Improving medication adherence: moving from intention and motivation to a personal systems approach.

Medication nonadherence is a challenging and prevalent problem in older adults. Effective medication management involves successfully completing a complex group of behaviors. Meta-analyses and narrative review findings support limited benefits to medication adherence with interventions preoccupied with personal characteristics, intention, and motivation. Evidence supports a paradigm shift toward changing personal systems in which the person lives to improve and maintain medication adherence behavior. Personal-systems change systematically improves individual systems through collaboratively shaping routines, involving supportive-others in routines, and using medication self-monitoring to improve and maintain behavior. Other advances that support personal systems change are also presented.