Editor's note: This text-based course was presented by Fawn Carson, OTD, OTR/L, ATP.
This content was created by Continued with AI assistance.
Learning Outcomes
- After this course, participants will be able to identify five areas of medication management as determined by AOTA's position paper.
- After this course, participants will be able to list two assessment tools used for medication management.
- After this course, participants will be able to list two intervention strategies and two resources for helping clients to manage medications.
Introduction
The first part of this course focuses on the American Occupational Therapy Association’s (AOTA) position paper, which outlines the role of occupational therapy practitioners (OTPs) in medication management. It introduces the key components of occupational therapy interventions in this area. Updates to the Occupational Therapy Practice Framework, 4th edition (OTPF‑4, 2020), broaden the scope of occupational therapy’s role by incorporating digital health literacy and telehealth‑based interventions. The course draws on real-world experiences, highlighting instances where policy directly influences clinical decision-making, especially in home health and outpatient settings, where medication routines are central to safety and daily functioning.
Recent clinical research expands our understanding of how occupational therapy interventions impact medication adherence. For example, Garrison et al. (2023) evaluated the Integrative Medication Self-Management (IMedS) program in primary care, demonstrating measurable improvements in adherence when OT-led strategies were implemented. Similarly, a 2023 feasibility study (Somerville et al., 2023), "Tailored Intervention for Medication Management," conducted by occupational therapists both in person and remotely, underscores the growing role of telehealth-based interventions in supporting medication adherence. These emerging studies reflect the evolution of occupational therapy practice from traditional education toward evidence-driven, structured programs that integrate medication management within real-world routines.
Participants will also examine the daily interventions that OTPs use to support medication adherence and safety, including strategies for activity modification, reviews of assistive equipment, and case studies based on home-based practice.
Throughout the course, the overarching aim is to bridge the gap between policy and practice by demonstrating how occupational therapy’s unique perspective promotes safe medication use while empowering clients to participate more fully in their everyday lives.
AOTA's Position Paper on Medication Management
We will start by discussing the American Occupational Therapy Association’s (AOTA) 2017 position paper on medication management. This foundational document offers a clear framework for understanding the occupational therapy practitioner’s role in supporting medication-related activities and includes several key statements that merit attention. It opens with the following definition:
“Medication management is an instrumental activity of daily living (IADL) of taking medications as prescribed. Medication management is a complex activity with many components, including negotiating with the provider for a prescription, filling the prescription at the pharmacy, interpreting complicated health information, taking the medication as prescribed, and maintaining an adequate supply of medication for ongoing use.”
This comprehensive description highlights the multifaceted nature of medication management. Far from being limited to remembering to take a pill, the process involves a series of cognitive, physical, and emotional steps—each of which may pose challenges based on a client’s functional abilities.
The position paper emphasizes the interprofessional nature of the medication management team, identifying prescribers, pharmacists, nursing staff, and occupational therapy practitioners as essential members. Prescribers are broadly defined to include physicians, physician assistants, nurse practitioners, advanced practice nurses, dentists, and optometrists. By explicitly including OTPs in this team, the paper affirms their evolving and essential role in helping clients manage medications safely and effectively.
Before delving into these roles in greater detail, the course pauses to explore why medication management matters—not only improves client outcomes but also shapes how occupational therapy practitioners define and advocate for their scope of practice. To underscore the significance of this topic, the course introduces compelling statistics that frame the importance of effective medication management and set the stage for deeper exploration.
Medication Adherence
Now, let's establish a common understanding of what we mean when we talk about medication adherence. This foundational concept will guide everything else we discuss today.
The World Health Organization (WHO) Definition
The World Health Organization (WHO) defines medication adherence as “the extent to which a person’s behavior—taking medication, following a diet, and/or executing lifestyle changes—corresponds with agreed recommendations from a health care professional.” This definition highlights a more comprehensive and realistic view of medication management. It emphasizes patient engagement and collaboration, core values within occupational therapy.
What makes this definition notable is its breadth. It moves beyond the simplistic notion of pill-taking and incorporates related behaviors such as maintaining dietary guidelines or committing to lifestyle changes. Occupational therapy practitioners often encounter clients for whom medication use is just one element of a larger treatment plan. These plans may involve walking programs, food preparation routines, or fatigue management. Client outcomes improve when these elements are coordinated with a medication routine.
Shift From Compliance to Adherence
The World Health Organization offers a five‑dimensional model for understanding adherence barriers, emphasizing patient‑related, therapy‑related, condition‑related, health‑system, and social/economic influences. This framework aligns closely with occupational therapy’s holistic approach, allowing practitioners to identify how these interacting dimensions affect a client’s ability to follow a regimen and target interventions accordingly.
The shift from “compliance” to “adherence” reflects a significant evolution in understanding the therapeutic relationship. While “compliance” implies a passive, directive model—where the provider issues instructions and the client is expected to follow them—“adherence” recognizes the client’s autonomy and emphasizes shared decision-making (Mir, 2023). This distinction is often evident in practice, particularly with clients who initially resist new medication regimens but become more engaged when allowed to express concerns and collaborate on decisions regarding timing, dosage, or side effects.
This patient-centered, collaborative model is foundational to occupational therapy. It aligns seamlessly with principles such as habit training, activity analysis, and environmental modification. Occupational therapy practitioners routinely help clients develop strategies that embed medication routines into meaningful daily activities—organizing a pillbox, adjusting a morning schedule, or adapting physical spaces to support consistency.
The concept of 100% adherence refers to all prescribed doses being taken as intended, within a treatment plan the client has agreed to and can realistically maintain. Though ambitious, this goal becomes more attainable when clients are supported through individualized therapy, empowered to take ownership of their health, and equipped with tools and strategies that fit their daily lives.
Calculating Medication Adherence
A basic formula for calculating medication adherence is pills consumed divided by pills prescribed. This simple fraction—such as two consumed over two prescribed, resulting in 1—was widely used to represent perfect adherence, or 100%. It was an accessible and practical tool, particularly useful in fast-paced or resource-limited clinical settings where straightforward metrics were essential.
Since then, the understanding and measurement of adherence have advanced considerably. Although pill counts remain in use due to their ease and affordability, they are now recognized as potentially inaccurate or incomplete. Some clients, for instance, have been known to "pill dump" before home visits to create the illusion of adherence. In contrast, others may unintentionally lose or misplace pills, leading to inflated estimates if counts are used in isolation.
Modern approaches to adherence measurement are more nuanced and precise. Technological innovations like Medication Event Monitoring Systems (MEMS) can record the exact time a pill bottle is opened, providing reliable data on timing and frequency. Electronic pillboxes and blister packs now feature near field communication (NFC) technology to log when doses are removed. Some systems go even further with ingestible sensors and wearable patches that verify ingestion in real time.
Pharmacy data has also become a valuable source of insight, especially in large-scale healthcare settings. Metrics such as the Medication Possession Ratio (MPR) and the Proportion of Days Covered (PDC) use dispensing records to gauge consistency in medication access. While not without limitations, these tools can reveal patterns and gaps that might otherwise go unnoticed.
The subjective experience remains essential as well. Despite its susceptibility to bias, self-reported adherence is still widely employed. Instruments like the Morisky Medication Adherence Scale (MMAS), structured interviews, and medication diaries help capture emotional, cognitive, and routine-based factors influencing adherence—elements frequently addressed in occupational therapy sessions. In many cases, a client’s misunderstanding or anxiety surrounding a medication regimen has had a more profound effect on adherence than logistical barriers.
Additional specialized strategies are available when needed. Therapeutic drug monitoring measures the presence of medication in the bloodstream, confirming ingestion. At the same time, Direct Observation Therapy (DOT) ensures medication is taken under professional supervision, critical in high-risk and public health contexts. Emerging analytic methods, such as group-based trajectory modeling (GBTM), allow researchers to categorize adherence patterns over time, offering insights into population-level behaviors and facilitating more targeted interventions.
Though the original pill-based formula remains a useful teaching reference, current best practices acknowledge the complexity of medication use in daily life. A holistic, multi-method approach—integrating technology, pharmacy data, patient self-report, and clinical observation—offers a far richer and more accurate picture of adherence. For OTPs, understanding and applying these tools is key to selecting effective interventions and contributing meaningfully to interdisciplinary care.
Medication Non-adherence
Now let's examine the flip side - medication non-adherence - and why this is such a critical issue that demands our attention. Adherence to medication routines remains a persistent challenge across healthcare settings.
Average Non-adherence
Foley and colleagues (2021) found that the range of reported non-adherence was approximately between 44% and 76.5%, depending on the type of reporting. The pooled prevalence of non-adherence was 42.6%. These figures are particularly concerning given the critical role that medication routines play in managing chronic conditions and maintaining safety in everyday life.
