Co esponding au ho : Jaide Kuma BR
Copy igh © 2025 Au ho (s) e ain he copy igh o his a icle. This a icle is published unde he e ms o he C ea i e Commons A ibu ion License 4.0.
Impac o ca egi e s and clinical pha macis s in enhancing medica ion adhe ence
among he elde ly
Mahima P akash M D, Sai Meenakshi ha Panyala, Jenni e James, Mahima H K ishna and Jaide Kuma BR *
Depa men o Pha macy P ac ice, JSS College o Pha macy, JSSAHER, Mysu u - 570015, Ka na aka, India.
Wo ld Jou nal o Biology Pha macy and Heal h Sciences, 2025, 24(01), 114-119
Publica ion his o y: Recei ed on 31 Augus 2025; e ised on 06 Oc obe 2025; accep ed on 08 Oc obe 2025
A icle DOI: h ps://doi.o g/10.30574/wjbphs.2025.24.1.0892
Abs ac
Medica ion adhe ence is a c i ical componen o e ec i e heal hca e, pa icula ly among he elde ly who o en ace
challenges such as polypha macy, cogni i e decline and mul iple ch onic condi ions. Non-adhe ence o a he apeu ic
egimen may esul in nega i e ou comes o he pa ien and may be exace ba ed in hem wi h co-mo bidi ies ha
equi e mul iple d ug he apy.
A p ospec i e coho s udy was conduc ed o e six mon hs om No embe 2022–Ap il 2023 in ol ing elde ly
pa icipan s aged mo e han 60 yea s om Mysu u esiden s and a ious ou pa ien depa men s o JSS Hospi al. Da a
was collec ed om wo g oups hose wi h ca egi e s and wi hou ca egi e s. Medica ion adhe ence was assessed using
he Medica ion Adhe ence Ra ing Scale (MARS). Non-adhe en pa icipan s om he g oup wi hou ca egi e s ecei ed
counselling and we e eassessed a e wo mon hs. Ou o 287 pa icipan s, 108 had ca egi e s and 179 did no ha e
ca egi e s. Adhe ence was signi ican ly highe among hose wi h ca egi e s (76.85%) compa ed o hose wi hou
(44.13%). A e counselling, adhe ence in he p e iously non-adhe en g oup imp o ed ma kedly, wi h 51 ou o 100
showing be e adhe ence.
Ca egi e s play a c ucial ole in enhancing medica ion adhe ence among he elde ly. Pa ien counselling p o ed
e ec i e in imp o ing adhe ence. In e en ions ocusing on ca egi e in ol emen and consis en pa ien educa ion a e
essen ial o op imal medica ion managemen in ge ia ic popula ions.
Keywo ds: Medica ion Adhe ence; Elde ly; Polypha macy; Ca egi e s; Pa ien Counselling; MARS Ques ionnai e
1. In oduc ion
India, now he mos popula ed coun y in he wo ld, aces a demog aphic ansi ion wi h a apidly aging popula ion.
Acco ding o a Uni ed Na ions epo , he sha e o India’s popula ion aged 60 and abo e is p ojec ed o inc ease o 20%
by 2050, amoun ing o one in e e y i e indi iduals being elde ly.[1] This signi ican shi places eno mous p essu e on
he heal hca e sys em o p o ide o he complex needs o he elde ly. As indi iduals age, due o mul iple como bid
condi ions such as hype ension, diabe es and ca dio ascula diseases which commonly equi e mo e han i e
medica ions.[2] While polypha macy may be clinically necessa y, i signi ican ly inc eases he isk o ad e se d ug
e en s, d ug in e ac ions and poo adhe ence o medica ion egimens.[3]
Medica ion adhe ence is de ined as he “ex en o which a pa ien akes hei medica ion as p esc ibed by hei
heal hca e p o ide ”. Poo adhe ence is a global conce n, pa icula ly among olde adul s, wi h non-adhe ence
con ibu ing o inc eased mo bidi y, hospi aliza ions and heal hca e cos s.[4][5] Non-adhe ence a es among he
elde ly can ange om 40% o 75%, especially in hose managing ch onic diseases.[3][6] Se e al ac o s con ibu e o
Wo ld Jou nal o Biology Pha macy and Heal h Sciences, 2025, 24(01), 114-119
115
poo adhe ence, including o ge ulness, ad e se e ec s, poo unde s anding o medica ion use, inancial bu den, and
complex dosing schedules.[6][7] Mo eo e , pa ien s’ belie s abou he necessi y and isks o medica ion o en in luence
hei adhe ence beha io s.[6]
Ca egi e s a e indi iduals who assis he elde ly pa ien s in aking hei medica ions, as well as hei o e all needs.
