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Sumbul-Sekerci B, Hanagasi HA, Bilgic B, Tufekcioglu Z, Gurvit H, Emre M. Medication management and treatment adherence in Parkinson's disease patients with mild cognitive impairment. Acta Neurol Belg 2022:10.1007/s13760-022-01916-1. [PMID: 35325434 DOI: 10.1007/s13760-022-01916-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 03/03/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The key feature that distinguishes mild cognitive impairment (MCI) from dementia is the absence of significant functional decline because of cognitive impairment. In Parkinson's disease patients (PD) with MCI (PD-MCI), the effect of cognitive impairment on complex instrumental daily activities, such as medication management, is not well established. METHOD 26 patients with PD-MCI (diagnosed to Level 2 Movement Disorders Society diagnostic criteria) and 32 idiopathic PD patients without cognitive impairment participated in the study. A detailed neuropsychological testing battery (including tests for attention and working memory, executive functions, language, visuospatial functions, episodic memory) and various prospective memory tasks were applied to the patients. Medication taking behaviors were evaluated using two different methods based on the performance (medication management ability assessment) and self-reporting (adherence scale). RESULTS The PD-MCI group obtained significantly lower scores in medication management assessment and made more mistakes on following prescription instructions (e.g., they took more or less tablets and did not use medications as instructed with regard to meal times). Cognitive areas predicting success in medication management performance were language, event-based prospective memory and visuospatial functions. There was no significant difference between the two groups' self-reporting of adherence. CONCLUSION Mild cognitive impairment in patients with PD adversely affects medication management. Diagnosing MCI in PD is important to ensure that the appropriate measures can be taken to provide support and improve the medication management process. Adherence assessments based on self-reporting may not provide reliable and sensitive information in patients with PD-MCI.
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Affiliation(s)
- Betul Sumbul-Sekerci
- Department of Neuroscience, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey.
- Department of Clinical Pharmacy, Faculty of Pharmacy, Bezmialem Vakıf University, Istanbul, Turkey.
| | - Hasmet A Hanagasi
- Behavioral Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Basar Bilgic
- Behavioral Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Zeynep Tufekcioglu
- Behavioral Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Hakan Gurvit
- Behavioral Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Murat Emre
- Behavioral Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Chou CC, Chien LY, Liaw JJ, Wang CJ, Liu PY. Association between cognitive function and self-reported antihypertensive medication adherence among middle-aged and older hypertensive women. J Clin Nurs 2021; 31:2839-2849. [PMID: 34723423 DOI: 10.1111/jocn.16106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 09/24/2021] [Accepted: 10/06/2021] [Indexed: 12/22/2022]
Abstract
DESIGN This study applied a cross-sectional, descriptive correlational design. AIMS AND OBJECTIVES The purpose of the study was to examine the relationship between cognitive function and self-reported antihypertensive medication adherence in middle-aged and older hypertensive women. BACKGROUND Although medication adherence is an essential key for preventing complications from hypertension, poor medication adherence is common among middle-aged and older hypertensive women. Taking medications involves a cognitive process. Little is known about the contribution of cognitive function to adherence to antihypertensive medication in middle-aged and older women. METHODS This study used a convenience sample of 137 women aged ≥50 years recruited from a medical centre in southern Taiwan. Participants completed a survey of demographic and clinical information and self-reported medication adherence, and received cognitive function tests. Hierarchical regression analyses were used to evaluate the association between cognitive function and medication adherence. This study followed the STROBE guidelines. RESULTS More than one-fourth of the women (27%) reported poor adherence. Women with poor adherence appeared to have a significantly lower memory than women with good adherence. Memory was positively associated with antihypertensive medication adherence after controlling for age, blood pressure and duration of hypertension. Working memory, executive function and psychomotor speed were not significantly related to antihypertensive medication adherence. CONCLUSIONS Reduced memory function was associated with poorer antihypertensive medication adherence among middle-aged and older women. Middle-aged and older women with hypertension and poor memory performance are at risk of poor medication adherence. Future prospective studies examining the causal relationship between cognitive function and antihypertensive medication adherence are warranted. RELEVANCE TO CLINICAL PRACTICE Nurses could evaluate the memory of middle-aged and older hypertensive women when assessing antihypertensive medication adherence in clinical practice and provide relevant interventions.
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Affiliation(s)
- Cheng-Chen Chou
- Institute of Community Health Care, College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Li-Yin Chien
- Institute of Community Health Care, College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Jen-Jiuan Liaw
- School of Nursing, National Defense Medical Center, Taipei, Taiwan
| | - Chi-Jane Wang
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Nursing, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Ping-Yen Liu
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Division of Cardiology, Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Merks P, Cameron J, Bilmin K, Świeczkowski D, Chmielewska-Ignatowicz T, Harężlak T, Białoszewska K, Sola KF, Jaguszewski MJ, Vaillancourt R. Medication Adherence and the Role of Pictograms in Medication Counselling of Chronic Patients: a Review. Front Pharmacol 2021; 12:582200. [PMID: 34489688 PMCID: PMC8417421 DOI: 10.3389/fphar.2021.582200] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 07/19/2021] [Indexed: 11/25/2022] Open
Abstract
Pharmaceutical care requires a patient-centered approach, focusing on the ability of patients to understand drug-related information and follow the instructions delivered by pharmacists as well as other health-care providers included in the circle of care. With the goal of ensuring the prescribed use of medications, called medication adherence, health-care providers have to consider many risk factors such as geography (culture), social economic status, age, and low literacy that may predispose patients to non-adherence, and considerations have to be made for chronic patients living with life-long disease states. The aim of this review is to provide a balanced and comprehensive review outlining a number of different medication counselling and education approaches that have been used to try to improve medication adherence and health outcomes with the use of clear and concise graphic illustrations—called pictograms. By highlighting the current landscape of the general use and efficacy of pharmaceutical pictograms to aid in the knowledge and recall of drug-related information, as well as outlining specific medication adherence outcomes with pharmaceutical pictograms in chronic patients, the current review describes the need for health-care providers to move beyond the traditional didactic methods of oral and verbal communication with patients regarding medication-taking behavior.