In 2017, Schwartz and Smith emphasized that the central goal of medication management interventions should be to support clients in achieving perfect or near-perfect adherence. Of particular note was their assertion that OTPs are uniquely positioned to support this outcome. They wrote, “As a profession, occupational therapy has an opportunity to enable millions of Americans to have healthy, productive lives by enhancing medication management performance and subsequent medication adherence.” This statement underscores the distinctive, function-based perspective occupational therapy brings to health management and deeply resonates with the profession's values.
Despite this potential, Schwartz and Smith identified a concerning gap in the literature and practice. At the time of their study, only 25% of surveyed occupational therapy practitioners reported addressing medication adherence goals with their clients. Furthermore, the study revealed limited OT-specific research focused on this intervention area. This disconnect is striking, especially in light of the practical, daily-life challenges clients face with medication routines and the demonstrated benefits of occupational therapy’s holistic, client-centered approach. The findings point to a clear and compelling opportunity for growth within the profession that calls for greater clinical attention, research, and advocacy around occupational therapy’s role in medication management.
Non-adherence Across Populations
A study from 2017 by Miralee and colleagues adds further context by documenting the serious consequences of medication noncompliance, including mortality and significant declines in health. As former U.S. Surgeon General C. Everett Koop famously stated, “Drugs don’t work in patients who don’t take them.” That quote resonates deeply with our perspective as occupational therapy practitioners. If clients aren’t taking their medications properly, our interventions may not have the intended effect—or worse, their non-adherence may be the very reason they need our help in the first place. We’ve worked with clients whose functional deficits could have been avoided or minimized had their medication regimens been followed consistently and effectively. For example, clients may have orthostatic hypotension, falls, or dizziness, and they may have cardiac issues if they're taking their medication at the incorrect time for when it was prescribed or the wrong dosage; these medication noncompliance factors contribute to why we see them for occupational therapy services. It's almost like a domino effect that plays into several other issues that may directly impair ADL function, balance, and endurance.
In a recent study by Ge, Heng, and Yap (2023), several compelling patterns emerged that underscore the complexity and variability of medication adherence across different age groups. The study found that non-adherence was significantly higher among young adults, with a rate of 38.4%, compared to 22.3% in older adults. What stood out most was that young adults were likelier to report unintentional and intentional non-adherence. Despite their differences, both groups shared a common concern: fear of developing drug dependency, reported by 74.8% of young adults and 73.5% of older adults. Interestingly, difficulty understanding medication labels was reported more often in older adults (8.8%) than young adults (3.7%).
The presence of depressive symptoms was a strong predictor of non-adherence in both groups, with significant odds ratios that highlighted elevated risk. Other influencing factors included employment status, the number of medications taken, personal income, smoking habits, and chronic health conditions such as diabetes, hypertension, and dyslipidemia. These findings reveal how multidimensional medication adherence is, shaped by psychological, cognitive, behavioral, and socio-economic factors.
These results align closely with clinical experiences in assisted living facilities and independent retirement communities. Over the past decade, there have been many positive changes in home healthcare delivery—improved access to healthcare providers, proactive education on prevention, stronger follow-up systems, and broader community support services. These shifts have supported aging in place more effectively than ever before.
Yet, even with these advancements, medication management remains an area where care frequently falls short. Too often, we see the responsibility for managing medications default entirely to nursing staff, regardless of the setting or the individual’s functional capacity. We've witnessed firsthand how residents struggle with aspects of medication adherence, whether due to cognitive limitations, poor organization, or simply a lack of engagement in their care. Nursing staff, focused primarily on administration and documentation, can often not assess or intervene from a performance-based or behavioral standpoint. This is where OTPs can offer vital contributions.
One promising initiative in this space is the Integrative Medication Self-Management Intervention (IMedS), a manualized OT intervention designed to improve adherence. This program helps individuals build new medication habits and integrate them into daily routines through structured therapeutic strategies. While IMedS holds tremendous potential to support long-term behavior change, it has not yet been tested in community-based clinical settings. That gap represents a challenge and an opportunity our profession should actively explore.
An additional layer to consider is deprescribing, a structured, interprofessional approach to reducing unnecessary or harmful medications. While typically led by prescribers or pharmacists, deprescribing intersects with occupational therapy when medication burden affects safety, cognition, or participation in daily activities. Occupational therapy practitioners can advocate for regimen simplification by providing functional insights on how polypharmacy impacts occupational performance.
In primary care, occupational therapy practitioners are uniquely positioned to deliver meaningful assessment and intervention around medication adherence. We can evaluate environmental barriers, identify cognitive or sensory processing challenges, and understand lifestyle routines that might interfere with consistent medication use. Drawing on our training in habit formation, routine development, adaptive strategies, and client-centered problem-solving, we can help clients successfully integrate medication routines into their daily lives.
Important Considerations for OTPs
Next, we will take a look at important considerations for OTPs.
Two Critical Questions
After reviewing these statistics and studies, two critical questions emerge for occupational therapy practitioners: Are we truly treating the primary health condition or responding to functional impairments caused by underlying medication noncompliance? Perhaps even more urgently, why do adherence rates remain persistently low despite increased awareness and growing support systems?
In 2012, Gadkari and McHorney conducted a large-scale survey that identified three of the most common reasons people fail to adhere to medication regimens: they forget, run out of medication, or find it challenging to keep up with the prescribed schedule. These may appear to be minor logistical problems, but their cumulative effects on health outcomes and functional independence—especially in populations with complex needs—can be substantial.
In 2016, Richie et al. examined the financial dimensions of adherence and highlighted the burden of medication costs. For fixed-income individuals, prescriptions often compete with essential expenses, such as food, housing, and utilities. Occupational therapy practitioners working in home-based settings frequently encounter clients who manage these competing priorities by cutting pills in half, skipping doses, or going without medication altogether. These situations reflect not a lack of compliance but rather a lack of access.
Also in 2016, Con, Enrique, Ruper, and Chan explored the role of health literacy. Their findings underscored the difficulty many clients face in navigating the healthcare system—understanding prescription instructions, coordinating refills, managing insurance and co-pays, and scheduling appointments—all of which require cognitive and executive functioning skills that not all clients possess. When these cognitive or systemic challenges go unaddressed, adherence suffers.
In 2025, Chapman and Chan offered a more contemporary and integrated framework. Their study categorized adherence barriers into five domains: patient-related, condition-specific, treatment-related, healthcare system limitations, and broader social or economic influences. They also introduced a crucial distinction between practical or unintentional non-adherence (e.g., forgetting, affordability) and perceptual or intentional non-adherence (e.g., distrust of medication, fear of side effects, emotional resistance). This distinction reframes non-adherence not as defiance or neglect but as a potentially rational response to lived experiences and personal belief systems.
Recent evidence also highlights a gap between self‑reported adherence and what is observed during performance‑based assessments (Schwartz et al., 2024). This reinforces the importance of direct task observation for occupational therapy practitioners—watching clients perform their medication routines in context—to capture barriers that may not emerge through interviews or standardized scales alone.
These findings strongly align with occupational therapy’s practice model. For successful adherence, three elements must intersect: client capacity (including cognitive and physical abilities), an enabling environment (with tools and supports), and internal motivation (rooted in the belief that the medication is worthwhile). This intersection—where function, context, and meaning converge—is where occupational therapy interventions are most effective.
One client example illustrates this well. The client’s son prepared her weekly pill organizer, and she understood the general instructions for taking medications in the morning. However, during assessment, she casually noted that she took them “whenever she feels like it”—sometimes in the afternoon. She had support, tools, and awareness, but lacked a routine grounded in her lived habits. Occupational therapy intervention focused on uncovering her typical morning sequence and identifying a meaningful and achievable point in her routine to anchor medication-taking. Rather than impose a strict schedule, the approach emphasized alignment with her existing rhythms, making adherence feel natural and sustainable.
In this case, the goal extended beyond medication education. It was about co-creating strategies that respected her autonomy, habits, and values. This personalized, context-driven approach is a hallmark of occupational therapy.
Ultimately, these studies and observations underscore a central truth: medication non-adherence is a layered, individualized issue, not reducible to forgetfulness or defiance. It shapes behavior, beliefs, access, literacy, emotional history, and daily life dynamics. When occupational therapy practitioners take the time to explore and address these factors, they do more than support medication adherence—they promote health, dignity, and full participation in life.
Health Literacy
Health literacy is pivotal in medication adherence, with real-world consequences that extend far beyond theoretical models. One client illustrates this clearly: unaware of the instruction to take her medication with food, she regularly consumed it on an empty stomach. Whether she missed or misunderstood the fine print, the outcome was the same—reduced medication effectiveness and increased risk of gastrointestinal complications. This case exemplifies a broader truth: providing information is insufficient; it must be comprehensible, applicable, and tailored to the client’s context.
Health literacy does not function in isolation. Even cognitively intact clients may struggle with medical instructions that read like a foreign language, filled with technical terminology, abbreviations, and assumptions about baseline understanding. These challenges only intensify for those with vision impairments, lower educational attainment, or limited English proficiency. In such cases, a medication regimen that appears simple on paper becomes a significant functional barrier in daily life.