These ca egi e s can ei he be a amily membe o a p o essional a endan who assis he elde ly wi h medica ion
managemen . Ca egi e s play a c i ical ole in o ganizing medica ions, eminding pa ien s o ake hei doses and
moni o ing ea men esponses.[7] In addi ion o ca egi e suppo , pa ien counselling deli e ed by clinical
pha macis s, has shown enhancemen in medica ion and p omo es adhe ence.[8] Counselling helps pa ien s ecognize
he impo ance o consis ency in medica ion use, po en ial side e ec s and he consequences o non-adhe ence.[9]
In India, he issue o poo adhe ence is pa icula ly conce ning, wi h s udies indica ing ha nea ly 50% o pa ien s ail
o ollow p esc ibed ea men s o condi ions like ca dio ascula diseases and diabe es.[10] This is o en exace ba ed
by limi ed access o heal h educa ion, social suppo and ge ia ic-speci ic se ices. The e o e, he e is a need o
implemen s a egies ha ocus on bo h ca egi e in ol emen and pa ien educa ion o imp o e adhe ence in elde ly
popula ions. This s udy aims o assess medica ion managemen p ac ices among elde ly esiden s and o e alua e he
impac o ca egi e p esence and pa ien counselling on medica ion adhe ence.
2. Me hodology
The s udy was designed as a p ospec i e coho s udy and was conduc ed o e a pe iod o six mon hs, om No embe
2022 o Ap il 2023, among elde ly esiden s o Mysu u Ci y. The pa icipan s we e selec ed om a ious ou pa ien
depa men s o he hospi al and esiden s o Mysu u ci y. E hical clea ance o he s udy was ob ained om he
Ins i u ional E hics Commi ee o JSS Medical College, Mysu u.
Pa ien s aged 60 yea s and abo e, o ei he gende , esiding in Mysu u and p esc ibed wi h polypha macy we e included
in he s udy. Those who we e bed idden o had cogni i e impai men s we e excluded. A e ob aining in o med consen
in bo h English and Kannada, he demog aphic de ails, medical his o y and in o ma ion on cu en medica ions we e
collec ed using a da a collec ion o m. Medica ion adhe ence was assessed using he Medica ion Adhe ence Ra ing Scale
(MARS), a 10-i em sel - epo ques ionnai e whe e highe sco es indica e be e adhe ence. Based on he p esence o a
ca egi e , he pa icipan s we e ca ego ized in o wo g oups hose wi h ca egi e s and hose wi hou . The adhe ence
le els in bo h g oups we e compa ed using he MARS sco es. The non adhe en s udy pa icipan s in he g oup wi hou
a ca egi e we e p o ided wi h pa ien counselling by clinical pha macis s. Counselling ocused on he impo ance o
medica ion adhe ence, he consequences o non-adhe ence and he co ec way o ake medica ions. Pa icipan s we e
ollowed up a e wo mon hs and hei adhe ence le els we e eassessed using he same MARS ques ionnai e. Da a
was en e ed in o Mic oso Excel and desc ip i e s a is ics was used o analyze. The indings we e used o de e mine
he impac o ca egi e p esence and pa ien counselling on medica ion adhe ence in he elde ly popula ion.
