Self-Reported Medication Adherence Barriers Among Ambulatory Older Adults with Mild Cognitive Impairment

Medication nonadherence in elderly patients is a huge problem affecting more than half of patients visiting community pharmacies and is expected to lead to greater than $100 billion costs to patients and healthcare systems. Furthermore, nearly 20% of this elderly patient population, aged 65 and over, has a diagnosis of mild cognitive impairment (MCI). MCI is an early stage impairment which increases a person’s risk of developing dementia. Because a majority of the elderly population suffers from multiple medical comorbidities and requires many different medications, it is important to address their cognitive ability and how it can impact their capability to be adherent to their medications.

Many interventions have been implemented to assist older adults in being adherent to their medications, but only one intervention focused on helping patients diagnosed with an MCI has been identified and involved reminder phone calls at each dosing time throughout the day. This article focuses on a study that compared barriers to adherence faced by older adults with MCI and those without at outpatient or home-care programs. The identification of barriers was used to create new interventions that would aid in adherence among this population. Patients were surveyed using a 17-item questionnaire to determine barriers to adherence related to knowledge, cost, behavior, and physical ability. Of the 200 participants surveyed, 82.5% reported to having at least one barrier to medication adherence. There was found to not be a significant different to the average number of barriers per patient between the MCI and non-MCI group. 49% of the barriers were categorized as difficulty remembering the time or number to take for the medication.

Many self-reported barriers to medication adherence were identified, regardless of whether or not the patient had been diagnosed with a cognitive disability. Overall, the need for multi-component intervention for older adults is important to recognize and these intervention program must make targeting a barrier caused by memory their priority. These interventions must be tailored to each patient’s need and work to minimize and adherence barriers.

The information presented in this article is important to recognize as a pharmacist. As an accessible healthcare provider present at the time of dispensing, we can play a very influential role in promoting adherence to our patients. By learning to recognize common barriers or challenges that certain populations are facing, we can address these concerns or identify resources available that can improve the overall health of our patients. I think this article also presents a very interesting point in that the prevalence of barriers to adherence in older patients. Regardless of an MCI diagnosis or not, patients still reported to facing roughly the same number and type of challenges, highlighting the fact that regardless off health conditions, most patients are still plagued by challenges leading to nonadherence. Once we learn to recognize these problems and identify the cause, we can develop strategies to help these patients.


Pharmacotherapy. 2016;36:196-202.