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Affiliation(s)
- Piotr Merks
- Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszyński University, Warsaw, Poland.,Department of Pharmaceutical Technology, Collegium Medicum, Nicolaus Copernicus University, Toruń, Poland
| | - Jameason Cameron
- Department of Pharmacy, Children's Hospital of Eastern Ontario, Centre Hospitalier pour Enfants de L'est de L'Ontario, Ottawa, ON, Canada
| | - Krzysztof Bilmin
- Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszyński University, Warsaw, Poland
| | - Damian Świeczkowski
- First Department of Cardiology, Medical University of Gdansk, Gdańsk, Poland
| | | | - Tomasz Harężlak
- Department of Pharmaceutical Technology, Collegium Medicum, Nicolaus Copernicus University, Toruń, Poland
| | | | | | | | - Regis Vaillancourt
- Department of Pharmacy, Children's Hospital of Eastern Ontario, Centre Hospitalier pour Enfants de L'est de L'Ontario, Ottawa, ON, Canada
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Amorim WW, Passos LC, Gama RS, Souza RM, Oliveira MG. Factors associated with older patients' misunderstandings of medication dosage regimen instructions after consultation in primary care in Brazil. J Eval Clin Pract 2021; 27:817-825. [PMID: 32909673 DOI: 10.1111/jep.13480] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 08/23/2020] [Accepted: 08/25/2020] [Indexed: 12/28/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES Misunderstanding medication dosage regimen instructions can lead to unintentional misuse of a prescribed medicine, non-adherence to providers' instructions, and other treatment-related issues. We aimed to evaluate the frequency of and factors associated with older patients' misunderstanding of medication dosage regimen instructions after consultation with a general practitioner. METHOD This cross-sectional study was conducted in 22 primary-care facilities in Brazil. Data were collected from September 2016 to December 2017 using a multidimensional questionnaire. Patients who were 60 years old or older who visited primary care units were included in the study (n = 416). RESULTS Of the older patients interviewed, 38.2% had a misunderstanding of medication dosage regimen instructions; being female was a protective factor against the misunderstanding of medication dosage regimen instructions (prevalence ratio [PR] = 0.63; 95% confidence interval [CI] = 0.45-0.89). In relation to other factors with an important association, misunderstanding medication dosage regimen instructions was 71% higher among illiterate participants (PR = 1.71; 95% CI = 1.25-2.35), 39% higher among people who considered their memory to be poor (PR = 1.39; 95% CI = 1.01-1.91), 49% higher in those who did not have a job at the time of the interview (PR = 1.49; 95% CI = 1.01-2.19), and 50% higher in patients who had been prescribed five or more medications (PR = 1.50; 95% CI = 1.02-2.20). CONCLUSIONS The results showed that older people's misunderstandings of medication dosage regimen instructions after consultation with a general practitioner was greater than expected due to a range of factors, especially polypharmacy, poor literacy, poor memory, and having a job at the time of the interview. Health services and professionals should implement strategies to increase the quality of the guidance given to elderly individuals and to ensure their adherence to the regimen instructions of their medications.
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Affiliation(s)
- Welma W Amorim
- Department of Natural Sciences, Medicine Course, State University of Southwest Bahia, Vitória da Conquista, Bahia, Brazil.,Postgraduate Program in Medicine and Health, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Luiz C Passos
- Postgraduate Program in Medicine and Health, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Romana S Gama
- Postgraduate Program in Medicine and Health, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Renato M Souza
- Postgraduate Program in Collective Health, Multidisciplinary Health Institute, Federal University of Bahia, Vitória da Conquista, Bahia, Brazil
| | - Marcio G Oliveira
- Postgraduate Program in Collective Health, Multidisciplinary Health Institute, Federal University of Bahia, Vitória da Conquista, Bahia, Brazil
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Tsai TH, Huang N, Lin IF, Chou YJ. Variation in the 11-year trajectories of medical care seeking behaviors in diabetes patients under a single payer system: persisting gaps to be filled. BMC Health Serv Res 2019; 19:580. [PMID: 31426781 PMCID: PMC6699076 DOI: 10.1186/s12913-019-4399-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Accepted: 08/02/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Care-seeking behavior is widely acknowledged to have strong influences on health outcomes among individuals with chronic conditions including diabetes. Despite its dynamic nature, care seeking behavior are often considered as time invariant in most studies. The likelihood of patients changing their regularity and source of chronic care over time is often neglected. This study aimed to determine the long-term trajectories of care-seeking patterns of both care-seeking regularity and health provider choices; and their associated factors among patients with type 2 diabetes under the National Health Insurance (NHI) program in Taiwan. METHODS We utilized population-based data from the National Health Insurance Research Database (NHIRD) in Taiwan. Three thousand, nine hundred and eighty-seven adult patients with newly diagnosed type 2 diabetes in 1999 were enrolled in the cohort. We assessed their trajectories of regular care visits and sources of diabetes care from 2000 to 2010. A group-based trajectory model was applied. RESULTS Seven distinct groups of long-term care-seeking patterns were identified. Only 51.44% of patients with newly diagnosed diabetes had regularly visited their providers over time. Among them, 56.41 and 16.09% had persistently sought care from generalized and specialized providers, respectively. 27.50% had sought care from different levels of providers. Patients who were male, elderly, low-income, and had a higher baseline diabetes severity were significantly more likely to either continue with their irregular care-seeking behavior or fail to maintain their regular care seeking behavior over time. Those who were younger, had a higher socioeconomic status, and lived in an urban area were significantly more likely to persistently seek care from specialized care settings. CONCLUSIONS This study is the first population-based assessment of long-term care-seeking behaviors of type 2 diabetes patients under a single-payer system with a comprehensive benefit coverage. The most alarming finding was that, despite the existence of the comprehensive universal health insurance coverage in Taiwan, almost 50% of patients did not seek or maintain regular visits to providers over time as recommended. Understanding variations in the long-term trajectories of care adherence and sources of care may help to identify gaps in diabetes care management.
