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Hassan Mahmoodi,1 Fatemah Jalalizad Nahand,2 Abdolreza Shaghaghi,2 Shahin Shooshtari,3 Mohammad Asghari Jafarabadi,4 Hamid Allahverdipour2 1Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran; 2Department of Health Education and Health Promotion, School of Public Health, Tabriz University of Medical Sciences, Tabriz, Iran; 3Departments of Family Social Sciences and Community Health Sciences, University of Manitoba; St. Amant Research Centre, Winnipeg, Manitoba, Canada; 4Department of Epidemiology and Biostatistics, School of Public Health, School of Public Health, Tabriz University of Medical Sciences, Tabriz, Islamic Republic of IranCorrespondence: Hamid AllahverdipourDepartment of Health Education & Promotion, Faculty of Health Sciences, Tabriz University of Medical Sciences, Attar-e-Neyshabouri Street, Golgasht Street, Tabriz 5165665931, IranTel +98 41 333 44 731Email allahverdipour@gmail.comBackground: Life course gender-role traits and social stereotypes could affect the pattern of medication adherence in old age.Objectives: The main purpose of this study was to investigate gender based cognitive determinants of medication adherence in a sample of older adults who suffer from at least a chronic condition.Methods: In this cross-sectional design, 455 older adults participated from five health centers in Tabriz city, Iran from June to August 2017 using a random sampling method. Next, required data about medication adherence, knowledge and beliefs about prescribed medications, perceived self-efficacy in medication adherence, illness perception, and reasons for medication non-adherence were gathered using a structured written questionnaire through face-to-face interviews with the attendees.Results: Low medication adherence was reported by 54.5% of the study participants. Perceived self-efficacy for medication adherence (OR = 1.04; 95% CI: 1.00, 1.08) and medication adherence reason (OR = 0.96; 95% CI: 0.92, 0.99) were two identified strong predictors of medication adherence among the studied older men. Illness perception (OR = 1.02; 95% CI: 1.00, 1.02) and beliefs toward prescribed medication (OR = 0.95; 95% CI: 0.93, 0.98) were both recognized as the significant predictors of medication adherence in the older women subgroup.Conclusion: Gender based variations were noted regarding the medication adherence in the studied sample and attributes of cognitive function were the main pinpointed elucidating parameters for the non-conformity. The explicit cognitive processes must be considered in care provision or interventional programs that target medication adherence in older adults.Keywords: chronic disease, Iran, medication regimen adherence, older adults