Medication Adherence of Older Adults with Hypertension: A Systematic Review

Suebsarn Ruksakulpiwat,1 Nicholas K Schiltz,2 Elliane Irani,2 Richard A Josephson,3 Jon Adams,4 Carolyn Harmon Still2 1Department of Medical Nursing, Faculty of Nursing, Mahidol University, Bangkok, Thailand; 2Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA; 3School of Medicine, Case Western Reserve University, Cleveland, OH, USA; 4School of Public Health, The University of Technology Sydney, Sydney, AustraliaCorrespondence: Suebsarn Ruksakulpiwat, Department of Medical Nursing, Faculty of Nursing, Mahidol University, Bangkok, Thailand, Email suebsarn25@gmail.comObjective: Hypertension (HTN) significantly increases the risk of stroke and heart disease, which are the leading causes of death and disability globally, particularly among older adults. Antihypertensive medication is a proven treatment for blood pressure control and preventing complications. However, medication adherence rates in older adults with HTN are low. In this review, we systematically identified factors influencing medication adherence in older adults with HTN.Methods: We applied the PRISMA guidelines and conducted systematic searches on PubMed, MEDLINE, and Google Scholar in July 2022 to identify preliminary studies reporting factors influencing medication adherence among older adults with HTN. The convergent integrated analysis framework suggested by the Joanna Briggs Institute for systematic reviews was adopted for data synthesis.Results: Initially, 448 articles were identified, and after title and abstract screening, 16 articles qualified for full-text review. During this phase, three articles were excluded for reporting on irrelevant populations or focusing on issues beyond the review’s aim, leaving thirteen studies in the final review. After data synthesis, fifteen themes were extracted from the key findings of the included studies. The most prevalent themes included the number of medications used (53.9%, n=7 studies), financial status (38.5%, n=5), sex (38.5%, n=5), age (30.1%, n=4), duration of disease (23.1%, n=3), comorbidities (23.1%, n=3), and health compliance (23.1%, n=3). Other themes, such as education, health literacy, health belief, medication belief, perception of illness, patient-physician relationship, self-efficacy, and social support, were also identified.Conclusion: The findings of this review highlight critical areas for developing innovative, evidence-based programs to improve medication adherence in hypertensive older adults. Insights from this review can contribute to improving medication adherence and preventing future health complications.Keywords: hypertension, medication adherence, older adults, systematic review