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Affiliation(s)
- Tzu-Ho Tsai
- Institute of Public Health, School of Medicine, National Yang-Ming University, No.115, Sec. 2, Linong Street, Taipei, Taiwan
- Department of Intensive Care, Cheng-Hsin Hospital, No. 45, Cheng Hsin Street, Taipei, Taiwan
| | - Nicole Huang
- Institute of Hospital and Health Care Administration, School of Medicine, National Yang-Ming University, No.115, Sec. 2, Linong Street, Taipei, Taiwan
| | - I-Feng Lin
- Institute of Public Health, School of Medicine, National Yang-Ming University, No.115, Sec. 2, Linong Street, Taipei, Taiwan
| | - Yiing-Jenq Chou
- Institute of Public Health, School of Medicine, National Yang-Ming University, No.115, Sec. 2, Linong Street, Taipei, Taiwan
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Teresi JA, Ocepek-Welikson K, Ramirez M, Fieo R, Fulmer T, Gurland BJ. Development of a Short-Form of the Medication Management Test: Evaluation of Dimensionality, Reliability, Information and Measurement Equivalence Using Latent Variable Models. J Nurs Meas 2018; 26:483-511. [PMID: 30593574 DOI: 10.1891/1061-3749.26.3.483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE The Medication Management Test (MMT) measures higher cognitive functioning. The aim of the analyses presented was to reduce assessment burden by developing a short-form version, and describe its psychometric properties. METHODS Factor analyses, item response theory (IRT), and differential item functioning (DIF) were performed to examine the dimensionality, reliability information, and measurement equivalence. RESULTS The ratio of the first two extracted eigenvalues from the exploratory principal component analysis was 7.62, indicating essential unidimensionality. Although one item "needs prompting for pill regime" evidenced DIF above the threshold for education and race/ethnicity, the magnitude was relatively small and the impact minimal. IRT-based reliability estimates were high (>0.80) across all subgroups. CONCLUSIONS Because medication management is an important task associated with independent living, it is critical to assess whether medications can be self-administered safely.
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Affiliation(s)
- Jeanne A Teresi
- Columbia University Stroud Center, New York State Psychiatric Institute, New York .,Research Division, Hebrew Home at RiverSpring Health, New York
| | | | - Mildred Ramirez
- Research Division, Hebrew Home at RiverSpring Health, New York.,Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College, New York
| | - Robert Fieo
- Department of Aging and Geriatric Research, University of Florida, Florida
| | | | - Barry J Gurland
- Columbia University Stroud Center, New York State Psychiatric Institute, New York
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Blocker KA, Insel KC, Koerner KM, Rogers WA. Understanding the Medication Adherence Strategies of Older Adults with Hypertension. ACTA ACUST UNITED AC 2017. [DOI: 10.1177/1541931213601498] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Many older adults are living with at least one chronic disease and must adhere to prescribed medication to mitigate and control its impact. Hypertension is one chronic disease that affects a significant portion of the world’s population, especially older adults, and is responsible for a high number of annual deaths. It is asymptomatic, meaning that there are no perceptible symptoms and, as such, older adults may struggle with adhering to their prescribed antihypertensive medications. How one internalizes the disease may influence the degree of success in managing the condition. The current study analyzed archival data from a multifaceted prospective memory intervention for older adults with hypertension who were nonadherent to their medication. We coded their responses to self-management interview questions to identify the common themes regarding the knowledge and sense of control the older adults held relevant to managing their illness. Participants’ responses revealed how they internalized hypertension and their medication, as well as the strategies and goals they reportedly used to manage the illness. The association strategy was found to be the most commonly used within participants’ routines. In addition, many participants expressed a general lack of knowledge about the disease or their medication, and their goals regarding hypertension management were general and inexplicit (e.g., “to reduce their blood pressure). This information informs the design of more effective and longer-lasting interventions geared toward significantly improving the medication adherence of older adults diagnosed with hypertension.
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Hudani ZK, Rojas-Fernandez CH. A scoping review on medication adherence in older patients with cognitive impairment or dementia. Res Social Adm Pharm 2016; 12:815-829. [DOI: 10.1016/j.sapharm.2015.11.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 11/20/2015] [Accepted: 11/20/2015] [Indexed: 10/22/2022]
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Ihle A, Inauen J, Scholz U, König C, Holzer B, Zimmerli L, Battegay E, Tobias R, Kliegel M. Prospective and retrospective memory are differentially related to self-rated omission and commission errors in medication adherence in multimorbidity. APPLIED NEUROPSYCHOLOGY-ADULT 2016; 24:505-511. [PMID: 27450575 DOI: 10.1080/23279095.2016.1209675] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
We investigated the relations of self-rated omission errors (i.e., forgetting to take one's medication) and commission errors (i.e., unnecessary repetitions of medication intake because of forgetting that it has already been taken) in medication adherence in multimorbidity to prospective and retrospective memory performance. Moreover, we examined whether these relations were moderated by the number of medications that had to be taken. Eighty-four patients with multimorbidity (aged 28-84 years, M = 62.4) reported medication adherence regarding the last seven days and the number of medications they had to take. In addition, we administered psychometric tests on prospective memory (PM) and retrospective memory performance. We found that reported omission errors in medication adherence were related significantly to lower PM performance. This relationship was increased in individuals with a lower number of medications. In comparison, reported commission errors in medication adherence were related significantly to lower retrospective memory performance. This relationship was increased in individuals with a larger number of medications. Present data suggest that omission errors in medication adherence in multimorbidity may reflect primarily PM errors, particularly if few medications have to be taken, while commission errors may reflect mainly retrospective memory failures, especially with a large number of medications that need to be taken as prescribed. From an applied neuropsychological perspective, these results underline the importance of trying to enhance PM and retrospective memory performance in patients with multimorbidity.