Previous research has consistently shown links between low health literacy and poor adherence, particularly in populations managing chronic conditions such as hypertension. Yet until recently, the mechanisms driving that connection were less clear. A 2023 study by Guo and colleagues provided much-needed clarity. Their findings demonstrated that health literacy and social support influence adherence through direct and indirect pathways. Being able to read and comprehend instructions is one part of the equation; equally critical is the presence of social support—someone to reinforce the information, offer reminders, or assist with organizing and taking medication.
Guo et al.’s work suggests that health literacy and support are not background characteristics but active components of intervention planning. When clients struggle with comprehension, occupational therapy practitioners can modify materials using visuals, simplified language, or shorter, repeated education sessions. If social support is limited, therapists can help clients identify alternate resources, such as family members, home health aides, community programs, or digital reminders.
These approaches align closely with occupational therapy’s core philosophy—facilitating participation through environmental adaptation, communication accessibility, and meaningful engagement. Guo’s findings reinforce how essential these practices are in the specific domain of medication management. When clients better understand their medications and are supported in taking them correctly, they gain confidence, autonomy, and improved health outcomes.
Adding to this complexity is the rise of digital health literacy. Increasingly, medication management occurs through online portals, refill automation systems, and mobile applications. While these tools offer convenience for some, they pose significant barriers for others, especially older adults, individuals from underserved communities, or those unfamiliar with digital technologies. A 2023 study by McCloud and colleagues highlighted this emerging issue, emphasizing the need for practitioners to recognize and address disparities in digital access and skills.
Occupational therapy practitioners are well-positioned to meet this need. By assessing clients’ comfort with digital tools, offering training, or advocating for low-tech alternatives, therapists can help close the gap in digital health equity. Addressing digital health literacy is not an add-on—it is now a fundamental part of supporting safe, effective medication use.
Emerging mHealth technologies are also reshaping adherence strategies. Smart pill dispensers with real‑time monitoring, smartwatch‑based sensors detecting pill‑taking gestures with up to 97% accuracy, and co‑designed reminder apps with multi‑channel alerts are expanding the toolkit for supporting clients. Occupational therapy practitioners are well‑positioned to assess clients’ comfort with these tools, provide training, and advocate for accessible alternatives when technology becomes a barrier rather than a solution.
Ultimately, medication adherence is not simply about taking the right pill at the right time. It’s about the entire system surrounding that action—the clarity of information, the accessibility of tools, the presence of support, and the fit within daily routines. Health literacy—both traditional and digital—is foundational to enabling clients to manage their medications safely and independently. For occupational therapy, the goal is not just better adherence—it’s better lives.
Cognitive and Physical Impairments
Medication adherence involves far more than remembering to take pills on time. It requires integrated cognitive and physical capabilities, significantly impacting a client’s functional status.
Cognitive
Cognitive skills play a foundational role in successful medication management. Clients must understand what each medication is for, how much to take, and when. They must also be able to recall whether they’ve taken a dose, anticipate when refills are needed, and recognize adverse effects. These tasks rely on intact executive functioning skills that are often compromised in clients with mild cognitive impairment, dementia, or other neurological conditions.
In one illustrative case, a client expressed difficulty managing her medications but couldn't specify what was going wrong. Upon assessment, it became clear she did not have an updated medication list, and her prescriptions were scattered around the house—some in the bathroom, others in the kitchen, and a few by her recliner. She didn’t know exactly which medications she was currently taking, when doses were due, or whether any had expired. Her verbalized confusion and visible overwhelm indicated significant cognitive and organizational challenges that had gone unaddressed.
In her case, occupational therapy intervention began with cognitive supports: developing a current medication list, introducing labeled containers, creating visual cues, and integrating a medication routine aligned with her daily habits. These strategies targeted executive functioning, memory, and organizational skills.
Physical
Physical limitations present their own challenges. For individuals living with arthritis, tremors, weakness, or pain, even basic tasks like opening a childproof bottle, pushing pills out of blister packs, or setting up a weekly pill organizer can become significant barriers. Vision impairments add another layer of complexity, making it difficult to read medication labels, distinguish between pills, or notice when doses are missed. These obstacles are frequently overlooked until observed during functional assessments. They’re not always identified through standard questioning, but often become apparent when clients are asked to demonstrate medication-related tasks.
In the same case described above, physical and environmental barriers also contributed to her difficulty—scattered medication storage made accessing and organizing prescriptions overwhelming. Occupational therapy intervention addressed these issues by reorganizing the environment, consolidating all medications into one safe and accessible area, and ensuring clear labeling with large-print instructions where needed. This process involved hands-on training, task simplification, and environmental modifications—core components of occupational therapy aimed at mitigating physical and sensory barriers to medication management.
The Overall Health Status
Adding further support to this approach, Adachi, Tsunekawa, and Tanimura (2025) emphasized the importance of tailoring medication information based on the patient’s capacity and overall health status. Rather than assume all clients can engage with medication education similarly, their findings affirm the need for personalized, context-sensitive delivery—an approach long embedded in occupational therapy. The goal isn’t just to inform—to ensure understanding, facilitate action, and support integration into daily life.
Together, these studies and clinical examples reveal that medication noncompliance is rarely a matter of simple forgetfulness or willful avoidance. Instead, it often stems from cognition, physical function, and system-level organization barriers. Occupational therapy practitioners are uniquely equipped to address these multifaceted issues. By assessing real-world performance, identifying breakdowns in routines, and implementing practical strategies, OTPs help clients achieve safe and sustainable medication adherence.
Social Support
Two key studies—Cole (2011) and another by Markham, Hanland, and Murray (2017)—explored the significant influence of social support and patient attitudes on medication management. Rather than focusing exclusively on an individual’s cognitive or physical capacity, these studies broadened the lens by asking contextual and relational questions: Does the client have someone to help maintain an accurate medication list? Is assistance available for transportation to the pharmacy or for reordering and organizing medications? These questions draw attention to the reality that functional independence in other areas of daily living may not translate into independent medication management, particularly when the routine becomes complex or fragmented.
These insights are especially relevant for occupational therapy practitioners, who often encounter clients struggling behind the scenes with the invisible labor of medication coordination. When adequate social support is lacking, even highly motivated clients can experience difficulty following through with medication routines.
AOTA and the World Health Organization have acknowledged that medication regimen complexity can be a significant barrier to adherence. Managing multiple prescriptions with distinct timing, dosage, and storage requirements can overwhelm clients. Some medications must be taken with meals; others on an empty stomach. One may need refrigeration, while another must be taken multiple times a day or only on alternate days. Occupational therapy practitioners frequently see the impact of this complexity firsthand, especially when cognitive or literacy challenges and disorganized systems for medication storage and administration compound it.
A 2021 literature review by Shahin, Kennedy, and Stupans added further depth to this conversation by analyzing the role of social support in adherence outcomes. Their findings indicated that family involvement or peer support can positively influence adherence across various patient populations. However, the review also highlighted a persistent gap in the literature regarding the mechanisms by which social support leads to improved adherence. What is clear, though, is the importance of evaluating whether clients have sufficient social scaffolding—not just assessing if they can take medication independently, but whether they should be expected to do so without help.
These insights reinforce the need to integrate social and environmental factors into intervention planning. For example, engaging a caregiver or family member in organizing medications, simplifying and personalizing dosing schedules, and using visual aids or timed dispensers with reminders can all enhance adherence. In some cases, simply helping a client identify a neighbor, home health aide, or family member willing to assist with medication logistics has made the difference in establishing a sustainable, consistent routine.
These studies point to a critical reality: medication adherence is not a solitary task but a socially supported, system-dependent behavior. For many clients, success hinges not only on individual capacity but on the presence of someone to lean on for logistical coordination and emotional reassurance. Occupational therapy practitioners are uniquely equipped to recognize these needs, educate care partners, and design intervention systems that reflect the full complexity of the medication regimen and the client’s lived experience.
Polypharmacy
Another increasingly recognized concern in the medication adherence literature is polypharmacy, commonly defined as the concurrent use of five or more medications. This issue has become especially prominent in research on aging populations and is now a key area of focus for occupational therapy. Polypharmacy is associated with increased risks for adverse outcomes—including falls, confusion, fatigue, and the overuse or misuse of medications such as opioids—all of which directly affect functional independence, safety, and quality of life.
According to a 2024 CDC report, 89% of adults aged 65 and older reported taking prescription medications in the past year. This represents a sharp rise from earlier data; in 2005, older adults comprised less than 13% of the U.S. population but were responsible for consuming nearly one-third of all prescription medications nationwide. The situation has since intensified. Between 2017 and 2020, over 40% of older adults reported taking five or more prescription medications within a 30-day window, a clear sign of growing polypharmacy.
