Podcast: Interventions for helping older adults prescribed multiple medications to use and take their medications

Older people often have multiple chronic health problems, requiring multiple different medicines. However, this can be challenging and a new Cochrane Review in May 2020 examines the effectiveness of interventions that might help them. Here’s lead author, Amanda Cross from Monash University in Parkville Australia to tell us what the review found.

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Monaz: Hello, I'm Monaz Mehta, editor in the Cochrane Editorial and Methods department. Older people often have multiple chronic health problems, requiring multiple different medicines. However, this can be challenging and a new Cochrane Review in May 2020 examines the effectiveness of interventions that might help them. Here’s lead author, Amanda Cross from Monash University in Parkville Australia to tell us what the review found.

Amanda: If older people who have been prescribed multiple medications for multiple conditions take these incorrectly, it can lead to poor health outcomes. So we set out to identify which types of intervention are most effective at helping them to take their medications and improve their ability to adhere to their prescribed treatment. 
We found 50 randomised trials, involving over 14,000 participants. Five studies tested interventions for improving medication-taking ability and 48 looked at ways for improving medication adherence, with three of the studies doing both. 
The studies were very different in terms of the interventions people received, where these were delivered, and how and when people's medication‐taking ability or adherence was measured. These differences and problems with how the trials were done mean that the overall quality of the current evidence is low or very low.
To make things manageable, we broadly grouped the studies into educational, behavioural and mixed interventions. Fourteen studies tested educational interventions whereby people received education regarding their medications or a health professional reviewed their medications. Seven studies tested behavioural interventions, such as changing dosing times, re‐packaging medications into multi‐compartment pill boxes, or sending text message adherence reminders. Twenty‐nine studies tested a combination of educational and behavioural interventions.
We found that interventions that contained a behavioural element, either on its own or combined with education, may improve the proportion of people who are adherent to their prescribed medication. But the effects of educational interventions alone are uncertain. None of the interventions were found to be effective in improving medication adherence when assessed using measures such as the percentage of medications consumed over a given time period.
Looking at some other outcomes, mixed interventions may reduce the number of emergency department visits or hospital admissions, while the effect of behavioural only interventions was unclear and educational interventions on their own probably have little or no effect on this outcome. 
Bringing it altogether, we can conclude that interventions with a behavioural component, either alone or in combination with education, may help people adhere to their prescribed medication but it’s not clear if there is an impact on medication‐taking ability. Mixed educational and behavioural interventions may also reduce the number of times an older person goes to an emergency department or needs to be admitted to hospital. Many uncertainties still remain and we need further high‐quality studies to identify the most effective ways to improve medication‐taking ability and medication adherence in older adults who have been prescribed multiple medications.”

Monaz: If you would like to find out more about the wide range of interventions that were assessed in Amanda’s review and watch for updates if those new studies are done, it’s available online. Just go to Cochrane Library dot com and search 'older adults and multiple medications' to see the link to it.

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