Campbell Noll L, Boustani Malaz A, Skopelja Elaine N, Gao Sujuan, Unverzagt Fred W, Murray Michael D
Department of Pharmacy Practice, Purdue University College of Pharmacy, West Lafayette, Indiana, USA.
Am J Geriatr Pharmacother. 2012 Jun;10(3):165-77. doi: 10.1016/j.amjopharm.2012.04.004.
Cognitive impairment challenges the ability to adhere to the complex medication regimens needed to treat multiple medical problems in older adults.
Our aim was to conduct a systematic evidence-based review to identify barriers to medication adherence in cognitively impaired older adults and interventions aimed at improving medication adherence.
A search of MEDLINE, EMBASE, PsycINFO, GoogleDocs, and CINAHL for articles published between 1966 and February 29, 2012 was performed. Studies included older adults with a diagnosis of cognitive impairment of any degree (mild cognitive impairment or mild, moderate, or severe dementia). To identify barriers to adherence, we reviewed observational studies. To identify relevant interventions, we reviewed clinical trials targeting medication adherence in cognitively impaired older adults. We excluded studies lacking a measure of medication adherence or lacking an assessment of cognitive function, case reports or series, reviews, and those focusing on psychiatric disorders or infectious diseases. Population demographics, baseline cognitive function, medication adherence methods, barriers to adherence, and prospective intervention methodologies were extracted.
The initial search identified 594 articles. Ten studies met inclusion criteria for barriers to adherence and three met inclusion criteria for interventional studies. Unique barriers to adherence included understanding new directions, living alone, scheduling medication administration into the daily routine, using potentially inappropriate medications, and uncooperative patients. Two studies evaluated reminder systems and showed no benefit in a small group of participants. One study improved adherence through telephone and televideo reminders at each dosing interval. The results of the review are limited by reviewing only published articles, missing barriers or interventions due to lack of subgroup analysis, study selection and extraction completed by 1 reviewer, and articles with at least an abstract published in English.
The few studies identified limit the assessment of barriers to medication adherence in the cognitively impaired population. Successful interventions suggest that frequent human communication as reminder systems are more likely to improve adherence than nonhuman reminders.
认知障碍对老年人遵守治疗多种疾病所需的复杂药物治疗方案的能力构成挑战。
我们的目的是进行一项基于证据的系统综述，以确定认知障碍老年人药物依从性的障碍以及旨在提高药物依从性的干预措施。
检索了MEDLINE、EMBASE、PsycINFO、GoogleDocs和CINAHL中1966年至2012年2月29日发表的文章。纳入的研究对象为诊断为任何程度认知障碍（轻度认知障碍或轻度、中度或重度痴呆）的老年人。为了确定依从性障碍，我们回顾了观察性研究。为了确定相关干预措施，我们回顾了针对认知障碍老年人药物依从性的临床试验。我们排除了缺乏药物依从性测量或缺乏认知功能评估的研究、病例报告或系列、综述以及关注精神疾病或传染病的研究。提取了人群人口统计学、基线认知功能、药物依从性方法、依从性障碍和前瞻性干预方法。
初步检索共识别出594篇文章。10项研究符合依从性障碍的纳入标准，3项研究符合干预性研究的纳入标准。依从性的独特障碍包括理解新的用药说明、独居、将药物服用安排到日常生活中、使用潜在不适当的药物以及不合作的患者。两项研究评估了提醒系统，在一小部分参与者中未显示出益处。一项研究通过在每个给药间隔进行电话和电视视频提醒提高了依从性。综述结果受到以下因素的限制：仅回顾已发表的文章、由于缺乏亚组分析而遗漏障碍或干预措施、由1名评审员完成研究选择和提取以及至少有摘要以英文发表的文章。
所识别的少数研究限制了对认知障碍人群药物依从性障碍的评估。成功的干预措施表明，作为提醒系统的频繁人际沟通比非人际提醒更有可能提高依从性。