3. Resul s
A o al o 310 elde ly indi iduals ini ially ag eed o pa icipa e in he s udy. Among which 287 pa icipan s we e
en olled, 108 pa icipan s (37.63%) had ca egi e s, while 179 pa icipan s (62.37%) wi hou ca egi e s. In he
ca egi e g oup, he majo i y we e in he middle-old ca ego y (45.37%) ollowed by young-old (36.11%) and old-old
(18.51%). Pa icipan s wi hou a ca egi e g oup had a highe p opo ion in he young-old ca ego y (49.72%). (Table
1)
Gende dis ibu ion showed a emale p edominance (50.09%) in he ca egi e g oup and male p edominance (53.07%)
in he g oup wi hou ca egi e s. In he ca egi e g oup 74.07% (n=80) we e non-smoke s and non-alcoholics ollowed
by 13.88% (n=15) smoke and alcoholic, 7.40% (n=8) alcoholics and 4.62% (n=5) smoke s. Among he s udy
pa icipan s wi hou a ca egi e g oup 68.15% (n=122) we e non-smoke s and non-alcoholics ollowed by 18.99%
(n=34) smoke and alcoholic, 9.49% (n=17) alcoholics and 3.35% (n=6) smoke s.
Wo ld Jou nal o Biology Pha macy and Heal h Sciences, 2025, 24(01), 114-119
116
Table 1 Socio-Demog aphic o he pa icipan s
Cha ac e is ics
Ca ego y
Wi h ca egi e (n=108)
Wi hou ca egi e (n=179)
Age
Young old (60-69)
39 (36.11%)
89 (49.72%)
Middle old (70-79)
49 (45.37%)
67 (37.43%)
Old-Old (>80)
20 (18.51%)
23 (12.8%)
Gende
Male
53 (49.07%)
95 (53.07%)
Female
5 (50.09%)
84 (46.92%)
Social habi s
Smoke and alcoholic
15 (13.88%)
34 (18.99%)
Non-smoke and non-alcoholic
80(74.07%)
122(68.15%)
Smoke
5 (4.62%)
6 (3.35%)
Alcoholic
8 (7.40%)
17 (9.49%)
MARS ques ionnai e esponses e ealed dis inc di e ences in adhe ence beha io be ween he wo g oups. 20.37% o
pa icipan s wi h ca egi e s epo ed o ge ing o ake hei medica ion, compa ed o 64.24% wi hou ca egi e s.
Simila ly, 49.07% o he ca egi e g oup admi ed o being ca eless abou aking medicines and 77.09% in he wi hou -
ca egi e g oup. (Table 2)
In e ms o s opping medica ion when eeling be e , only 11.11% o he ca egi e g oup epo ed his beha io ,
compa ed o 27.37% in he non-ca egi e g oup. A ound 60.89% wi hou ca egi e s op aking medicine a e eeling
wo se. Mo eo e , 100% o he ca egi e g oup belie ed ha s aying on medica ion could p e en illness, compa ed o
91.62% in he g oup wi hou ca egi e s.
Table 2 Ques ionnai e Responses
Ques ions
Wi h ca egi e
(n=108)
Wi hou
ca egi e
(n=179)
Do you e e o ge o ake you medica ion?
Yes 22 (20.37%)
No 86 (79.6%)
Yes 115(64.24%)
No 64 (35.7%)
A e you ca eless a imes abou aking you medicines?
Yes 53(49.07%)
No 55 (50.92%)
Yes 138(77.09%)
No 41 (22.90%)
When you eel be e do some imes s op aking you medicines?
Yes 12 (11.11%)
No 96 (88.8%)
Yes 49 (27.37%)
No 130 (72.62%)
Some imes i you eel wo se when you ake he medicine, do you s op aking
i ?
Yes 69 (63.88%)
No 39 (36.11%)
Yes 109 (60.89%)
No 70 (39.10%)
I ake my medica ion only when I am sick.
