Characteristics and clinical correlates of objective medication adherence in older adults with cognitive impairment

Objective: Older adults are at risk of medication nonadherence. However, clinical correlates of objective adherence are understudied in those with neurocognitive disorders who self-manage medications. Method: Eighty-three older adults with neurocognitive disorders who self-manage medications completed two months of adherence monitoring using pill counts and medication event monitoring systems (MEMS). Because some participants used MEMS inconsistently, MEMS analyses were restricted to Consistent Users (n = 65). Cognitive domains (Attention/Processing Speed [AP], Executive Functioning [EF], Memory), Medication Management Ability Assessment (MMAA) performance, and self-reported compensatory strategy use were examined as correlates. Results: Suboptimal adherence was common: 46% demonstrated ≤90% pill count adherence (16% <80%), and 39% demonstrated ≤90% MEMS adherence (23% <80%). Inconsistent MEMS Users showed poorer Memory performance but comparable pill count adherence to Consistent MEMS Users, suggesting memory affected successful device integration rather than medication-taking behavior. Clinical correlates of adherence varied: pill count accuracy related to AP and MMAA, whereas MEMS accuracy related to EF. Although AP and EF were related to the MMAA, only MMAA performance uniquely predicted high- and low-adherence group classification. Compensatory strategy use was commonly reported but unrelated to overall adherence; yet, those with high adherence showed relationships between more frequent strategy use and AP/EF when performance was lower. Conclusions: Performance-based assessments identify cognitively impaired older adults at risk for medication nonadherence. While compensatory strategies are utilized, effectiveness may vary by insight into weaknesses and/or strategy quality. Difficulties in AP, EF, and MMAA performance may therefore signal need for medication monitoring to guide targeted interventions to support adherence.