title: A scoping review on medication adherence in older patients with cognitive impairment or dementia.
abstract: Cognitive impairment is common in older patients, many of whom receive multiple and complex medication regimens. Such patients are at high risk for medication non-adherence. Limited information exists regarding adherence in this population. A scoping review was conducted to explore aspects of medication adherence in this population.
  
  
  
  A comprehensive search of MEDLINE, EMBASE, CINAHL, IPA and Psychinfo was conducted during 1966 to January 2015. Arksey and O'Malley's framework for scoping reviews was utilized.
  
  
  
  From an initial 582 citations, 42 research papers and 2 conference proceedings were eligible for review. The prevalence of non-adherence ranged from 2% to 59%. The most common assessment tool was self-reported adherence (32%). Barriers to adherence were cognitive impairment, non-Caucasian race, poor communication with prescribers, lack of social support, and increased pill burden. Interventions to improve adherence included alternate dosage forms, and multi-compartment pillboxes.
  
  
  
  Additional research is needed to address various gaps in the literature such as studies describing the effects of cognitively impaired caregivers on patient's medication adherence, the comparative effectiveness of different adherence enhancing strategies, development of instruments suitable for use in this population, and the role of pharmacists in identifying and improving medication adherence.
authors.affiliation: University of Waterloo, School of Pharmacy, 10 Victoria St S, Room 4015, Kitchener, ON N2G 1C5, Canada.
authors.forename: Zain K
authors.initials: ZK
authors.lastname: Hudani
authors.affiliation: Schlegel Research Chair in Geriatric Pharmacotherapy, Schlegel-UW Research Institute ON Ageing & School of Pharmacy, University of Waterloo, 10 Victoria St S, Room 7004, Kitchener, ON N2G 1C5, Canada. Electronic address: carlos.rojas-fernandez@uwaterloo.ca.
authors.forename: Carlos H
authors.initials: CH
authors.lastname: Rojas-Fernandez
mesh_terms: D000368:Aged; D060825:Cognitive Dysfunction / Q000150:complications*; D003142:Communication; D003704:Dementia / Q000150:complications*; D006801:Humans; D055118:Medication Adherence; D004364:Pharmaceutical Preparations / Q000008:administration & dosage; D012944:Social Support
chemical_list: D004364:Pharmaceutical Preparations
keywords: Aged; Cognitive impairment; Dementia; Geriatrics; Medication adherence; Older patients; Pharmacy; Scoping review