Cost-related nonadherence further complicates this picture. Roughly 21% of older adults acknowledged that they had not taken their medications as prescribed at some point in the past year due to affordability challenges. As chronic conditions like diabetes and multimorbidity continue to rise, prescription dependence grows, exacerbating problems tied to financial strain, adverse side effects, and declining adherence.
The risks associated with high medication burden are both clinical and systemic. Adverse drug events (ADEs)—defined as harm resulting from medication use—are disproportionately high among older adults. The CDC estimates that adults 65 and older account for nearly 450,000 emergency department visits annually due to ADEs, more than double the rate of younger populations. A landmark study by Maher, Hanlon, and Hajjar (2014) revealed that nearly half of older adults in nursing homes were prescribed medications that may not have been medically necessary. This alarming statistic highlights the need for more intentional oversight and review.
Adding nuance to the issue, Verloo et al. (2013) explored the challenges of integrating medication schedules into everyday routines. Medications support function, but their timing can sometimes interfere with meaningful activities. For example, a medication that causes drowsiness may be better scheduled for nighttime use, while others might be timed before morning activities to optimize energy, alleviate pain, or enhance movement. This capacity to align medication timing with the client’s functional patterns is a distinct contribution occupational therapy can make, in close collaboration with prescribing providers.
Further advancing this discussion, Quigg, Marks, Hogan, Campbell, and Cox (2021) conducted a study on the occupational therapy profession’s role in identifying and addressing polypharmacy. Despite being ideally positioned to notice functional impairments linked to polypharmacy—such as dizziness, fatigue, constipation, or confusion—the study found that many OT practitioners do not consistently screen for or address medication overload. Encouragingly, the researchers also found that a simple infographic intervention significantly boosted therapists’ awareness, knowledge, and willingness to act on polypharmacy-related concerns. This underscores the power of brief, accessible educational tools in empowering therapists to engage with this issue proactively.
Taken together, these findings present a compelling case: polypharmacy is a growing public health concern with direct implications for occupational therapy. Medication overload can compromise balance, endurance, cognition, and the ability to participate in daily routines. Occupational therapy practitioners have the skills to recognize these patterns, adapt environments and routines accordingly, and advocate for safer medication use. As polypharmacy continues to affect a larger share of the aging population, the OT profession must respond by incorporating medication-related risks into routine assessments and interventions. Doing so supports adherence and safeguards function, independence, and overall quality of life.
Intervention
AOTA's Position on Medication Management: Five Core Ways to Support Clients
Now, let’s turn to AOTA’s position on medication management. While the 2017 position paper's core concepts on occupational therapy's role in medication management remain relevant, please refer to the 2020 Occupational Therapy Practice Framework: Domain and Process. The OTPF-4 places medication management within the broader domain of "Health Management," reinforcing the occupational therapy role in developing and maintaining medication routines and addressing self-care for health and wellness. This summary delineates occupational therapy practitioners' appropriate and meaningful role in this complex care area.
In this position paper, the authors identified five core ways in which OTPs can support clients in medication management.
First, practitioners can analyze client performance in medication-related tasks, such as filling a pill organizer, understanding dosing instructions, or maintaining a medication list. Second, they can identify environmental, physical, and social barriers and supports influencing clients' ability to manage medications safely and consistently. Third, they can collaborate with healthcare providers and clients to develop realistic and client-centered routines. Fourth, practitioners can teach self-advocacy skills, empowering clients to communicate their preferences, ask questions, and express concerns to other healthcare team members. Finally, OTPs can directly address cognitive, motor, or perceptual impairments that interfere with safe and effective medication use through targeted interventions and training.
Equally important is knowing the boundaries of practice and what occupational therapy practitioners are not allowed to do. OTPs cannot prescribe or recommend medications, adjust dosages, or modify prescribed schedules. They also may not administer medications or physically place them into pill organizers or dispensing devices. These responsibilities remain within the scope of prescribers, pharmacists, and nursing staff. Respecting these limits ensures ethical collaboration and protects the integrity of interprofessional care.
This distinction is further clarified in a statement by Schwartz and Smith (2017), who wrote, “Occupational therapy practitioners cannot prescribe medications or alter medical advice from a physician or pharmacist, but they can help clients better navigate many of the tasks associated with medication management.” This emphasis on functional implementation over medical decision-making defines occupational therapy's unique contribution in this domain.
OTPs excel at bridging the gap between a medical regimen and a client’s real-life routines. Practitioners can assist in establishing structured schedules and environmental cues that promote adherence, and when necessary, advocate alongside clients to request medication timing adjustments that better support participation in daily activities. This advocacy must always be grounded in collaboration and informed by the client’s actual performance in their natural context.
Five key intervention domains align with occupational therapy’s scope in medication management: health literacy, cognition, community mobility, fine motor coordination, and vision. These interconnected areas form the foundation of practice and provide multiple access points for intervention. Let’s begin with a closer examination of health literacy.
OTPs excel at bridging the gap between a medical regimen and a client’s real-life routines. Practitioners can assist in establishing structured schedules and environmental cues that promote adherence, and when necessary, advocate alongside clients to request medication timing adjustments that better support participation in daily activities. This advocacy must always be grounded in collaboration and informed by the client’s actual performance in their natural context.
Health Literacy Interventions
As previously discussed, health literacy refers to an individual’s ability to understand and use health-related information to make informed decisions. For clients and caregivers, this includes navigating the healthcare system, acquiring prescriptions, interpreting instructions, and adhering to medication regimens.
AOTA’s 2017 societal statement defines occupational therapy’s role in supporting this process: “Occupational therapy practitioners can assist in ensuring that all health-related information and education provided to recipients of occupational therapy or other health-related services match each person’s literacy abilities, cultural sensitivities, and verbal, cognitive, and social skills.”
Levasseur and Carrier (2012) reinforced this position by highlighting the layered complexity of health literacy. Even individuals with high general literacy may struggle to interpret medical documents, insurance forms, or medication instructions. The challenge is even greater for clients with cognitive impairments or without adequate support networks. Many of us can relate personally—navigating Explanation of Benefits (EOBs) or deciphering medical bills can feel confusing or overwhelming. To address these challenges in practice, the Health Literacy Universal Precautions Toolkit, 3rd Edition, is a valuable resource. It encourages practitioners to assume that all clients may have difficulty with health information unless it is clearly conveyed.
Levasseur and Carrier also emphasized that health literacy aligns with occupational therapy’s foundational value of contextual, client-centered practice. Education is most effective when integrated into the client’s real environment, routines, and support systems—not delivered in isolation. Helping clients understand their medication schedule in the context of their daily life increases the likelihood that they will follow it consistently and safely.
Their scoping review outlined six key areas where occupational therapy practitioners can contribute to improved health literacy:
Be informed about and recognize the signs of limited health literacy
Standardize clear and consistent communication practices
Make health information accessible in various formats
Build strong, collaborative therapeutic relationships with clients
Intervene directly when barriers to comprehension or implementation arise
Collaborate across healthcare teams to support shared goals
This may involve assisting clients and their families in understanding how frequently a medication must be taken, supporting them in refilling prescriptions via phone or online systems, or introducing tools to monitor side effects and adherence. Occupational therapy practitioners are also well-positioned to help clients advocate for themselves—initiating conversations with prescribers to adjust regimens when necessary and ensuring they have the knowledge and confidence to speak up about adverse effects or challenges.
By embedding health literacy support into occupational therapy interventions, practitioners help reduce confusion, improve adherence, and promote greater health autonomy. The goal is not just to deliver information, but to make it usable, relevant, and empowering in the context of each client’s life.
Cognitive Interventions
Now turning to cognition—one of the most critical domains supporting medication adherence. Clients must have sufficient memory, attention, and executive functioning to follow instructions accurately, manage refills, and troubleshoot emerging problems. Even highly motivated individuals may experience breakdowns in their medication routines when these cognitive processes are impaired.
Several standardized assessments used in occupational therapy incorporate medication management as a performance indicator. The updated Kohlman Evaluation of Living Skills (KELS), the Short Blessed Test, the Mini-Mental State Exam (MMSE), and the Saint Louis University Mental Status (SLUMS) exam are commonly used to evaluate cognitive capacity about instrumental activities of daily living. AOTA’s 2017 position paper on medication management includes a comprehensive reference table in Appendix C outlining these and other cognitive assessments, and this resource remains a foundational guide in clinical practice.
More recently, cognitive assessment tools have evolved to reflect advances in both research and technology. The Montreal Cognitive Assessment (MoCA) version 8.1, released in 2022, offers enhanced sensitivity for identifying mild cognitive impairment and is now available in app-based formats. These digital platforms improve accessibility in outpatient, home health, and telehealth settings, allowing occupational therapy practitioners to screen clients more efficiently and conveniently.
