OBJECTIVES: Thirty-two million Americans use three or more medications daily. Approximately 75% of patients fail to adhere to physician prescribed treatment regimens. The economic impact of non-adherence is estimated to cost $100 billion annually. Evidence suggests that the elderly are one of the largest groups contributing to the economic burden associated with non-adherence. Studies support the development of visual focused tools to improve adherence among older persons. The aim of this study was to explore the use of visual adherence tools in the hospital, clinic, and home settings to determine effectiveness in improving patient adherence and negating hospital readmissions.  METHODS: Electronic databases such as PubMed and Google Scholar were searched from 2000 – 2014.  Key words were “visual,” “adherence,” “elderly,” “readmissions,” and “visual adherence tool.”  Studies were included if they were conducted outside of the U.S. since few U.S. studies examined visual adherence tools. A custom-designed table included year of publication, author, study design, intervention, findings, and sources. RESULTS: A total of 24 articles and economic evaluations were retrieved. Older adults are the largest users of prescription medication. Whilst evidence suggests that visual medication adherence tools are useful, the tools are not being widely used in hospitals. This may be due to lack of knowledge about benefits. Exploration in psychology and marketing denotes that humans have a cognitive preference for picture-based, as opposed to text-based information. Reports have shown that pictorial aids expand recall, comprehension, and adherence. These instruments can also be particularly valuable for conveying dosage times, instructions on when to take medicine, as well as the importance of completing a course of therapy. Studies show that older persons prefer medication tools that focus on visual characteristics such as large print and simplified information.  CONCLUSIONS: Several studies focused on the clinic and home setting, but few were hospital based. Further research is warranted.