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A systematic review of medication non-adherence in persons with dementia or cognitive impairment
Open accessAbstract
BACKGROUND: Adherence to medication is vital for disease management while simultaneously reducing healthcare expenditure. Older persons with cognitive impairment (CI) are at risk for non-adherence as cognitive processes are needed to manage medications. This systematic review focuses on the relationship between medication non-adherence and specific cognitive domains in persons with CI, and explores determinants of medication non-adherence. When available, relationships and factors are compared with cognitively intact populations. METHODS: A seven database systematic search of studies published between 1 January 1949-31 December 2015 examining medication non-adherence in community dwelling persons with CI or dementia was conducted. Articles reporting medication non-adherence in people with CI or dementia in the community, with or without caregiver supports were eligible for inclusion. Papers reporting adherence to treatments in cognitively intact populations, populations from hospital or institutional settings, for non-prescribed medication or those describing dementia as a factor predicting medication non-adherence were excluded. Data on study and population characteristics, research design, data sources and analysis, specific cognitive domains, non-adherence prevalence, measurement of adherence, salient findings, factors associated with adherence and strategies to improve medication adherence were extracted. Study limitations included inconsistencies between data sources and definitions, resulting in a loss of fidelity in the value and comprehensiveness of data, as well as exclusion of non-pharmacological treatments and regimens. FINDINGS: Fifteen studies met inclusion criteria. Adherence among CI subjects ranged from 10.7%-38% with better rates of adherence in non-CI individuals. Medication non-adherence definitions varied considerably. New-learning, memory and executive functioning were associated with improved adherence and formed the focus of most studies. Multiple factors were identified as modulators of non-adherence. CONCLUSION: This review highlights a gap in knowledge on how specific cognitive domains contribute to medication non-adherence amongst CI populations, and demonstrates the current focus is limited to two domains: memory and executive functioning.
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“Nevertheless, the present meta-analysis finding is a bit lower than a finding from a systematic review which revealed that adherence in psychiatric patients ranged from 10.7 to 38% [76].”
From Psychotropic medication non-adherence and its associated factors among patients with major psychiatric disorders: A systematic review and meta-analysis (2020) · cites this paper as [76]
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Metadata
- Authors
- Smith, D., Lovell, J., Weller, C., Kennedy, B., Winbolt, M., Young, C., & Ibrahim, J.
- Affiliations
- Monash University (AU)
- Ballarat Health Services (AU)
- La Trobe University (AU)
- Corresponding author
- Smith, Daisy
- Venue
- PLOS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2017-02-06
- Volume
- 12
- Issue
- 2
- Pages
- e0170651
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC5293218
- OpenAlex
- W2586543796
- Cited by
- 242
- References
- 46
- Citations by year
- 2026: 24 · 2025: 36 · 2024: 26 · 2023: 23 · 2022: 25 · 2021: 28 · 2020: 31 · 2019: 21 · 2018: 23 · 2017: 5
- FWCI
- 3.65
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Monash University Research Portal (Monash University) (submittedVersion, other-oa)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Figshare (submittedVersion, cc-by)
- Funders
- Australian Government
- Topics
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
- Keywords
- medication non-adherence, dementia, cognitive impairment, cognitive domain, memory, executive function, learning, predictors of adherence, community-dwelling older adults, caregiver support, adherence measurement
- MeSH terms
- Prescription Drug Overuse, Cognition Disorders, Dementia, Humans, Phenotype, Risk Factors, Severity of Illness Index, Medication Adherence, Patient Outcome Assessment
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