Emerging technologies continue to expand the possibilities for cognitive screening. In a 2023 study, Tanaka, Watanabe, and Shimizu described using natural language processing and tablet-based platforms to conduct in-home cognitive assessments. These tools allow practitioners to evaluate executive function, attention, and language in low-pressure, client-friendly environments, offering a promising adjunct to traditional assessments, especially for use in community and remote-care settings.
Despite these advances, direct observation is one of the most effective ways to assess cognition in the context of medication management. Watching clients perform real-world tasks—such as locating, identifying, and describing their medications—can yield critical insights. Practitioners may ask clients to read medication labels aloud and explain when and how each is taken. This allows for a simultaneous assessment of memory, sequencing, problem-solving, attention to detail, and comprehension. It also surfaces immediate safety concerns, such as confusing two look-alike pills or omitting a critical instruction like “take with food.”
This type of contextual observation becomes even more essential when clients are managing complex medication regimens—multiple drugs, varied dosages, and specific timing instructions. These routines can challenge even individuals without cognitive deficits and may be unmanageable for those with mild cognitive impairment or executive dysfunction. Guided practice runs, mock medication prep, or real-time walkthroughs of daily routines can help identify areas of cognitive breakdown and lead to tailored, function-based interventions.
Intervention strategies in this domain often include reading and interpreting prescription instructions, simplifying routines with visual aids, using written medication schedules, color-coding or labeling containers, identifying pills by shape or color, and rehearsing pharmacy interactions. These practical, functional interventions are rooted in real-life participation and align closely with the occupational therapy model.
By integrating standardized assessments, observational analysis, and meaningful task-based interventions, occupational therapy practitioners are equipped to do more than identify cognitive challenges—they can help clients successfully manage their medication routines in the context of their daily lives. This is the unique strength of occupational therapy: transforming insight into action through individualized, function-focused strategies that support safety, adherence, and long-term independence.
Community Mobility Interventions
Let’s now consider the next critical domain: community mobility. This area has a direct and often underestimated influence on a client’s ability to manage medications. For individuals with mobility limitations or restricted access to reliable transportation, filling a prescription can present a significant challenge. Many older adults no longer drive, and those living in suburban, rural, or underserved urban areas often face limited public transit options and poorly maintained or nonexistent pedestrian infrastructure.
Access to a local pharmacy is not always a given. This leads to the overlapping concepts of food deserts and pharmacy deserts. A food desert is a geographic area where residents lack access to affordable, nutritious food due to the absence of grocery stores, farmers' markets, or similar retailers. These areas often correlate with pharmacy deserts, since many pharmacies are co-located with grocery stores. As a result, clients living in these communities may be unable to conveniently obtain prescribed medications, over-the-counter treatments, or access pharmacist guidance, especially if they also face financial, sensory, or physical limitations.
Medication delivery or online ordering services may seem viable alternatives for clients in pharmacy deserts. However, these options introduce new barriers, especially digital ones. Navigating online platforms typically requires creating user accounts, uploading insurance documentation, verifying prescriptions, and completing payment steps. Clients with limited digital literacy, visual impairment, cognitive challenges, or limited support may struggle to complete these tasks, resulting in missed doses or delayed medication access.
This is where occupational therapy practitioners can provide essential support. OTPs can work with clients to identify and assess transportation alternatives, including paratransit services, nonprofit transport options, rideshare programs, and community-based medical shuttle services. Training may also focus on increasing the client’s physical capacity—such as strength, balance, and endurance—for safe use of public transit, including bus stops or train platforms that require walking, standing, or transferring between systems.
Beyond mobility training, occupational therapy intervention can address the digital access gap. Practitioners can teach clients how to use online ordering platforms, create step-by-step guides for reordering prescriptions, or identify simpler, more accessible options when available. In cases where self-management is not feasible, therapists can support clients in connecting with care coordinators, case managers, or local agencies who can assist with medication delivery, ride scheduling, or insurance logistics.
Community mobility is not solely about a client’s ability to travel—it is about their ability to fully access the systems and services that support medication adherence and broader health outcomes. Occupational therapy practitioners bring a dual lens, enabling individuals to perform at their best while addressing systemic and environmental barriers that often stand in the way. Through direct intervention and advocacy, OTPs help ensure that clients are not left behind simply because they cannot get to or navigate the pharmacy.
Fine Motor Skills and Vision Interventions
Now, the focus is shifting to two critical areas—fine motor skills and vision—directly influencing a client’s ability to manage medications safely, accurately, and independently. These components are central to occupational therapy practice and fall squarely within the scope of intervention defined by AOTA’s position on medication management.
AOTA emphasizes the role of occupational therapy practitioners in supporting clients as informed and health-literate consumers of medication. This goes beyond providing education about routines that support adherence. It includes addressing physical and sensory limitations—such as reduced hand strength, poor manual dexterity, and visual impairments—that often interfere with a client’s ability to perform essential medication-related tasks. When remediation is impossible, occupational therapy practitioners implement compensatory strategies, adapt environments, and collaborate with the care team to advocate for medication adjustments that align with the client’s functional abilities and context. Additionally, OTPs can serve in a preventative capacity, identifying side effects like dizziness, blurred vision, or sedation that may compromise safety or interfere with daily routines.
Fine motor coordination plays a pivotal role in medication management. Tasks like opening child-proof bottles, pressing tablets from blister packs, sorting small pills, drawing liquid medications into syringes, or correctly operating devices such as inhalers or insulin pens can pose significant challenges for clients with arthritis, tremors, neuropathy, or muscle weakness. These seemingly minor difficulties often result in skipped doses, errors in administration, or complete task avoidance—not from noncompliance, but because the physical process is too frustrating or inaccessible.
Vision is another key factor. Clients must be able to read prescription labels, differentiate between medications that may appear similar, interpret printed schedules, and recognize cautionary instructions. Vision loss due to macular degeneration, glaucoma, cataracts, or diabetic retinopathy can significantly disrupt these tasks. In some cases, clients may be unaware of the full extent of their vision changes, increasing their risk of errors and injury.
While standardized tools are available to measure fine motor ability and visual acuity, some of the most valuable insights emerge through direct task-based observation. Watching a client attempt to open a bottle, identify medications, or read instructions provides clear indicators of where breakdowns occur. This practical assessment enables occupational therapy practitioners to implement individualized solutions in real time.
Intervention strategies in this domain may include using adaptive tools such as easy-open or non-childproof caps (with pharmacist and prescriber approval), pill splitters, preloaded blister packs, or spring-loaded scissors. For clients with visual impairments, interventions may involve magnifiers, high-contrast or large-print labels, color-coded organizers, tactile identifiers, or auditory reminder systems. In some cases, collaborating with the pharmacist or prescriber to modify the medication format—switching to liquids, using pre-filled syringes, or simplifying the dosing schedule—can significantly reduce complexity and improve adherence.
Fine motor and visual limitations are not just medical concerns—they represent functional impairments that interfere with daily occupational performance. Occupational therapy practitioners are uniquely positioned to assess these barriers, offer tailored interventions, and advocate for practical adjustments that make medication routines manageable and sustainable. Whether training clients in the safe use of a pill organizer, adapting the home environment to support medication visibility and access, or helping care teams understand a client’s needs, the practitioner’s role is both essential and highly impactful.
Across all settings, the goal remains consistent: to empower clients to manage their medications as independently, safely, and confidently as possible, within the context of their real lives and meaningful routines.
Fine motor and visual deficits aren’t just medical diagnoses—they’re functional limitations directly impacting occupational performance. As occupational therapy practitioners, we are uniquely qualified to assess and intervene at this level. Whether we teach clients to safely manipulate a pillbox, adapt their environment to better support routines, or help their care team understand how to simplify instructions, our role is critical.
Ultimately, our goal remains the same across all settings: to empower clients to manage their medications as independently, safely, and confidently as possible, within the context of their real, everyday lives.
Research Studies
Occupational therapy has long been recognized for its unique role in supporting clients’ medication routines through occupation-based interventions. Earlier foundational studies, such as Sokol-McKay in 2011, highlighted how occupational therapy practitioners assist individuals with diabetes in developing and maintaining health routines that include glucose monitoring, personal hygiene, meal planning, physical activity, and emotional regulation. These interventions often rely on compensatory techniques and adaptive tools to support independence for clients with sensory, visual, or motor impairments.
Building on that foundation, Sanders and Van Oss 2013 demonstrated how embedding medication-taking into meaningful daily routines significantly improved adherence, especially in individuals managing diabetes or cognitive and behavioral health conditions.
More recently, multiple studies published between 2023 and 2025 have strengthened this evidence base. Garrison and colleagues in 2023 conducted a randomized controlled trial using the Integrative Medication Self‑Management model in primary care. The occupational therapy-led intervention improved medication adherence through routine-building and health literacy strategies, with moderate to large effect sizes. Schwartz and colleagues, in 2024, found that traditional assessments do not reliably predict real-world medication adherence, highlighting the importance of performance-based, occupation-centered evaluation methods in occupational therapy practice. A 2023 feasibility study on habit formation for adults with type 2 diabetes (Feldhacker et al., 2023) confirmed that occupational therapy strategies aimed at embedding health routines, including medication use, are both viable and effective. Additionally, a 2025 cross-sectional study by Segev-Jacubovski et al. showed that engagement in daily purposeful activities correlates with stronger diabetes self-management and medication adherence, reinforcing the value of routines rooted in meaningful occupation.
