Hudani Zain K, Rojas-Fernandez Carlos H
University of Waterloo, School of Pharmacy, 10 Victoria St S, Room 4015, Kitchener, ON N2G 1C5, Canada.
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.
Res Social Adm Pharm. 2016 Nov-Dec;12(6):815-829. doi: 10.1016/j.sapharm.2015.11.011. Epub 2015 Dec 2.
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.
认知障碍在老年患者中很常见，其中许多人接受多种复杂的药物治疗方案。这类患者存在药物治疗依从性差的高风险。关于该人群依从性的信息有限。进行了一项范围综述以探讨该人群药物治疗依从性的各个方面。
在1966年至2015年1月期间对MEDLINE、EMBASE、CINAHL、IPA和Psychinfo进行了全面检索。采用了阿克西和奥马利的范围综述框架。
从最初的582篇文献中，有42篇研究论文和2篇会议论文符合综述条件。不依从的发生率在2%至59%之间。最常用的评估工具是自我报告的依从性（32%）。依从性的障碍包括认知障碍、非白种人种族、与开处方者沟通不良、缺乏社会支持以及药片负担增加。改善依从性的干预措施包括替代剂型和多格药盒。
需要进行更多研究以填补文献中的各种空白，例如描述认知受损的照顾者对患者药物治疗依从性影响的研究、不同依从性增强策略的比较效果、开发适用于该人群的工具以及药剂师在识别和改善药物治疗依从性方面的作用。