Yes 1 (0.92%)
No (99.07%)
Yes 10(5.58%)
No 169 (94.41%)
I is unna u al o my mind and body o be con olled by medica ion.
Yes 91 (84.25%)
No 17 (15.74)
Yes 141 (78.77%)
No 38 (21.22%)
My hough s a e clea e on medica ion.
Yes 90(83.33%)
No 18(16.66%)
Yes 123 (68.71%)
No 56 (31.28%)
By s aying on medica ion, I can p e en ge ing sick.
Yes 108 (100%)
No 0
Yes 164 (91.62%)
No 15 (8.37%)
I eel wei d like a zombie on medica ion.
Yes 8 (7.40%)
No 100
(92.59%)
Yes 13 (7.26%)
No 166 (92.73%)
Medica ion makes me eel i ed and sluggish.
Yes 23(21.29%)
No 85 (78.70%)
Yes 82(45.81%)
No 97 (54.18%)
Wo ld Jou nal o Biology Pha macy and Heal h Sciences, 2025, 24(01), 114-119
117
Medica ion adhe ence was assessed using he Medica ion Adhe ence Ra ing Scale (MARS). In he ca egi e g oup,
76.85% (83 pa icipan s) we e classi ied as adhe en , while only 44.13% (79 pa icipan s) wi hou -ca egi e g oup
we e adhe en . This clea ly indica es ha he p esence o ca egi e s signi ican ly imp o es adhe ence among elde ly
pa ien s. (Table 3)
Assessmen o medica ion adhe ence o bo h g oups we e done by asking ques ions om MARS ques ionnai e. I was
ound ha among he 108 s udy pa icipan s who had a ca egi e 83 (76.85%) we e adhe en and 25 (23.14%) we e
non adhe en . Among he 179 s udy pa icipan s who did no ha e a ca egi e i was ound ha 100 (55.86%) we e non
adhe en and 79 (44.13%) we e adhe en . The 100 non-adhe en s udy pa icipan s om he g oup wi hou ca egi e
was p o ided wi h counselling ega ding he impo ance o medica ion adhe ence and we e ollowed up a e wo
mon hs. The s udy pa icipan s who ecei ed counselling we e ollowed up and hei adhe ence was assessed again by
MARS ques ionnai e. I was ound ha 130 (54.83%) s udy pa icipan s’ adhe ence imp o ed pos counselling and 42
(45.96%) emained non adhe en .
Table 3 Adhe ence Assessmen
Ca ego y
Adhe en
Non-adhe en
Wi h Ca egi e (n=108)
83 (76.9%)
25 (23.1%)
Wi hou Ca egi e (n=179)
79 (44.1%)
100 (55.9%)
Be o e pa ien counselling (Wi hou ca egi e , n=179)
79 (44.1%)
100 (55.9%)
A e pa ien counselling (Wi hou ca egi e , n=179)
130 (54.83%)
49 (45.96%)
4. Discussion
This s udy assessed he medica ion managemen p ac ices among elde ly esiden s in Mysu u, ocusing on he impac
o ca egi e p esence and pa ien counselling on medica ion adhe ence. This s udy indica es ha elde ly indi iduals
abo e 60 yea s wi h ca egi e s exhibi ed signi ican ly highe adhe ence (76.85%) compa ed o hose wi hou
ca egi e s (44.13%). Mo eo e , pa ien counselling imp o ed adhe ence in 51% o non-adhe en pa icipan s,
unde lining he e ec i eness o di ec pa ien educa ion.
