title: Improving medication adherence: moving from intention and motivation to a personal systems approach.
abstract: Medication nonadherence is a challenging and prevalent problem in older adults. Effective medication management involves successfully completing a complex group of behaviors. Meta-analyses and narrative review findings support limited benefits to medication adherence with interventions preoccupied with personal characteristics, intention, and motivation. Evidence supports a paradigm shift toward changing personal systems in which the person lives to improve and maintain medication adherence behavior. Personal-systems change systematically improves individual systems through collaboratively shaping routines, involving supportive-others in routines, and using medication self-monitoring to improve and maintain behavior. Other advances that support personal systems change are also presented.
authors.affiliation: University of Missouri, Sinclair School of Nursing, University of Missouri, Columbia, MO 65211, USA. RussellC@missouri.edu
authors.forename: Cynthia L
authors.initials: CL
authors.lastname: Russell
authors.forename: Todd M
authors.initials: TM
authors.lastname: Ruppar
authors.forename: Michelle
authors.initials: M
authors.lastname: Matteson
mesh_terms: D000368:Aged; D002908:Chronic Disease / Q000188:drug therapy*; D006801:Humans; D055118:Medication Adherence / Q000523:psychology; D008509:Medication Systems / Q000639:trends; D010353:Patient Education as Topic; D018802:Patient-Centered Care; D019338:Polypharmacy; D011582:Psychological Theory