Medical Adherence Reports

Multilevel Interventions to Improve Medication Adherence in Older Adults: A Systematic Review and Meta-Analysis of Cognitive, Digital, Behavioral, and Socioeconomic Strategies (2015–2025)

A 2025 systematic review and meta‑analysis found that adherence among older adults ranged from 25% to 97%, depending on setting and support level.

  • Institutionalized seniors averaged 25–54% adherence, meaning nearly half regularly missed doses.
  • When caregivers or digital reminders were involved, adherence improved to 77–97%

Medication Non-adherence in Older Adults: Underlying Factors, Potential Interventions and Outcomes

A 2025 scoping review reported that memory deficits, polypharmacy, and physical challenges are major contributors to missed doses. It emphasized that non‑adherence is “common and complex,” requiring personalized interventions

Medication errors are a significant driver of hospital admissions among the elderly

  • Increased Admission Risk: Adults aged 65 and older are admitted to the hospital nearly twice as often as younger adults due to medication concerns. [1.1]
  • Polypharmacy Vulnerability: For individuals 75 or older taking five or more medications, the risk of experiencing a medication error increases by 38%. [1.1]
  • Post-Discharge Sensitivity: Transitions from hospital to home are high-risk periods. A 2024 study found that 39% of adults 65+ made at least one medication error within just 7 days of discharge, rising to 50% after 90 days. [2.2]
  • Readmission Drivers: Medication-related errors are a leading cause of preventable Emergency Department (ED) visits and hospital readmissions for seniors. [2.2]
  • Inappropriate Prescribing: Roughly two in three hospitalized seniors are prescribed medications that are considered potentially inappropriate for their age group, which significantly raises the risk of adverse reactions and subsequent rehospitalization. [4.1]

Common Causes and Trends

  • Dosage Errors: The most frequently reported incident type is incorrect dose or frequency, often involving “high-alert” medications like insulin or anticoagulants. [1.2]
  • Settings of Error: While many errors occur in clinical settings, 90% of medication errors reported to poison control centers occur at home, frequently involving commission errors (e.g., repeating a dose or miscalculating a dosage). [1.1, 4.3]
  • Economic Impact: Globally, the cost associated with medication errors is estimated at $42 billion USD annually, a significant portion of which is driven by the intensive care required for elderly patients. [4.2]

Polypharmacy—generally defined as the daily use of five or more medications

1. Increased Risk of Falls and Fractures

Falls are the leading cause of injury-related loss of independence for seniors. Polypharmacy significantly increases this risk through:

  • Drug-Drug Interactions: Certain combinations can cause dizziness, orthostatic hypotension (a sudden drop in blood pressure when standing), and blurred vision.
  • The “Fall-Risk-Increasing Drugs” (FRIDs): Taking multiple medications from classes like benzodiazepines, antidepressants, and antihypertensives is strongly associated with an increased frequency of falls.
  • Impact: A single fall often leads to a “fear of falling,” which causes seniors to limit their activity, leading to muscle atrophy and a faster decline in mobility.
  • Sources:

2. Cognitive Impairment and “Brain Fog”

Polypharmacy is a known contributor to cognitive decline, which is a primary barrier to self-sufficiency.

  • Anticholinergic Burden: Many common medications for bladder control, allergies, and sleep have anticholinergic effects. When taken together, they can cause confusion, memory loss, and delirium.
  • Misdiagnosis: The side effects of multiple medications are sometimes mistaken for early-stage dementia or Alzheimer’s, leading to unnecessary lifestyle restrictions or additional (unneeded) prescriptions.
  • Sources:

3. Decline in Activities of Daily Living (ADLs)

Independence is measured by the ability to perform Activities of Daily Living (ADLs), such as dressing, bathing, and preparing meals.

  • Functional Decline: Studies show that seniors on five or more medications are significantly more likely to experience a decline in their functional status over a two-year period compared to those taking fewer drugs.
  • Reduced Physical Performance: Polypharmacy is associated with slower gait speed and reduced grip strength, both of which are clinical markers for frailty and loss of autonomy.
  • Sources:

4. The Burden of “Treatment Interference”

Maintaining independence requires the cognitive and physical energy to manage one’s own life.

  • Medication Management Stress: Complex regimens (taking different pills at various times of the day) can become a full-time job. The fear of making an error or the physical difficulty of opening multiple bottles can lead to anxiety and a reliance on caregivers for basic daily tasks.
  • Adverse Drug Events (ADEs): The symptoms of ADEs—such as fatigue, nausea, and gastrointestinal issues—can sap the energy required for social engagement and physical exercise, leading to social isolation.
  • Sources: