title: Interventions to improve medication adherence among older adults: meta-analysis of adherence outcomes among randomized controlled trials.
abstract: OBJECTIVE
  This study investigated the effectiveness of interventions to improve medication adherence (MA) in older adults.
  
  
  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  Meta-analysis was used to synthesize results of 33 published and unpublished randomized controlled trials.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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: RN, S317 Sinclair School of Nursing, University of Missouri, Columbia, MO 65211, USA. conn@missouri.edu
authors.forename: Vicki S
authors.initials: VS
authors.lastname: Conn
authors.forename: Adam R
authors.initials: AR
authors.lastname: Hafdahl
authors.forename: Pamela S
authors.initials: PS
authors.lastname: Cooper
authors.forename: Todd M
authors.initials: TM
authors.lastname: Ruppar
authors.forename: David R
authors.initials: DR
authors.lastname: Mehr
authors.forename: Cynthia L
authors.initials: CL
authors.lastname: Russell
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004358:Drug Therapy; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D008962:Models, Theoretical; D017063:Outcome Assessment, Health Care; D010349:Patient Compliance; D016032:Randomized Controlled Trials as Topic