Occupational therapy practitioners also play a central role in promoting adherence among clients with cognitive or behavioral health diagnoses. Evidence supports using environmental modifications, structured routines, cueing systems, and caregiver training to reduce confusion and enhance participation in medication routines.
This growing body of evidence affirms that occupational therapy interventions, when grounded in real-life routines and personalized supports, are critical to improving medication adherence, safety, and independence across diverse populations and diagnoses.
PEO
To organize our intervention strategies more effectively, I use the Person–Environment–Occupation (PEO) model, developed by Law, Cooper, Strong, Stewart, Rigby, and Letts in 1996. Many of you may already be familiar with this model, but I’ll provide a brief overview.
- The Person component includes roles, self-concept, personality, health status, cognition, physical performance, and sensory abilities.
- The Environment consists of physical, cultural, institutional, social, and socioeconomic factors that shape a client’s daily context.
- Occupation refers to the clusters of tasks and activities an individual engages in for self-care, productivity, and leisure.
These three domains are in constant interaction with one another. As the authors describe:
“This model can be viewed as an assessment tool to understand and analyze problematic areas that affect clients' occupational performance, or as an intervention tool to improve clients' occupational performance by enhancing the congruence of the three domains.”
Addressing all three domains—the person, the environment, and the occupation—is essential to optimizing function. That’s exactly how we approach medication management, using the PEO model to guide and frame our interventions.
Person
Health Literacy
Occupational therapy practitioners must begin with a foundational understanding of the various types and categories of medication clients may be prescribed. This knowledge supports both accurate assessment and effective intervention. A critical early step in the occupational therapy process is evaluating whether clients can manage their medication regimens independently and safely. This includes determining their ability to fill prescriptions, understand dosing instructions, adhere to scheduled times, and recognize each medication's purpose and expected effects.
Practitioners must also assess insight—does the client understand why each medication has been prescribed, and can they ask informed questions of healthcare providers? These insights inform the practitioner’s understanding of the client's health literacy, cognitive status, and readiness for self-management.
One practical occupational therapy strategy involves creating a user-friendly medication chart or spreadsheet with clients and caregivers. This document typically includes columns for the name of the medication, dosage, purpose, and a section for concerns, side effects, or reminders. For example, in the case of a client with mild dementia—referred to here as Mrs. Jones—who was prescribed 30 mg of Lasix twice daily, frequent confusion arose around her urgent need to urinate. A clear note added to her medication chart explaining that Lasix is a diuretic helped both the client and her caregivers anticipate and understand the effect, reducing anxiety and improving adherence.
Resources from the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) further support this approach. These organizations offer client education tools, medication safety guidelines, and plain-language materials that reinforce the principles of medication literacy. When incorporated into occupational therapy practice, such resources enhance practitioners' ability to tailor interventions and reinforce client understanding.
Occupational therapy practitioners help clients build routines that promote safety, comprehension, and autonomy by combining knowledge of pharmacological categories with individualized education and practical tools. Whether the client is managing one medication or several, the occupational therapist’s role is to make that process as manageable and meaningful as possible.
Cognition
Cognitive capacity is central in determining a client’s ability to manage medications independently. Occupational therapy practitioners assess cognitive function to understand a client’s current capabilities and anticipate how cognitive changes may impact long-term adherence and safety. A thorough evaluation allows practitioners to determine whether clients can accurately follow a pre-filled pillbox, respond to scheduled alarms or auditory prompts, or identify appropriate situations for taking as-needed medications.
These assessments extend beyond general memory or attention—they encompass executive functioning elements such as initiation, sequencing, problem-solving, and the ability to follow one- and two-step commands. These cognitive components directly influence a client’s capacity to interpret instructions, remember doses, and recover from medication-related errors, such as taking the wrong pill or forgetting a dose.
Occupational therapy practitioners frequently observe how cognitive capacity evolves in geriatric populations. A client who initially demonstrates complete independence using a weekly pill organizer may begin to show signs of confusion, forgetting whether medication has been taken, misinterpreting dosage instructions, or dropping pills during administration. These subtle changes often signal a shift in cognitive status and the need for reassessment.
Through regular monitoring and dynamic evaluation, practitioners can determine when additional supports are needed. This may involve introducing visual or tactile cues, simplifying medication routines, or trialing automated medication dispensers—provided the client can still interact with the device meaningfully and safely. For some, auditory prompts or voice reminders may offer sufficient support, while others may benefit from increased caregiver involvement or more structured delivery systems.
By tailoring intervention strategies to the client’s evolving cognitive profile, occupational therapy practitioners ensure that medication management remains safe and functional. This ongoing process of assessment and adaptation reflects the client-centered, performance-focused nature of occupational therapy practice, supporting independence for as long as it is safely possible, and guiding transitions when needed.
Community Mobility
Occupational therapy practitioners assess not only a client’s cognitive and perceptual abilities, but also their physical capacity to access medications. This includes evaluating whether the client is mobile enough to retrieve prescriptions independently by walking, driving, or public transportation. Questions about access must consider the full spectrum of mobility needs: Can the client safely transfer in and out of a vehicle? Navigate curbs, stairs, or ramps? Carry items while using an assistive device?
These assessments often extend beyond the home and into the community. Practitioners explore what transportation services exist that can bridge identified access gaps. For example, in some regions, senior service vans are available and specifically designed to meet the needs of older adults or individuals with physical limitations. These services often employ drivers trained to assist individuals using walkers, wheelchairs, or other mobility aids, ensuring safe transit to and from the pharmacy while supporting a degree of independence.
Community-based supports are essential resources occupational therapy practitioners can help clients discover and access. When transportation limitations pose barriers to medication management, interventions may include assisting the client in scheduling and using local ride services, coordinating pharmacy deliveries, or working with case managers to integrate medication access into broader care planning.
Ultimately, physical medication access is not a secondary concern but an essential part of the medication management process. Occupational therapy practitioners are uniquely equipped to assess functional mobility in context and implement practical strategies that promote access, autonomy, and safety.
Fine Motor Skills
Occupational therapy practitioners routinely assess clients' fine motor control, grip strength, and range of motion to determine their ability to safely and independently manage medications. This includes evaluating the physical demands of opening child-resistant pill bottles, manipulating blister packs, using liquid medication droppers, sorting pills into organizers, and bringing medications to the mouth—tasks that may be deceptively complex for clients with upper extremity limitations.
In practice, even clients with otherwise adequate hand strength can experience barriers. For example, one client with good bilateral grip strength was unable to open the small compartments on her weekly pillbox due to arthritic changes in her fingers. The issue wasn’t overall weakness, but limited joint mobility and pain during precise movements. In this case, a simple adaptation—a hook-and-loop (Velcro) modification paired with a universal cuff—allowed her to open one pillbox slot at a time with minimal strain. This small intervention restored her independence and confidence in completing her daily routine.
These types of task-specific solutions are central to occupational therapy. Interventions may also include recommending assistive tools, such as pill poppers for blister packs, non-slip surfaces, bottle openers designed for limited grip, or switching clients to non-childproof packaging (with input from the pharmacist and prescriber) when appropriate. Training may focus on joint protection techniques, energy conservation strategies, or compensatory methods using adaptive equipment.
By targeting the physical interaction between the client and their medications, occupational therapy practitioners help reduce frustration, enhance safety, and support consistent adherence. These interventions are not just about comfort—they are about enabling participation in a critical self-care activity and maintaining the client’s autonomy in managing their health.
Vision
Occupational therapy practitioners assess a client’s ability to read and interpret medication labels, follow dosing schedules, and distinguish between different pills—all essential for safe and effective medication management. This includes evaluating whether the client can recognize key symbols, warnings, and instructions such as “take with food,” “do not crush,” or “avoid sunlight.”
For clients with visual impairments—whether due to macular degeneration, glaucoma, cataracts, or diabetic retinopathy—these tasks can be particularly challenging. Visual limitations may make it difficult to differentiate between similar-looking pills, read fine print on prescription bottles, or identify which medications to take at what time of day.
To address these challenges, occupational therapy practitioners often implement compensatory strategies that rely on visual contrast and pattern recognition. One approach involves using simple visual cues: a yellow sun sticker on morning medications and a blue moon sticker on evening medications provides an intuitive, nonverbal system that helps clients distinguish between times of day. Many commercially available pill organizers are also color-coded by dosage time—often with bright shades for morning, noon, evening, and bedtime—which adds another layer of support.
