease management [1].”
Background
[Obesity hypoventilation syndrome and initial compliance with non-invasive ventilation].
Payen, F., Greil, A., & Caillaud, D. (2020) · Revue des maladies respiratoires · doi:10.1016/j.rmr.2020.09.003 · Cited by 1
Telepresence Robots for Healthcare Management: COVID-19 Experience (Preprint)Preprint
(mHBR), P. M. F. B. A. R. R., Wang, M.-Z., & Pan, C.-D. (2020) · doi:10.2196/preprints.19683 · Cited by 1
Behavioral economic insights to improve medication adherence in adults with chronic conditions: a scoping review protocol
Roseleur, J., Harvey, G., Stocks, N. P., & Karnon, J. D. (2019) · The JBI Database of Systematic Reviews and Implementation Reports · doi:10.11124/jbisrir-2017-003971 · Cited by 3
The Effects of Intervention for the Health Literacy of Patients: A Systematic Review of Randomized Controlled Trials
Hori, S., Fujimoto, S., Sugita, S., Kobayashi, M., & Komukai, K. (2018) · An Official Journal of the Japan Primary Care Association · doi:10.14442/generalist.41.100 · Cited by 1
Adhärenz bei älteren Patienten
Burkhardt, H. (2021) · Praxishandbuch Gerontopsychiatrie und -Psychotherapie · doi:10.1016/b978-3-437-24435-3.00006-1 · Cited by 1
Medication Management in Older Adults with Dementia
Adeola, M., Fernandez, J. M., & Sherer, J. (2020) · Springer eBooks · doi:10.1007/978-3-030-46398-4_4 · Cited by 1
The Nuances of Cost-Related Medication Non-Adherence in Patients Receiving Immunosuppression Compared to Patients with Chronic Disease: A Cross-Sectional Study
Good, S. D., England, B. R., & Volkmann, E. R. (2026) · Journal of Personalized Medicine · doi:10.3390/jpm16100524
“Prior studies have identified that overall health and health-related quality of life are associated with general non-adherence [40–42].”
Treatment Adherence and its Association with Demographic Characteristics and Clinical Factors Among Patients with Hypertension: A Cross-Sectional, Descriptive-Correlational Study
Vafaei, A., Ghorbani, R., Zarvani, P., & Nobahar, M. (2026) · Vascular Health and Risk Management · doi:10.2147/vhrm.s646427
“30 33 However, treatment adherence remains challenging for both patients and healthcare providers.”
The Development of Theory of Adherence Behavior to Treatment Regimens among Older Adults Utilizing the Deductive Axiomatic Approach
Mejia, P. C. G., & Nguyễn, C. V. (2026) · International Journal of Drug Delivery Technology · doi:10.25258/ijddt.16.7.145
“Health care factors play an interestingly important role in patient’s adherence to medications (22).”
Influential
Pharmacist-Led Tailored Interventions to Adress Medication-Adherence Barriers and Improve Health-Related Quality of Life in Patients with Heart Failure: A Prospective Pre-Post Study
Ramadhanty, Z. T., Sitorus, D. W. A., Nilamsari, W., Susilo, H., Alsagaff, M. Y., Hamidah, K. F., Tan, C.-S., & Sunaidar, K. A. A. A. (2026) · JURNAL FARMASI DAN ILMU KEFARMASIAN INDONESIA · doi:10.20473/jfiki.v13i22026.263-276
Yaşlılarda ilaç uyumunun geliştirilmesine yönelik stratejiler
Mete, S., & Özdil, K. (2026) · Mersin Üniversitesi Sağlık Bilimleri Dergisi · doi:10.26559/mersinsbd.1836626
Development and internal validation of GENADHECAR: a screening instrument for identifying probable statin non-adherence in patients with ischemic heart disease
Quesada, J., López-Pineda, A., Nouni-García, R., Cordero, A., Carbonell-Soliva, Á., Esquerdo-Arroyo, A., Pereira-Expósito, A., Guillen-Garcia, S., Arrarte, V., Bertomeu-González, V., et al. (2026) · Frontiers in Pharmacology · doi:10.3389/fphar.2026.1860683
“…and cultural determinants (income, place of residence); patients (sex, gender-related factors, beliefs, educational attainment); the disease (symptoms); therapy (polypharmacy, perceived side effects); and the health system (communication, trust) (Gagnon et al., 2017; Yap et al., 2016).”
