Improving self-administered medication adherence for older adults: a systematic review / Lina Syazana Zainal Abidin

Background: The therapeutic benefit of self-administered medication for long-term use is limited by an average 50% nonadherence rate. Patient forgetfulness is a common factor in unintentional nonadherence. With a growing ageing population, strategies to improve self-administration of medication adherence are essential. Our aim was to review systematically the effects of interventions to optimise self­ administration of medication. Method: Database searched were MEDLINE, EMBASE, and PsynINFO from 1980. Search term included were 'self­ administration', 'self-care', 'medication adherence', and 'intervention'. Two independent reviewers undertook screening and methodological quality assessment, using the Downs and Black rating scale. Results: The search strategy retrieved 6 studies that met inclusion criteria. Three intervention strategies were identified: self­ administration medication programme (SAMP), nursing education and medication packaging (pill calendar). Nursing education programme that focused on improving patients' behavioral self-management of drug prescribing were the most studied area with three studies highlighting an improvement in self-administration of medication. Conclusion: Results are mixed and there is no one interventional strategy that has proved to be effective. Nevertheless, self-administration of medication programme seems to show most promise. A multi-faceted approach and clearer policy guideline are likely to be required to improve prescribing for these vulnerable patients. Mixed results were found for SAMP. Medication packaging (pill calendar) was evaluated in one study showing a significant improvement in self-administration of medication. A meta-analysis could not be performed due to heterogeneity in the outcome measures.