The ole o socio-demog aphic ac o s also canno be igno ed. Male pa icipan s and hose in he younge -old ca ego y
(60–69 yea s) we e mo e o en non-adhe en , which is consis en wi h he indings o Smaje e al., who epo ed ha
gende and age can in e sely a ec medica ion adhe ence.[11]
The p esence o ca egi e s signi ican ly imp o ed adhe ence le els in his s udy. Ca egi e s help b idge he gap
be ween complex medica ion egimens and pa ien limi a ions, including cogni i e decline and low heal h li e acy. P io
s udies ha e highligh ed he c ucial ole ca egi e s play in ensu ing medica ion is aken co ec ly, managing side e ec s
and p o iding emo ional suppo Resea ch by Muñoz-Con e as e al. suppo s ou indings, showing ha ca egi e
in ol emen imp o es adhe ence, especially in pa ien s wi h demen ia o mul iple ch onic condi ions.[12]
The in e en ion o pa ien counselling also showed p omising esul s. Ou o 100 ini ially non-adhe en pa icipan s
who ecei ed counselling, 51 demons a ed imp o ed adhe ence upon ollow-up. Counselling p o ides elde ly pa ien s
wi h cla i y on he impo ance o medica ion use, consequences o non-adhe ence and he bene i s o adhe ence, e en
when symp oms imp o e. This aligns wi h p e ious indings ha emphasize he need o con inuous educa ion o
coun e ac in en ional non-adhe ence and misbelie s abou medica ions.[E o ! Re e ence sou ce no ound.E o !
Re e ence sou ce no ound.,E o ! Re e ence sou ce no ound.] S udies ha e shown ha pe sonalized counselling,
especially by clinical pha macis s, can posi i ely in luence pa ien ou comes in ch onic disease managemen .[13]
Mo eo e , pa icipan s wi hou ca egi e s we e mo e likely o o ge medica ion o s op i p ema u ely due o side
e ec s o eeling be e , beha io s ha align wi h hose desc ibed by Si ey e al., who no ed ha up o 41% o olde
adul s epo a leas one non-adhe en beha io due o psychological o p ac ical ba ie s.[14] These include
o ge ulness, nega i e belie s abou medica ion and cos conce ns all ele an o he popula ion s udied he e.
Ano he ac o con ibu ing o non-adhe ence is he complexi y o ea men egimens in polypha macy. The
associa ion be ween polypha macy and ad e se ou comes, including inc eased mo ali y and hospi aliza ions, has been
documen ed in s udies such as hose by Huang e al. and B ahma e al.[15][16] In e en ions such as egula medica ion
Wo ld Jou nal o Biology Pha macy and Heal h Sciences, 2025, 24(01), 114-119
118
e iews, as ecommended by C oss e al., can help s eamline he apy and educe pill bu den, he eby suppo ing be e
adhe ence.[17]
The posi i e impac o pha macis -led in e en ions is well-suppo ed by Ma cum e al., who ound ha adhe ence
imp o ed signi ican ly when pa ien s ecei ed educa ion and ollow-up om pha macis s.[18] Simila ly, Capiau e al.
concluded ha medica ion counselling p o ided p io o hospi al discha ge helps imp o e knowledge, educe
eadmissions and suppo adhe ence, especially among he elde ly.[19]
In u al and esou ce-limi ed se ings, he lack o ca egi e suppo and minimal access o heal h educa ion ools
exace ba e he issue. Look and S one ound ha u al ca egi e s play an indispensable ole in he managemen o elde ly
pa ien s’ medica ions, especially when o mal heal h sys ems a e unde - esou ced.[20] This emphasizes he need o
inco po a e ca egi e suppo in o na ional elde ly heal hca e policies.
The s udy indica es ha non-adhe ence is mul i ac o ial, in ol ing pe sonal, sys emic and he apeu ic componen s. As
highligh ed by Balk ishnan, in e en ions mus be mul i ace ed and ailo ed o add ess bo h modi iable and non-
modi iable p edic o s o adhe ence.[21]
5. Conclusion
This s udy highligh s he signi ican challenges associa ed wi h medica ion managemen among he elde ly popula ion
in Mysu u Ci y, pa icula ly in he con ex o polypha macy and age- ela ed cogni i e and physical limi a ions. The
indings demons a e ha he p esence o a ca egi e plays a c ucial ole in imp o ing medica ion adhe ence. Elde ly
indi iduals wi h ca egi e s showed signi ican ly highe adhe ence le els compa ed o hose wi hou . Fu he mo e,
pa ien counselling was ound o be an e ec i e in e en ion in enhancing adhe ence among non-complian indi iduals.