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Affiliation(s)
- Andreas Ihle
- a Department of Psychology , University of Geneva , Geneva , Switzerland.,e Center for the Interdisciplinary Study of Gerontology and Vulnerability , University of Geneva , Geneva , Switzerland.,f Swiss National Center of Competences in Research LIVES-Overcoming Vulnerability: Life Course Perspectives
| | - Jennifer Inauen
- b Department of Psychology , University of Zurich , Zurich , Switzerland.,g Center of Competence Multimorbidity , University of Zurich , Zurich , Switzerland.,h University Research Priority Program "Dynamics of Healthy Aging" , University of Zurich , Zurich , Switzerland.,i Department of Psychology , Columbia University , New York , USA
| | - Urte Scholz
- b Department of Psychology , University of Zurich , Zurich , Switzerland.,g Center of Competence Multimorbidity , University of Zurich , Zurich , Switzerland.,h University Research Priority Program "Dynamics of Healthy Aging" , University of Zurich , Zurich , Switzerland
| | - Claudia König
- b Department of Psychology , University of Zurich , Zurich , Switzerland.,h University Research Priority Program "Dynamics of Healthy Aging" , University of Zurich , Zurich , Switzerland
| | - Barbara Holzer
- c Department of Internal Medicine , University Hospital Zurich , Zurich , Switzerland.,g Center of Competence Multimorbidity , University of Zurich , Zurich , Switzerland.,h University Research Priority Program "Dynamics of Healthy Aging" , University of Zurich , Zurich , Switzerland
| | - Lukas Zimmerli
- d Department of Internal Medicine , Hospital Olten , Olten , Switzerland.,g Center of Competence Multimorbidity , University of Zurich , Zurich , Switzerland
| | - Edouard Battegay
- c Department of Internal Medicine , University Hospital Zurich , Zurich , Switzerland.,g Center of Competence Multimorbidity , University of Zurich , Zurich , Switzerland.,h University Research Priority Program "Dynamics of Healthy Aging" , University of Zurich , Zurich , Switzerland
| | - Robert Tobias
- b Department of Psychology , University of Zurich , Zurich , Switzerland
| | - Matthias Kliegel
- a Department of Psychology , University of Geneva , Geneva , Switzerland.,e Center for the Interdisciplinary Study of Gerontology and Vulnerability , University of Geneva , Geneva , Switzerland.,f Swiss National Center of Competences in Research LIVES-Overcoming Vulnerability: Life Course Perspectives
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Peters E, Hess TM, Västfjäll D, Auman C. Adult Age Differences in Dual Information Processes: Implications for the Role of Affective and Deliberative Processes in Older Adults' Decision Making. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2016; 2:1-23. [DOI: 10.1111/j.1745-6916.2007.00025.x] [Citation(s) in RCA: 207] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Age differences in affective/experiential and deliberative processes have important theoretical implications for judgment and decision theory and important pragmatic implications for older-adult decision making. Age-related declines in the efficiency of deliberative processes predict poorer-quality decisions as we age. However, age-related adaptive processes, including motivated selectivity in the use of deliberative capacity, an increased focus on emotional goals, and greater experience, predict better or worse decisions for older adults depending on the situation. The aim of the current review is to examine adult age differences in affective and deliberative information processes in order to understand their potential impact on judgments and decisions. We review evidence for the role of these dual processes in judgment and decision making and then review two representative life-span perspectives (based on aging-related changes to cognitive or motivational processes) on the interplay between these processes. We present relevant predictions for older-adult decisions and make note of contradictions and gaps that currently exist in the literature. Finally, we review the sparse evidence about age differences in decision making and how theories and findings regarding dual processes could be applied to decision theory and decision aiding. In particular, we focus on prospect theory ( Kahneman & Tversky, 1979 ) and how prospect theory and theories regarding age differences in information processing can inform one another.
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Affiliation(s)
| | | | - Daniel Västfjäll
- Decision Research, Eugene, Oregon
- Goteborg University, Goteborg, Sweden
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Mickelson RS, Willis M, Holden RJ. Medication-related cognitive artifacts used by older adults with heart failure. HEALTH POLICY AND TECHNOLOGY 2015; 4:387-398. [PMID: 26855882 PMCID: PMC4741110 DOI: 10.1016/j.hlpt.2015.08.009] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To use a human factors perspective to examine how older adult patients with heart failure use cognitive artifacts for medication management. METHODS We performed a secondary analysis of data collected from 30 patients and 14 informal caregivers enrolled in a larger study of heart failure self-care. Data included photographs, observation notes, interviews, video recordings, medical record data, and surveys. These data were analyzed using an iterative content analysis. RESULTS Findings revealed that medication management was complex, inseparable from other patient activities, distributed across people, time, and place, and complicated by knowledge gaps. We identified fifteen types of cognitive artifacts including medical devices, pillboxes, medication lists, and electronic personal health records used for: 1) measurement/evaluation; 2) tracking/communication; 3) organization/administration; and 4) information/sensemaking. These artifacts were characterized by fit and misfit with the patient's sociotechnical system and demonstrated both advantages and disadvantages. We found that patients often modified or "finished the design" of existing artifacts and relied on "assemblages" of artifacts, routines, and actors to accomplish their self-care goals. CONCLUSIONS Cognitive artifacts are useful but sometimes are poorly designed or are not used optimally. If appropriately designed for usability and acceptance, paper-based and computer-based information technologies can improve medication management for individuals living with chronic illness. These technologies can be designed for use by patients, caregivers, and clinicians; should support collaboration and communication between these individuals; can be coupled with home-based and wearable sensor technology; and must fit their users' needs, limitations, abilities, tasks, routines, and contexts of use.