Additional strategies might include increasing font size with magnifiers or printed medication schedules in large print, using high-contrast labels (e.g., black text on white or yellow backgrounds), incorporating tactile markers for clients with combined visual and sensory deficits, and using voice-enabled reminder systems for those with progressive vision loss.
These supports help reduce the cognitive load required to interpret medication instructions and mitigate the risk of errors. Occupational therapy interventions in this domain are highly individualized and focused on enabling clients to navigate their medication routines with confidence, despite visual limitations. By adapting both the physical and informational environment, practitioners promote safe, accessible, and consistent adherence to prescribed regimens.
Environment
Supports and barriers
Environmental supports and barriers play a significant role in medication performance. Occupational therapy practitioners carefully evaluate the client’s home and community environments to determine whether these settings facilitate or hinder safe and consistent medication management. Common barriers include distance from a pharmacy, lack of transportation, difficulty reading medication labels, poor lighting, and fragmented medication storage, where medications are scattered across multiple locations within the home. These factors increase the risk of confusion, missed doses, or accidental duplication.
The evaluation process begins with assessing the client’s primary medication storage area. Key questions include: Can the client safely access this area? Is there sufficient lighting to read labels or sort pills? Are tripping hazards nearby, such as loose rugs, cluttered surfaces, or unstable furniture? Ideally, all medications should be consolidated into one well-lit, stable, and easily accessible location to support routine and minimize error.
Medication delivery has become a valuable resource, especially for clients with transportation challenges or who move between residences seasonally. Some clients now receive prescriptions at multiple addresses depending on the time of year—a flexibility that, when well coordinated, can support continuity of care. Occupational therapy practitioners can assist by helping clients coordinate delivery services, track delivery schedules, and understand how to receive medications securely.
Organizing medications weekly or monthly is another evidence-informed strategy to reduce the risk of error. One effective method involves sorting all medication bottles into a basket and moving each bottle to the opposite side of a table as it is opened, checked, or transferred into a pill organizer. This simple visual approach offers a clear system of progress, helping clients avoid omissions or duplications—particularly helpful for those with mild cognitive impairment, attention difficulties, or anxiety around medication routines.
Environmental modifications may include labeling systems, task lighting, clear counter surfaces, or visual and tactile prompts. For clients with low vision, placing contrasting placemats or trays under the medication area can help delineate workspace boundaries. In cases where medication preparation poses a fall risk, interventions may involve modifying the setup to avoid standing at high counters or encouraging seated routines with supportive posture aids.
Through careful environmental analysis and practical, individualized interventions, occupational therapy practitioners reduce risk and promote more consistent adherence. These strategies not only support medication performance but also enhance the client’s overall safety, confidence, and ability to manage health independently.
A checklist or written medication log
Keeping an up-to-date medication list is a foundational strategy in occupational therapy interventions for medication management. Occupational therapy practitioners often encourage clients to maintain this list in a format that best suits their abilities, routines, and preferences—whether on paper, a smartphone, or with the help of a trusted caregiver.
The list should include each medication’s name, dosage, purpose, administration schedule, and any relevant notes (e.g., “take with food,” “may cause drowsiness,” or “monitor for side effects”). It is a day-to-day reference and a critical communication tool during medical appointments, pharmacy visits, hospitalizations, or emergencies.
For tech-savvy clients, smartphone apps or notes features can be convenient solutions. For others, a simple paper chart—taped to the refrigerator, stored in a wallet, or placed near the medication area—may feel more intuitive and accessible. Some clients benefit from caregiver involvement, particularly when cognitive impairments are present. In these cases, occupational therapy practitioners can collaborate with caregivers to ensure the list is updated consistently and that both the client and caregiver understand its contents.
Maintaining a current medication list helps reduce the cognitive load associated with remembering complex regimens and supports informed decision-making during care transitions. It also reinforces the client’s sense of control and engagement in their healthcare—a core goal of occupational therapy practice.
Equipment
A range of medication management tools allows occupational therapy practitioners to recommend options that align with a client’s specific functional needs, preferences, and routines. The choice of system often depends on factors such as cognitive status, fine motor skills, vision, lifestyle, and caregiver involvement.
Compact “to-go” pillboxes are often ideal for clients who value portability and independence. These small organizers are easy to carry in a purse or pocket. They can support single-day or single-dose use, particularly helpful for clients active in the community or frequently away from home.
Others may benefit from larger weekly pill organizers, especially those with compartments divided by time of day (e.g., morning, noon, evening, bedtime). These systems are helpful for clients managing multiple medications throughout the day, offering a clear and visual structure that reduces confusion and supports routine adherence.
Automatic pill dispensers offer enhanced safety and convenience for clients with cognitive impairments or complex regimens. Some models can hold a 30-day supply and dispense medication at pre-programmed times into individual cups. These devices reduce the need for daily handling and can minimize dosing errors.
Advanced electronic systems, such as MedMinder, add another layer of support. These units can provide voice reminders, flash visual cues, and even trigger automated phone calls if a dose is missed. Caregivers can receive text or email alerts when nonadherence is detected, making these systems particularly valuable in supporting aging in place for clients with memory loss or declining executive function.
Occupational therapy practitioners must select and train clients to use these tools effectively. This includes evaluating the client’s comfort with technology, trialing systems to assess usability, and collaborating with caregivers to ensure successful implementation. Ultimately, the right medication management tool can enhance safety, reduce stress, and promote sustained independence for clients managing chronic conditions.
Other low-tech solutions
Various low- and high-tech tools can support medication management, and occupational therapy practitioners play an important role in matching the right tools to each client’s individual needs, preferences, and routines.
Some clients benefit from arthritis-friendly medication bottles, which feature easy-to-open caps or push-down-and-turn lids designed with larger grips. These reduce the strain and frustration often experienced by individuals with joint pain, stiffness, or decreased grip strength. Pre-packaged single-dose blister packs are another useful option, as they simplify dosing and eliminate the need to open multiple bottles. However, these can be difficult to separate or open and may not be ideal for clients with significant fine motor challenges or poor bilateral coordination.
Timers, alarms, calendars, and notebooks offer flexible solutions for many clients. These tools can serve as prompts and trackers, helping individuals stay organized and develop a consistent routine. For clients comfortable with digital tools, smartphones offer built-in alarm and reminder features that can be set for specific times each day. Medication management apps are also available, offering functions like dose logging, refill alerts, and side effect tracking.
For others, particularly those who feel overwhelmed by technology or have limited digital literacy, paper-based systems—such as checklists, printed schedules, or daily notebooks—can provide greater control. Writing things down reinforces memory and supports problem-solving, especially for clients who prefer tactile engagement with their routines.
Occupational therapy practitioners assess cognitive, motor, sensory, and emotional factors to recommend functional tools that are aligned with the client’s preferred method of learning and organizing. The goal is always to empower clients with tools that reduce error risk, promote confidence, and fit seamlessly into the rhythm of daily life.
Occupation
The final component in the PEO model—occupation—focuses on the actual activity of taking medication. This performance element ties together the person’s capabilities and the environmental context. Personal and environmental supports must align for successful occupational performance in medication management. If either is missing or insufficient, even a well-structured routine can break down.
Occupational therapy practitioners facilitate this process by supporting routine development and structured practice. Breaking the medication task into manageable steps allows clients to build confidence and reduce errors. These steps may include retrieving the medication, identifying the correct dose, interpreting labels, using any required tools (such as syringes or inhalers), and following up with safe storage or documentation. Rehearsing these steps with intention reinforces procedural memory and builds habits that support long-term success.
For example, a client may need to establish a prescription delivery system. Occupational therapy intervention might involve practicing retrieving the delivered package, opening it safely, reading and interpreting the medication labels, and organizing the medications according to a weekly schedule. Each step is a functional component of the larger occupation, and each should be addressed with clarity and repetition.
Caregiver involvement is also essential. Educating and training caregivers helps ensure consistency when the practitioner is not present. Caregivers who understand the client’s routine and support strategies can reinforce cues, assist with organization, and monitor for safety concerns. Their role becomes crucial in progressive conditions or when clients experience fluctuating capacity. A well-informed caregiver can preserve independence, prevent medication errors, and provide essential continuity in care.
Ultimately, by directly addressing the occupation of medication-taking through practice, rehearsal, and structured support, occupational therapy practitioners help ensure that all elements of the routine are sustainable. This hands-on, performance-based approach reinforces the core value of occupational therapy: empowering clients to engage in meaningful activities that promote health, safety, and independence in daily life.
Case Studies
We will now review some case studies to illuminate some issues and interventions.
Mrs. R
The first case study features Mrs. R, a 68-year-old female living in a private family home with her 76-year-old spouse and 12-year-old granddaughter. Mrs. R serves as the primary caregiver for her spouse, who is legally blind and recently underwent a total hip replacement following a fall. She also has full custody of her granddaughter, as her son and daughter-in-law are on active duty in the military and are currently deployed overseas.
