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Background Medication non-adherence can exacerbate disease severity, leading to impairments that interfere with self-care activities in older adults, and, ultimately, death. Elder self-neglect is the most common report to Adult Protective Services (APS) across the USA and is a significant risk factor for early mortality. These individuals often suffer from multiple comorbid diseases that require careful management, but for various reasons they are unwilling or unable to provide themselves with the self-care resources necessary for maintaining health and safety. No studies have assessed whether medication adherence is associated with elder self-neglect. Objective The purpose of this study was to assess and describe medication adherence in this population, as well as evaluate associations between medication adherence and cognitive impairment, depression, physical function, and abilities to perform basic and instrumental activities of deily living (BADL5 and IADLs). Methods A cross-sectional study of 100 communitydwelling adults 65 years of age and older with APS-subs:antiated elder self-neglect were assessed. In-home cornprehensive geriatric assessments (CGAs) were completed and included medication reviews. Information on each medication, including the amount taken from the date dispensed, was collected and used to determine adherence. The criteria for non-adherence were taking <80 or >110 % of at least one medication. The sample was also split into groups of low adherence (≤29 %), moderate adherence (29-86 %) and high adherence (≥86 %). Scores on the CGA measures Mini-Mental State Examination, Geriatric Depression Scale, Physical Performance Test (PPT) and Kohlman Evaluation of Living Skills were assessed to determine whether cognitive impairment, depression, physical function, and/or ability to perform BADLs and IADLs were associated with non-adherence or low, moderate or high levels of adherence. Results Twenty-five per cent of the sample was taking more than seven medications daily. The average rate of adherence was 59 %. Only eight participants (10 %) were adherent to their entire medication regimen, and thus, 90 % were considered non-adherent to at least one medication. The mean number of medications to which individuals were non-adherent was 3.4. The cognitive impairment, depression, physical function and BADL/IADL measures were not statistically associated with medication nonadherence using the cut-points of <80 or >110 %. However, when split into tertiles, the lowest medication adherence level (≤29 %) was significantly associated with a greater number of medications being consumed and lower objective physical function levels as measured by the PPT. Conclusions Medication non-adherence is a very prevalent problem among older adults who are self-neglecting, and higher non-adherence levels were associated with the number of medications being consumed as well as lower physical function. Physicians who find high rates of medication non-adherence in their patients should consider barriers to adherence, including a large number of medications, lower physical function and the possibility of elder self-neglect. Future efforts should focus on studying the underlying reasons for medication non-adherence in larger samples of older adults who are self-neglecting. This would facilitate the development of interventions to reduce medication non-adherence in this population. [ABSTRACT FROM AUTHOR]