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Affiliation(s)
- Robin S. Mickelson
- Vanderbilt School of Nursing, Vanderbilt University, Nashville, TN, USA
- The Center for Research and Innovation in Systems Safety (CRISS), Vanderbilt University Medical Center, Nashville, TN, USA
| | - Matt Willis
- School of Information Studies, Syracuse University, Syracuse, NY, USA
| | - Richard J. Holden
- Department of BioHealth Informatics, Indiana University School of Informatics and Computing, Indianapolis, IN, USA
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Schnitzspahn KM, Scholz U, Ballhausen N, Hering A, Ihle A, Lagner P, Kliegel M. Age differences in prospective memory for everyday life intentions: A diary approach. Memory 2015; 24:444-54. [PMID: 25750997 DOI: 10.1080/09658211.2015.1018276] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The age benefit found in many naturalistic prospective memory (PM) tasks has been taken as evidence that PM performance in real life may be spared from aging. However, this conclusion lacks empirical confirmation. Hence, the aim of the present study was to examine possible age differences in the content of everyday PM intentions and their performance. Everyday PM was assessed in young and older adults using a diary approach. Results confirmed a general age benefit for real-life PM tasks. Importantly, this finding was qualified by revealing that the benefit only held true for specific types of intentions such as health and social intentions. Further, moderation analyses showed that the relationships between cognitive functioning and everyday PM were different for young and older adults. While better inhibition, short-term and long-term memory were related with successful PM performance in the young, this was not the case in the older adults. The present findings suggest that the age benefit found in naturalistic experimenter-given tasks extends to real-life PM performance, but may differ depending on the type of intention. Furthermore, cognitive functioning predicts performance in the young, but not in the older adults.
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Affiliation(s)
- Katharina M Schnitzspahn
- a Faculté de psychologie et des sciences de l'éducation , Université de Genève , Genève , Switzerland
| | - Urte Scholz
- b Psychologisches Institut , Universität Zürich , Zürich , Switzerland
| | - Nicola Ballhausen
- a Faculté de psychologie et des sciences de l'éducation , Université de Genève , Genève , Switzerland
| | - Alexandra Hering
- a Faculté de psychologie et des sciences de l'éducation , Université de Genève , Genève , Switzerland
| | - Andreas Ihle
- a Faculté de psychologie et des sciences de l'éducation , Université de Genève , Genève , Switzerland
| | - Prune Lagner
- a Faculté de psychologie et des sciences de l'éducation , Université de Genève , Genève , Switzerland
| | - Matthias Kliegel
- a Faculté de psychologie et des sciences de l'éducation , Université de Genève , Genève , Switzerland
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Woods SP, Weinborn M, Maxwell BR, Gummery A, Mo K, Ng ARJ, Bucks RS. Event-based prospective memory is independently associated with self-report of medication management in older adults. Aging Ment Health 2014; 18:745-53. [PMID: 24410357 PMCID: PMC4040152 DOI: 10.1080/13607863.2013.875126] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Identifying potentially modifiable risk factors for medication non-adherence in older adults is important in order to enhance screening and intervention efforts designed to improve medication-taking behavior and health outcomes. The current study sought to determine the unique contribution of prospective memory (PM) (i.e. 'remembering to remember') to successful self-reported medication management in older adults. METHODS Sixty-five older adults with current medication prescriptions completed a comprehensive research evaluation of sociodemographic, psychiatric, and neurocognitive functioning, which included the memory for adherence to medication scale (MAMS), prospective and retrospective memory questionnaire (PRMQ), and a performance-based measure of PM that measured both semantically related and semantically unrelated cue-intention (i.e. when-what) pairings. RESULTS A series of hierarchical regressions controlling for biopsychosocial, other neurocognitive, and medication-related factors showed that elevated complaints on the PM scale of the PRMQ and worse performance on an objective semantically unrelated event-based PM task were independent predictors of poorer medication adherence as measured by the MAMS. CONCLUSIONS PM plays an important role in self-report of successful medication management among older adults. Findings may have implications for screening for older individuals 'at risk' of non-adherence, as well as the development of PM-based interventions to improve medication adherence and, ultimately, long-term health outcomes in older adults.
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Affiliation(s)
- Steven Paul Woods
- Department of Psychiatry, University of California-San Diego, La Jolla, California,School of Psychology, University of Western Australia, Crawley, Western Australia
| | - Michael Weinborn
- School of Psychology, University of Western Australia, Crawley, Western Australia
| | - Brenton R. Maxwell
- School of Psychology, University of Western Australia, Crawley, Western Australia
| | - Alice Gummery
- School of Psychology, University of Western Australia, Crawley, Western Australia
| | - Kevin Mo
- School of Psychology, University of Western Australia, Crawley, Western Australia
| | - Amanda R. J. Ng
- School of Psychology, University of Western Australia, Crawley, Western Australia
| | - Romola S. Bucks
- School of Psychology, University of Western Australia, Crawley, Western Australia
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Brom SS, Schnitzspahn KM, Melzer M, Hagner F, Bernhard A, Kliegel M. Fluid mechanics moderate the effect of implementation intentions on a health prospective memory task in older adults. Eur J Ageing 2013; 11:89-98. [PMID: 28804317 DOI: 10.1007/s10433-013-0288-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The aim of the present study was to test if a cognitive strategy improves older adults' prospective memory performance in a naturalistic health task. Moreover, it was tested if a possible strategy effect is moderated by individual differences. Therefore, a group of older adults was asked to perform a task taken from the medication adherence literature (i.e., blood pressure monitoring). Half of them were asked to form implementation intentions. Additionally, crystallized pragmatics and fluid mechanics, conscientiousness, self-efficacy, and lifestyle factors were assessed as possible moderators. Results showed a strong positive strategy effect on prospective memory. Moreover, the effect was qualified by a significant interaction and only emerged for participants with low levels in fluid mechanics. No other moderator showed an effect. In conclusion, an enhancing effect of implementation intentions on prospective memory seems to be dependent on individual differences in cognitive capacity and less related to key motivational or personality variables.
