Medication adherence feedback with older adults with cognitive impairment: a mixed Methods study

Objective: Older adults with cognitive impairment are at risk of medication-taking errors. This study assessed the impact of providing medication adherence feedback to cognitively impaired older adults. Methods: Forty participants with mild cognitive impairment or mild dementia had their medication adherence electronically monitored for 8 weeks. They were provided with verbal and visual feedback about their adherence results. Initial participant reactions were elicited using a Motivational Interviewing approach, and self-reported behavior changes were assessed during a follow-up interview. Quantitative analyses assessed relationships among electronically monitored and self-rated adherence, initial reactions to adherence feedback, and subsequently reported medication self-management changes. Thematic analysis determined facilitators and barriers to making self-management changes. Results: Although self-rated adherence was high, electronic monitoring revealed that 20% of the sample had suboptimal adherence (took the recommended dose on <80% of monitored days). Fifty-three percent of the sample reported feeling surprised by their adherence results, and 45% endorsed initial motivation to change self-management behaviors. Motivated participants demonstrated worse electronically monitored adherence than unmotivated peers, and those who were surprised by their medication-taking errors expressed greater initial motivation to change. At follow-up, 50% reported having made changes, and 82.4% of them indicated that this study played a role. Facilitators of making changes included awareness of medication-taking errors and cognitive impairment, whereas barriers included lack of perceived difficulty/need. Conclusions: Adherence monitoring with feedback is feasible and impactful in cognitively impaired older adults. Increasing awareness of medication-taking errors fosters motivation to improve medication self-management and results in participant-reported behavior change.