Digital Health Interventions to Improve Medication Adherence Among Older Adults: A Systematic Review
Haile, K., Shahin, W., Gebreyohannes, E., Yabeyu, A. B., Hareem, A., Kalayou, M. H., Yi, X., & Wang, K. N. (2026) · Australasian Journal on Ageing · doi:10.1111/ajag.70206
Non-pharmacological interventions for older adults with comorbid hypertension and type 2 diabetes: A systematic review of randomized controlled trials.
Wang, G.-Z., Song, W.-J., Xue, N.-F., Zhao, H.-R., Ma, Y., Zhang, T.-Y., Wei, J., Sun, L.-X., Hertz, J. T., Yap, M., et al. (2026) · Geriatric Nursing · doi:10.1016/j.gerinurse.2026.104179
Multiple Chronic Conditions and Multimorbidity Among Older Adults in Southern Albania: Distribution and Impact on Care Needs, Medication Adherence, and Quality of Life
Subashi, B., Kamberi, F., & Kokalla, E. (2026) · Healthcare · doi:10.3390/healthcare14142058
“As highlighted in a systematic review by Yap et al. (2016), polypharmacy and complex therapeutic regimens can significantly reduce adherence among older adults with MM [26].”
Small-Molecule Strategies for Polymyalgia Rheumatica and Giant Cell Arteritis in Older Adults
Kurdybacha, J., Kravets, O., Lekston, N., Kotyla, K., Gumkowska-Sroka, O., & Kotyla, P. (2026) · Molecules · doi:10.3390/molecules31132218
“Consequently, shared decision-making (SDM) involving both patients and their caregivers should form an integral part of treatment planning, enabling personalized care and an optimal balance between clinical benefits and treatment burden [94,95].”
Medication adherence and associated factors among patients with multimorbidity in Bangladesh: a cross-sectional study
Medha, M. R. B., Iktidar, M. A., Chowdhury, T., Chowdhury, N., Dutta, S., Punnya, A. J., Najiat, N., Kabir, K., Moniruzzaman, M., Chowdhury, A. A. A., et al. (2026) · Discover Public Health · doi:10.1186/s12982-026-02044-4
“Studies from India, Pakistan, and Sri Lanka have reported differing prevalence rates of multimorbidity, ranging from 10% to 45% among adults [3].”
Influential
The Need to Feel Safe: Older Adults’ and Family Caregivers’ Perspectives on Safe and Person-Centered Medication Management in Home Nursing Care
Olsen, U. S., Jakobsen, E., Solberg, W., Stjern, K., Arnevik, O., Myren, G. E. S., Sletvold, H., & Devik, S. (2026) · Patient Preference and Adherence · doi:10.2147/ppa.s606768
Validity of self-reported use of antihypertensives and lipid modifying agents: Results from the population-based HUNT Study.
Olsen, K. S., Hallan, S. I., Selbæk, G., Næss, M., Krokstad, S., Holmen, J., & Ernstsen, L. (2026) · Annals of Epidemiology · doi:10.1016/j.annepidem.2026.110122
Applying a hypothetical strategy to the intercurrent event of non-adherence with the parametric g-formula: a post hoc secondary analysis of the MET-PREVENT randomised controlled trial
Hiu, S., Wilson, N., Wilson, K., Lin, N., Witham, M., & Wason, J. (2026) · Trials · doi:10.1186/s13063-026-09708-1
“Variables identified as mediator-outcome confounders were informed by the intersection between the literature on factors which influence adherence to medication [15–18] and predictors of walk speed amongst older adults, and by discussions with an expert (MDW).”
The Daily Medication Frequency at Which Participants Begin to Perceive Dosing as Excessive: A Questionnaire-Based Study Using the Personal Health Record Infrastructure via Electronic Medication Notebooks.
Imai, S., Asano, M., Shimizu, Y., Kizaki, H., Tsuchiya, M., Ito, Y., Tsuchiya, M., Kuriyama, R., Yoshida, N., Shimada, M., et al. (2026) · Biological and Pharmaceutical Bulletin · doi:10.1248/bpb.b25-00554

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
DOI: 10.1111/ggi.12616
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
FWCI: 2.05
Type: journal article
Language: en
Open access: closed
Licence: onlinelibrary.wiley.com/termsAndConditions#vor (vor)
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
Health Sciences › Health Professions › Pharmacy › 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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Systematic review of the barriers affecting medication adherence in older adults

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