Interventions to enhance in-home taking medication among older adults. A systematic review
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Background: Global population ageing is linked to increasing multimorbidity and polypharmacy. This shift places pressure on caregivers, who often lack training and face challenges like medication mismanagement. Our objective was to collate scientific evidence on interventions to enhance medication management among multimorbid older adults living in the community. Methods: We conducted a systematic review and meta-analysis (PROSPERO: CRD42024513056) following PRISMA guidelines. PubMed, Web of Science, and ClinicalTrials.gov were searched up to July 9, 2024. Eligible studies were RCTs or quasi-experimental designs involving home-dwelling adults aged ≥60 years with ≥2 chronic conditions or ≥5 medications, assessing adherence or health outcomes, and ≥30 days of follow-up. Screening, data extraction, and quality assessment were performed in duplicate. Random-effects meta-analyses were conducted using R. ORs (95% CI) were calculated for binary outcomes and SMDs (95% CI) for continuous variables. Results: Of 7,648 citations, 43 studies met criteria. The Morisky Scale showed a favourable but non-significant effect (OR=1.45; 95% CI 0.86–2.44), and continuous measures showed no effect (SMD=0.00; 95% CI=-0.09–0.10; I²=9%). Readmissions showed a protective effect at medium-term (OR=0.41; 95% CI 0.25–0.69). ED visits were inconclusive due to heterogeneity. Primary care contacts showed a weak, non-significant effect. No effect was found for quality of life or mortality. DRPs and costs lacked conclusive evidence. Risk of bias was high in most studies. Conclusions: No intervention consistently improved adherence or outcomes. This review highlights evidence gaps, including standardised outcomes, long-term effects, economic evaluation, and methodological quality, to optimise future interventions and support evidence-based policymaking. Registration: This systematic review was prospectively registered in PROSPERO with the registration number CRD42024513056.
