El-Saifi Najwan, Moyle Wendy, Jones Cindy, Tuffaha Haitham
1 School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University, Nathan Campus, Brisbane, Queensland, Australia.
2 School of Medicine, Menzies Health Institute Queensland, Griffith University, Nathan Campus, Brisbane, Queensland, Australia.
J Pharm Pract. 2018 Jun;31(3):322-334. doi: 10.1177/0897190017710524. Epub 2017 May 24.
Older patients with dementia are often unable to take their medications as prescribed due to cognitive and physical impairment.
To review the evidence on medication adherence in older patients with dementia in terms of the level of adherence, outcomes, contributing factors, and available interventions.
A systematic literature review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Searched databases included CINAHL, Cochrane Library, DARE, MEDLINE, and PubMed.
Eighteen studies reported levels of medication adherence or discontinuation and related factors. Medication adherence ranged from 17% to 42%, and medication discontinuation before the end of treatment ranged from 37% to 80%. Nonadherence was associated with an increased risk of hospitalization or death, while increasing age, choice of medication, use of concomitant medications, and medicines' costs were reported to decrease medication adherence. Telehealth home monitoring and treatment modification were the only interventions reported in the literature to improve medication adherence in this population.
Older patients with dementia have a low level of medication adherence. Future research should focus on the development and implementation of interventions to help older patients with dementia and their caregivers make better use of medications.
患有痴呆症的老年患者常因认知和身体功能障碍而无法按医嘱服药。
从依从性水平、结局、影响因素和可用干预措施等方面综述老年痴呆患者药物依从性的相关证据。
按照系统评价和Meta分析的首选报告项目（PRISMA）指南进行系统文献综述。检索的数据库包括护理学与健康领域数据库（CINAHL）、考克兰图书馆、循证卫生保健数据库（DARE）、医学索引数据库（MEDLINE）和医学期刊数据库（PubMed）。
18项研究报告了药物依从性或停药水平及相关因素。药物依从性范围为17%至42%，治疗结束前停药率范围为37%至80%。不依从与住院或死亡风险增加相关，而年龄增长、药物选择、合并用药的使用以及药物费用据报道会降低药物依从性。远程医疗家庭监测和治疗调整是文献中报道的仅有的可改善该人群药物依从性的干预措施。
老年痴呆患者的药物依从性较低。未来研究应聚焦于开发和实施干预措施，以帮助老年痴呆患者及其照护者更好地用药。