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Affiliation(s)
- Sarah Susanne Brom
- Department of Psychology, Technische Universität Dresden, 01062 Dresden, Germany
| | | | - Marlen Melzer
- Department of Psychology, Technische Universität Dresden, 01062 Dresden, Germany
| | - Franziska Hagner
- Department of Psychology, Technische Universität Dresden, 01062 Dresden, Germany
| | - Anka Bernhard
- Department of Psychology, Technische Universität Dresden, 01062 Dresden, Germany
| | - Matthias Kliegel
- Faculté de psychologie et des sciences de l'éducation, Université de Genève, 1211 Geneva, Switzerland
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15
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Boron JB, Rogers WA, Fisk AD. Everyday memory strategies for medication adherence. Geriatr Nurs 2013; 34:395-401. [PMID: 23810198 DOI: 10.1016/j.gerinurse.2013.05.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Revised: 05/16/2013] [Accepted: 05/27/2013] [Indexed: 11/24/2022]
Abstract
The need to manage chronic diseases and multiple medications increases for many older adults. Older adults are aware of memory declines and incorporate compensatory techniques. Everyday memory strategies used to support medication adherence were investigated. A survey distributed to 2000 households in the Atlanta metropolitan area yielded a 19.9% response rate including 354 older adults, aged 60-80 years. Older adults reported forgetting to take their medications, more so as their activity deviated from normal routines, such as unexpected activities. The majority of older adults endorsed at least two compensatory strategies, which they perceived to be more helpful in normal routines. Compensatory strategies were associated with higher education, more medications, having concern, and self-efficacy to take medications. As memory changes, older adults rely on multiple cues, and perceive reliance on multiple cues to be helpful. These data have implications for the design and successful implementation of medication reminder systems and interventions.
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Affiliation(s)
- Julie Blaskewicz Boron
- Department of Psychology, Youngstown State University, 1 University Plaza, Youngstown, OH 44555, USA.
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16
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Zartman AL, Hilsabeck RC, Guarnaccia CA, Houtz A. The Pillbox Test: An Ecological Measure of Executive Functioning and Estimate of Medication Management Abilities. Arch Clin Neuropsychol 2013; 28:307-19. [DOI: 10.1093/arclin/act014] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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17
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Utility of the Millon Behavioral Medicine Diagnostic to predict medication adherence in patients diagnosed with heart failure. J Clin Psychol Med Settings 2011; 18:1-12. [PMID: 21222020 DOI: 10.1007/s10880-010-9217-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Medication non-adherence is common and a primary reason for poor medical outcomes among individuals with heart failure (HF). This study's aims were to determine whether depression, hostility, and the personality-based Millon Behavioral Medicine Diagnostic (MBMD) Medication Abuse scale were associated with medication adherence (e.g., beta-blockers, ACE inhibitors, diuretics, statins) beyond contributions of demographic, medical, and psychosocial variables in an ethnically-diverse sample of 105 men and women diagnosed with HF. In hierarchical regression, greater MBMD Medication Abuse scale scores were associated with poorer adherence above and beyond both depression (β = .236, t[102] = 2.113, p = .037) and hostility (β = .244, t[102] = 2.506, p = .014). The Medication Abuse scale also completely mediated the relationship between adherence and depression. These findings suggest that personality measures such as the MBMD and hostility scales might be utilized in future studies investigating predictors of adherence and also used clinically to predict medication adherence among HF patients.
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18
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Smith J, Lewis J, Prichard D. Physiotherapy exercise programmes: Are instructional exercise sheets effective? Physiother Theory Pract 2009; 21:93-102. [PMID: 16392462 DOI: 10.1080/09593980590922316] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Effective compliance with physiotherapy exercises is only possible if patients remember the exercises accurately. The purpose of this study was to assess how well elderly in-patients remembered simple physiotherapy exercises, by comparing the ability to accurately reproduce a set of exercises in a group of patients that had received a written exercise sheet, with a group that had not. The study also aimed to investigate the relationship between memory for exercises and cognition. Sixty-four in-patients in an acute hospital were taught 3 exercises. Half of the subjects were randomised to receive exercise sheets to reinforce the teaching (Group 1). The rest of the subjects did not receive this memory aid (Group 2). Two to three days later subjects were asked to demonstrate their exercises. The accurate recall of the exercises was scored using a new assessment scale with a maximum score of 24. The mean exercise score was 17.19 for group 1 (SD = 5.91) and 16.24 for Group 2 (SD = 6.01). There was no significant difference in exercise score between groups (Mann Whitney U test p = 0.44). There was a statistically significant small positive correlation between exercise score and cognition (tau = 0.263). The study showed that older adult in-patients do not remember physiotherapy exercises effectively after a single teaching session and that their memory is not significantly improved by provision of an exercise sheet.
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Affiliation(s)
- Jo Smith
- Medical Rehabilitation Department, Chelsea and Westminster Healthcare NHS Trust, London.
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19
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Peters E, Diefenbach MA, Hess TM, Västfjäll D. Age differences in dual information-processing modes: implications for cancer decision making. Cancer 2008; 113:3556-67. [PMID: 19058148 PMCID: PMC2755493 DOI: 10.1002/cncr.23944] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Age differences in affective/experiential and deliberative processes have important theoretical implications for cancer decision making, as cancer is often a disease of older adulthood. The authors examined evidence for adult age differences in affective and deliberative information processes, reviewed the sparse evidence about age differences in decision making, and introduced how dual process theories and their findings might be applied to cancer decision making. Age-related declines in the efficiency of deliberative processes predict poorer-quality decisions as we age, particularly when decisions are unfamiliar and the information is numeric. However, age-related adaptive processes, including an increased focus on emotional goals and greater experience, can influence decision making and potentially offset age-related declines. A better understanding of the mechanisms that underlie cancer decision processes in our aging population should ultimately allow us to help older adults to better help themselves.
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Chisholm-Burns MA, Kwong WJ, Mulloy LL, Spivey CA. Nonmodifiable characteristics associated with nonadherence to immunosuppressant therapy in renal transplant recipients. Am J Health Syst Pharm 2008; 65:1242-7. [DOI: 10.2146/ajhp070630] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Marie A. Chisholm-Burns
- Department of Pharmacy Practice and Science, The University of Arizona College of Pharmacy (UACP), Tucson
| | - W. Jaqueline Kwong
- Worldwide Health Economics and Pricing, Johnson and Johnson Pharmaceutical Services, Raritan, NJ
| | - Laura L. Mulloy
- Section of Nephrology, Hypertension and Transplantation Medicine, Medical College of Georgia School of Medicine, Augusta
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21
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Park DC, Gutchess AH, Meade ML, Stine-Morrow EAL. Improving Cognitive Function in Older Adults: Nontraditional Approaches. J Gerontol B Psychol Sci Soc Sci 2007; 62 Spec No 1:45-52. [PMID: 17565164 DOI: 10.1093/geronb/62.special_issue_1.45] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
This article considers two nontraditional approaches for developing interventions to improve cognition in older adults. Neither of these approaches relies on traditional explicit training of specific abilities in the laboratory. The first technique involves the activation of automatic processes through the formation of implementation intentions that enhance the probability that a desired action will be completed, such as remembering to take medications. The second involves experimentally studying the role of active social and cognitive engagement in improving cognition. We then consider methodological issues associated with the use of these novel techniques.