By educa ing pa ien s abou he impo ance o medica ion adhe ence and p ope usage, heal hca e p o essionals,
especially clinical pha macis s, can posi i ely in luence ea men ou comes. The e o e, in eg a ing ca egi e suppo
and egula pa ien counselling in o ge ia ic ca e s a egies is essen ial o p omo ing be e medica ion adhe ence,
educing ad e se heal h ou comes and imp o ing he o e all quali y o li e in he elde ly.
Compliance wi h e hical s anda ds
Acknowledgmen s
The au ho s a e g a e ul o he P incipal, all he Facul ies o Depa men o Pha macy P ac ice, JSS College o Pha macy,
Mysu u, Communi y Pha macis s, pa ien s and leade ship o JSS AHER o hei cons an suppo and guidance.
Disclosu e o con lic o in e es
The au ho s ha e no con lic s o in e es o decla e ha a e ele an o he con en o his a icle.
E hical App o al
E hical clea ance o he s udy was ob ained om he Ins i u ional E hics Commi ee o JSS Medical College, Mysu u.
S a emen o in o med consen
In o med consen was ob ained om all indi idual pa icipan s included in he s udy.
Re e ences
[1] PTI. Sha e o popula ion o e age o 60 in India p ojec ed o inc ease o 20% in 2050: UN. Economic Times. 2019,
h ps://economic imes.india imes.com/news/poli ics-and-na ion/sha e-o -popula ion-o e -age-o -60-in-
india-p ojec ed- o-inc ease- o-20-in-2050-un/a icleshow/68919318.cms, Las accessed on 13/04/2023
[2] Ross SM. De ining polypha macy and unde s anding i s isks and bene i s. Cu ea .com. 2021,
h ps://blog.cu ea .com/de ining-polypha macy-and-unde s anding-i s- isks-and-bene i s, Las accessed on
13/04/2023
[3] Alhabib MY, Alhazmi TS, Alsaad SM, AlQah ani AS, Alna isah AA. (2022). Medica ion adhe ence among ge ia ic
pa ien s wi h ch onic diseases in Riyadh, Saudi A abia. Pa ien P e e Adhe ence. 10.2147/PPA.S363082
Wo ld Jou nal o Biology Pha macy and Heal h Sciences, 2025, 24(01), 114-119
119
[4] Dobbels F, Van Damme-Lombae R, Vanhaecke J, De Gees S. (2005) G owing pains: non-adhe ence wi h he
immunosupp essi e egimen in adolescen ansplan ecipien s. Pedia ic T ansplan a ion. 10.1111/j.1399-
3046.2005.00356.x
[5] Neiman AB, Ruppa T, Ho M, Ga be L, Weidle PJ, Hong Y, e al. (2017) CDC g and ounds: Imp o ing medica ion
adhe ence o ch onic disease managemen — inno a ions and oppo uni ies. Mo bidi y and Mo ali y Weekly
Repo . 10.15585/mmw .mm6645a2
[6] Ho ne R, Chapman SCE, Pa ham R, F eeman le N, Fo bes A, Coope V. (2013) Unde s anding pa ien s’ adhe ence-
ela ed belie s abou medicines p esc ibed o long- e m condi ions: a me a-analy ic e iew o he Necessi y-
Conce ns F amewo k PLOS One. 10.1371/jou nal.pone.0080633
[7] Shockney LD. The ole o ca egi e s in ensu ing pa ien adhe ence o o al oncoly ic he apy. Conque . 2016
h ps://conque -magazine.com/issues/2016/ ol-2-no-1- eb ua y-2016/333- he- ole-o -ca egi e s-in-
ensu ing-pa ien -adhe ence- o-o al-oncoly ic- he apy Las accessed on 13/04/2023
[8] The a P. Impo ance o pa ien counselling o apid eco e y. Medium. 2017
h ps://medium.com/@p iya. he a /impo ance-o -pa ien -counselling- o - apid- eco e y-5c65 183a9a2
Las accessed on 13/04/2023
[9] K a ns öm K, Wes e holm A, Ai aksinen M, Lii a H. (2021) Fac o s con ibu ing o medica ion adhe ence in
pa ien s wi h a ch onic condi ion: A scoping e iew o quali a i e esea ch. Pha maceu ics.