Mrs. R experienced a cerebrovascular accident (CVA) and, following a four-week stay at an inpatient rehabilitation facility, returned home with home health care services. Upon discharge, she demonstrated cognitive deficits including impaired safety awareness, limited short-term memory, and poor insight into her impairments. Functionally, she ambulated within her home with modified independence using a rolling walker, which she later progressed to a cane and eventually no assistive device. She was able to complete simple instrumental activities of daily living (IADLs) with modified independence, while family members, neighbors, and friends provided assistance with community mobility needs such as transportation to appointments and shopping.
Despite her gains in mobility and self-care, Mrs. R continued to struggle with medication management due to impaired problem-solving, short-term memory, and limited visual comprehension. An automated pill dispenser with audio reminders was introduced. Initially placed on the kitchen counter, the device’s location beneath overhead cabinets led to poor lighting and incidents of dropped or missed pills. The dispenser was subsequently relocated to a buffet table between the kitchen and living room under a dedicated light fixture. This adjustment significantly reduced errors, and Mrs. R was thereafter able to manage her daily medications effectively.
Interdisciplinary collaboration was key to success in this case. Ongoing coordination with the speech therapist supported Mrs. R’s memory challenges and expressive aphasia. This case underscores the value of team-based approaches in promoting client safety and independence.
Mr. T
The second case study describes Mr. T, a 92-year-old male residing in an assisted living apartment within a retirement community. Recently widowed after 64 years of marriage, Mr. T disclosed that his late wife had always handled his medication regimen. Although the assisted living facility staff were available to administer his medications, Mr. T expressed a desire to manage them independently, citing concerns about staff workload and his preference for autonomy.
Mr. T, a retired university professor, demonstrated strong baseline cognition with a Mini-Mental State Exam (MMSE) score of 19/20 and no noted visual deficits. However, he lacked an updated medication list. Coordination with his primary care physician and facility staff led to creating a detailed spreadsheet including medication names, dosages, purposes, and timing. Given Mr. T’s strong attention to detail, the list also included generic names to reduce confusion, as facility staff often used varying terminology.
To support adherence, a color-coded pillbox was introduced. Medications, previously stored on the kitchen counter, were relocated to a basket at the end of Mr. T’s table, allowing him to sit comfortably while managing his regimen. This change helped mitigate fatigue associated with prolonged standing. His daughter, who held power of attorney and was actively involved in his care, received a digital copy of the spreadsheet and was trained to assist with future updates. With these environmental and educational interventions, Mr. T resumed independent medication management.
Mrs. M
The third case study highlights Mrs. M, an 84-year-old female living alone in an independent senior living apartment. Mrs. M is deaf and communicates via American Sign Language, lip reading, and written notes. She also uses a smart TV-based communication aid service that enables phone conversations with interpreter support. She has severe rheumatoid arthritis and recently underwent bilateral carpal tunnel surgery. She was referred for home health occupational therapy following discharge from a rehabilitation center, citing difficulty managing her medications due to fine motor limitations. She demonstrated no cognitive or visual deficits.
Interventions focused on improving hand strength, coordination, and endurance to address fine motor challenges. Mrs. M was motivated and compliant with her home exercise program. Although she maintained a handwritten medication list, her standard pillbox aggravated arthritic symptoms, which also interfered with her ability to use sign language. With the support of a local pharmacy, she transitioned to medication delivery services and began using a single-dose medication dispenser. Adapted scissors with built-up handles enabled her to open packaging independently. Additional medications were provided in arthritis-friendly bottles until they could be incorporated into the dispenser system. Intermittently, she also used built-up writing utensils. Caregiver training was completed with her son to prepare for future adjustments to her regimen.
These three case studies demonstrate how occupational therapy practitioners can tailor interventions based on cognitive, physical, sensory, and environmental considerations. Each client’s success was rooted in personalized strategies, adaptive tools, and interdisciplinary collaboration that honored their desire for independence while ensuring safety and consistency in medication adherence.
Resources
Several key resources reinforce the critical role that occupational therapy practitioners play in medication management, reflecting both the depth and scope of the profession's contribution to this essential area of care.
AOTA Position Paper on Occupational Therapy and Medication Management
The AOTA Position Paper on Occupational Therapy and Medication Management is a foundational reference. While this document has been cited throughout the discussion, a direct excerpt underscores its significance:
“Medication adherence depends on effective medication management, which is an essential daily activity for those prescribed medications to preserve health and function. Occupational therapists analyze and formulate tailored solutions to problems associated with the performance of medication management activities.”
The paper further emphasizes the distinct contribution occupational therapy practitioners make:
“Occupational therapy practitioners implement interventions that reduce barriers and promote routine, effective medication management. We make a distinct contribution to interprofessional efforts to support medication management at the level of individual client performance and in setting- or facility-wide efforts to promote adherence.”
OT's Role in Home Health Fact Sheet
Another important reference is the OT’s Role in Home Health Fact Sheet by Bondoc and Siebert (2010), which identifies chronic condition management as a central focus of daily activity support. Occupational therapy practitioners are uniquely positioned to translate medical recommendations into sustainable, client-centered routines that improve safety and function.
AARP Personal Medication Record
The AARP Personal Medication Record is another widely used tool. This simple, client-friendly form allows individuals to document medication names, dosages, pharmacy and provider contacts, allergies, and other relevant details. It can be stored in the home or carried to medical appointments, improving continuity of care.
AOTA's Critically Appraised Topic (CAT) on Productive Aging for Community-Dwelling Older Adults
AOTA’s Critically Appraised Topic (CAT) on Productive Aging for Community-Dwelling Older Adults is also valuable. This CAT reviewed evidence for occupational therapy interventions targeting health self-management, particularly in relation to instrumental activities of daily living. Its conclusions reaffirm Lawton and Brody’s foundational 1969 framework, which positioned tasks like food preparation, transportation, financial management, and medication use as essential components of daily life that fall well within the scope of OT.
NYU's Bilingual Fact Sheets
New York State’s bilingual fact sheets in English and Spanish offer another accessible tool. These visual aids contain practical questions clients can ask their healthcare team, such as:
Why do I need this medication?
What side effects should I watch for?
Can this medication be combined with other treatments?
Is there a more affordable alternative?
How can I remember to take my medications?
These prompts support medication literacy and empower clients to participate actively in shared decision-making.
FDA's Guidance for Older Adults
The FDA’s guidance for older adults also provides vital context. As aging alters drug metabolism—due to changes in liver and kidney function—older adults face increased risk for adverse drug events. The FDA recommends maintaining an updated medication list, following prescription instructions precisely, and reviewing medications regularly with a healthcare provider. Occupational therapists can assist clients in applying these recommendations in real-world routines.
MedlinePlus
MedlinePlus, a National Institutes of Health resource, offers an accessible, evidence-based database on medications, safety, side effects, and interactions. It is beneficial for educating clients with varying health literacy levels.
AOTA Gerontology Special Interest Section Newsletter
The AOTA Gerontology Special Interest Section Newsletter has also addressed medication non-adherence as a common yet preventable cause of hospitalization. In a 2013 article, Sanders and Vanas outlined home-based occupational therapy strategies that promote adherence and emphasized the importance of collaboration during hospital discharge planning to ensure continuity of routines in the home environment.
Several policy and advocacy resources also highlight the expanding role of occupational therapy in medication management:
AOTA’s 2024 Official Documents Update reaffirmed the profession’s scope and explicitly positioned medication management as part of daily life within OT's domain.
The reintroduction of the Medicare Home Health Accessibility Act seeks to expand access to OT services in the home health setting, including safety monitoring related to medication use.
AOTA’s reported advocacy successes in the 2025 Medicare Part B Final Rule include fee schedule provisions that support expanded OT service delivery, enhancing opportunities to address medication management across settings.
Taken together, these clinical tools, resources, and policy updates form a robust framework that supports the inclusion of medication management as a key focus within occupational therapy practice. The task draws on multiple domains—health literacy, cognition, fine motor coordination, vision, and community mobility—and reflects the profession’s commitment to enabling clients to engage meaningfully in their everyday lives. Through assessment, intervention, caregiver education, and advocacy, occupational therapy practitioners help ensure that clients not only adhere to medication regimens but do so with confidence, independence, and improved quality of life.
Summary
In summary, medication management is a critical instrumental activity of daily living, multifaceted and often challenging. It requires coordination across a wide interprofessional team and draws on multiple domains of function. Occupational therapy practitioners are uniquely positioned to support clients and their caregivers by addressing the essential components of medication adherence, including health literacy, cognitive function, community mobility, fine motor coordination, and vision. Through comprehensive evaluation, education, environmental adaptation, and collaboration, occupational therapists play a vital role in ensuring that medication routines are safe and sustainable within each client’s real-life environment.
References
See attached handout.
Citation
Carson, F. (2025). Medication management for occupational therapy. OccupationalTherapy.com, Article 5821. Available at www.occupationaltherapy.com