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Affiliation(s)
- Denise C Park
- University of Illinois at Urbana-Champaign, 405 North Mathews Avenue, Urbana, IL 61801, USA.
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22
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Insel K, Morrow D, Brewer B, Figueredo A. Executive function, working memory, and medication adherence among older adults. J Gerontol B Psychol Sci Soc Sci 2006; 61:P102-7. [PMID: 16497953 DOI: 10.1093/geronb/61.2.p102] [Citation(s) in RCA: 224] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
The purpose of this study was to investigate the association between cognitive processes and medication adherence among community-dwelling older adults. Ninety-five participants (M = 78 years) completed a battery of cognitive assessments including measures of executive function, working memory, cued recall, and recognition memory. Medication adherence was examined over 8 weeks for one prescribed medicine by use of an electronic medication-monitoring cap. In a simultaneous regression, the composite of executive function and working memory tasks was the only significant predictor (beta =.44, p <.01). Findings suggest that assessments of executive function and working memory can be used to identify community-dwelling older adults who may be at risk for failure to take medicines as prescribed.
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Affiliation(s)
- Kathleen Insel
- University of Arizona, College of Nursing, P.O. 210203, Tucson, AZ, 85721, USA.
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23
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Finucane ML, Mertz CK, Slovic P, Schmidt ES. Task complexity and older adults' decision-making competence. Psychol Aging 2005; 20:71-84. [PMID: 15769215 DOI: 10.1037/0882-7974.20.1.71] [Citation(s) in RCA: 135] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This article reports progress in an ongoing research program examining older adults' decision-making competence (DMC). Using a theoretical framework that emphasizes the person-task fit in assessing DMC, the authors report the results of a study comparing older versus younger adults' decision performance on simple and complex tasks about health, finance, and nutrition. The authors hypothesized and found that increasing age and task complexity were related to greater comprehension errors and inconsistency in decision making. Hierarchical regression analyses showed that a large amount of age-related variance in performance on the decision tasks could be accounted for by exogenous social variables, health measures, basic cognitive skills, and attitudinal measures. The discussion emphasizes several directions for future research, including the need to validate the meaning of performance on these tasks for real-life decision processes.
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24
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Bosworth HB, Olsen MK, Oddone EZ. Improving blood pressure control by tailored feedback to patients and clinicians. Am Heart J 2005; 149:795-803. [PMID: 15894959 DOI: 10.1016/j.ahj.2005.01.039] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Hayden B Bosworth
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA
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25
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Hayes K. Designing Written Medication Instructions: Effective Ways to Help Older Adults Self-Medicate. J Gerontol Nurs 2005; 31:5-10. [PMID: 15916198 DOI: 10.3928/0098-9134-20050501-04] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
One of the goals of Healthy People 2010 is for 95% of patients who are ordered medication to receive written medication instructions. The declining physical condition often associated with advanced age, lower literacy levels, and education among members of the current elderly cohorts, and increasingly complex medication regimes for chronic illness affect the ability of many older adults to learn. This article addresses Geragogy, the art and science of helping older adults learn, complimentary theories of learning, and examples of how they can be used to guide the construction of appropriate written medication instructions for older adults.
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Affiliation(s)
- Karen Hayes
- Wichita State University, Wichita, Kansas 67260, USA
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26
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Fisk JE. Age and probabilistic reasoning: Biases in conjunctive, disjunctive and Bayesian judgements in early and late adulthood. JOURNAL OF BEHAVIORAL DECISION MAKING 2005. [DOI: 10.1002/bdm.488] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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McDonald-Miszczak L, Maris P, Fitzgibbon T, Ritchie G. A pilot study examining older adults' beliefs related to medication adherence: the BERMA survey. J Aging Health 2004; 16:591-614. [PMID: 15448274 DOI: 10.1177/0898264304265772] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To establish a multifactorial measure of older adults' beliefs related to medication adherence. METHODS Ninety-two older adults (M = 71.42 years) were asked to provide medication and health-related information, memory strategies, and complete the Beliefs Related to Medications (BERMA) Survey. RESULTS The final version of the BERMA survey contains 53 questions with three scales. The overall reliability of the scale is excellent (Cronbach's alpha =.94), as is the reliability of the scales. Correlations show that better rated memory for medications was associated with higher reported adherence and fewer external memory strategies. Higher perceived ability to deal with health professionals was related to higher importance of medication adherence and greater perceived seriousness of one's medical condition. Finally, more positive attitudes about medications were associated with better self-rated health and fewer side effects. DISCUSSION The results indicate that the BERMA survey is a potentially useful research tool for understanding older adults' medication adherence.
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28
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Liu LL, Park DC. Aging and medical adherence: the use of automatic processes to achieve effortful things. Psychol Aging 2004; 19:318-25. [PMID: 15222825 DOI: 10.1037/0882-7974.19.2.318] [Citation(s) in RCA: 104] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This research examined whether forming detailed implementation plans for achieving a goal improved older adults' adherence to a health behavior. Nondiabetic participants (N = 31) rehearsed, deliberated, or formed implementation intentions to perform home blood glucose monitoring, 4 times daily for 3 weeks. The implementation group performed tests nearly 50% more often than the 2 comparison groups. Results were not attributable to a priori differences in intentions to perform testing. Findings indicate that implementation intentions can facilitate older adults' performance of important medical self-care tasks in naturalistic settings over sustained periods of time and concur with previous research that implicates automatic cognitive processes that do not show age-related decline. These results support the utility of this technique for improving adherence to health behaviors in clinical populations.
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Affiliation(s)
- Linda L Liu
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA.