10.3390/pha maceu ics13071100.
[10] Sandilya S. ‘Lack o adhe ence o medical aid is a c i ical public heal h challenge.’ The Indian Exp ess. 2021 Oc 6
h ps://indianexp ess.com/a icle/ci ies/pune/lack-o -adhe ence- o-medical-aid-is-a-c i ical-public-heal h-
challenge-7555016/, Las accessed on 13/04/2023
[11] Smaje A, Wes on-Cla k M, Raj R, O lu M, Da is D, Rawle M. (2018) Fac o s associa ed wi h medica ion adhe ence
in olde pa ien s: A sys ema ic e iew. Aging Med (Mil on). 10.1002/agm2.12045.
[12] Muñoz-Con e as MC, Sega a I, López-Román FJ, Gale a RN, Ce dá B. (2022) Role o ca egi e s on medica ion
adhe ence managemen in polymedica ed pa ien s wi h Alzheime ’s disease o o he ypes o demen ia. F on
Public Heal h. 10.3389/ pubh.2022.98793
[13] Jimmy B, Jose J. (2011) Pa ien medica ion adhe ence: measu es in daily p ac ice. Oman Medical Jou nal.
10.5001/omj.2011.38
[14] Si ey JA, G een ield A, Weinbe ge MI, B uce ML. (2013). Medica ion belie s and sel - epo ed adhe ence among
communi y-dwelling olde adul s. Clinical The apeu ics 10.1016/j.clin he a.2013.01.001
[15] Huang Y-T, S ep oe A, Wei L, Zanino o P. (2021). The impac o high- isk medica ions on mo ali y isk among
olde adul s wi h polypha macy: e idence om he English Longi udinal S udy o Ageing. BMC Medicine.
10.1186/s12916-021-02192-1.
[16] B ahma DK, Wahlang JB, Ma ak MD, Ch Sangma M. (2013). Ad e se d ug eac ions in he elde ly. Jou nal o
Pha macology and Pha maco he apeu ics. 10.4103/0976-500X.110872
[17] C oss AJ, Ellio RA, Pe ie K, Ku u illa L, Geo ge J. (2020). In e en ions o imp o ing medica ion- aking abili y
and adhe ence in olde adul s p esc ibed mul iple medica ions. Coch ane Da abase Sys emic Re iew.
10.1002/14651858.CD012419.pub2.
[18] Ma cum ZA, Jiang S, Bacci JL, Ruppa TM. (2021). Pha macis -led in e en ions o imp o e medica ion adhe ence
in olde adul s: A me a-analysis. Jou nal o Ame ican Ge ia ic Socie y. 10.1111/jgs.17373
[19] Capiau A, Foube K, Van de Linden L, Walg ae e K, Hias J, Spinewine A, e al. (2020) Medica ion counselling in
olde pa ien s p io o hospi al discha ge: A sys ema ic e iew. D ugs and Aging. 10.1007/s40266-020-00780-z
[20] Look KA, S one JA. (2019). Con ex ual ac o s in luencing medica ion managemen by u al in o mal ca egi e s
o olde adul s. Resea ch in Social and Admins a i e Pha macy. 10.1016/j.sapha m.2018.10.007
[21] Balk ishnan R. (1998). P edic o s o medica ion adhe ence in he elde ly. Clinical The apeu ics: 10.1016/s0149-
2918(98)80139-2