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29
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Abstract
Patients' willingness to take a newly prescribed medication is an important, but little studied, part of the medication process. The authors studied the impact of patient age on the perceived importance and interaction of three factors known to influence young people: severity of their medical condition, extent of possible medication side effects, and level of trust in their physician. A convenience sample of 170 French adults aged 18 to 93 rated their likelihood of taking a medication intended to alleviate physical suffering in 27 scenarios in which three levels (low, moderate, and high) of each of the above three factors were combined in an orthogonal factorial design. Among younger participants, high trust in the physician was not considered a sufficient reason for high acceptance of a new medication; it had to be accompanied by low side effects. Among very elderly participants, high trust led to high acceptance almost irrespective of the severity of possible side effects. Among the middle aged, trust and side effects had largely independent effects. To promote patients' acceptance of newly prescribed medications, physicians need to establish trust, but not abuse its power in elderly patients.
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Affiliation(s)
- Catherine Hervé
- Départment de Psychologie, Université François-Rabelais, Tours, France
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30
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Finucane ML, Slovic P, Hibbard JH, Peters E, Mertz CK, MacGregor DG. Aging and decision-making competence: an analysis of comprehension and consistency skills in older versus younger adults considering health-plan options. JOURNAL OF BEHAVIORAL DECISION MAKING 2002. [DOI: 10.1002/bdm.407] [Citation(s) in RCA: 101] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Abstract
Research has addressed the problem of poor adherence for the past 4 decades. Much of the research has focused on the prevalence and predictors of adherence, research methodologies, and the development of measures of adherence. To a much lesser extent, attention has been given to intervention studies designed to evaluate strategies to improve adherence to treatment regimens. This article provides an up-to-date review of the literature on medication adherence in chronic disease.
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Affiliation(s)
- J Dunbar-Jacob
- University of Pittsburgh, School of Nursing, 350 Victoria Building, 3500 Victoria St., Pittsburgh, PA 15261, USA.
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McCormack LA, Burrus BB, Garfinkel SA, Gibbs D, Harris-Kojetin LD, Sangl JA. Providing information to help Medicare beneficiaries choose a health plan. J Aging Soc Policy 2001; 12:49-72. [PMID: 11303366 DOI: 10.1300/j031v12n02_04] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Many Medicare beneficiaries have limited knowledge of the Medicare program and related health insurance options. This is due in part to the complexity of the Medicare program and supplemental health insurance market. A recent congressional mandate through the Balanced Budget Act of 1997 called for broad dissemination of information to educate beneficiaries about their health plan options and to encourage informed health plan decision-making. In response, the Health Care Financing Administration (HCFA) launched the National Medicare Education Program (NMEP) to support the educational objectives of the BBA. This paper provides an overview of the components of the NMEP information campaign. We also review lessons learned from our experience in designing and testing a prototype consumer handbook that explains the different health plan options to Medicare beneficiaries. Through our discussion of the handbook, we highlight several ways to communicate information effectively about a complex publicly funded program to an older adult population.
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Affiliation(s)
- L A McCormack
- Research Triangle Institute, Health and Social Policy Division, P.O. Box 1219, 3040 Cornwallis Road, Cox Building, Room 163, Research Triangle Park, NC 27709-2194, USA.
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Abstract
Much has been written about adherence to interventions in older adults. What has not been discussed as extensively is how adherence is influenced and affected by the multiple interacting layers of the social context. Guided by an ecological or multilevel system model, this paper explores how social context may impact adherence. We conclude that when considering strategies to promote adherence to a particular regime, one must take into consideration the interplay between the social context and the adherence-related behavior. Control Clin Trials 2000;21:184S-187S
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Affiliation(s)
- K E Kidd
- Department of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA.
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34
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Anderson RT, Ory M, Cohen S, McBride JS. Issues of aging and adherence to health interventions. CONTROLLED CLINICAL TRIALS 2000; 21:171S-83S. [PMID: 11018572 DOI: 10.1016/s0197-2456(00)00075-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This review article describes several processes and considerations that are important to adherence in aging research and potential strategies that could be used to facilitate adherence among older adults. In many large aging trials participants are purposefully selected to reduce the risk of suboptimal adherence and retention. This selection often involves screening out those with barriers such as transportation needs, sensory deficits, functional dependence, major diseases limiting life expectancy, or apparent psychological distress. However, trends toward extending interventions to the general population of older adults require specific knowledge about the circumstances and processes that support adherence among older adults or the conditions that make them vulnerable to adherence problems. Addressing the diversity of needs, expectations, and capabilities of older adults that promote adherence is a key consideration in aging research. Control Clin Trials 2000;21:171S-183S
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Affiliation(s)
- R T Anderson
- Section on Social Sciences and Health Policy, Department of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
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35
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Hayes KS. Adding medications in the emergency department: effect on knowledge of medications in older adults. J Emerg Nurs 1999; 25:178-82. [PMID: 10346838 DOI: 10.1016/s0099-1767(99)70201-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Older adults constitute 20% of the ED population. Of older patients discharged from the emergency department, 40% receive at least one new medication to add to their already complex medication regimen. The purpose of this study was to determine the effect of increasing medication complexity on knowledge of newly prescribed medications for older adults discharged from the emergency department. METHODS The complexity of self-administered medications after ED treatment was measured with the Medication Complexity Index to determine its potential influence on the patient's knowledge of medication. The Knowledge of Medication Subtest, a measure of the effectiveness of medication teaching, was administered by telephone interview 48 to 72 hours after ED discharge. RESULTS Sixty rural ED patients ranging in age from 60 to 98 years completed the study. Higher medication complexity after the addition of medications in the emergency department was associated with less knowledge of their medications (r = 0.37, P =. 004). DISCUSSION The increase in medication complexity that results from ED therapeutic intervention may decrease knowledge of medications. A heightened emphasis should be placed on effective medication teaching, counseling, and follow-up for older adult ED patients.
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Affiliation(s)
- K S Hayes
- Wichita State University, Kansas, USA
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36
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Morrow DG, Leirer VO, Andrassy JM, Hier CM, Menard WE. The influence of list format and category headers on age differences in understanding medication instructions. Exp Aging Res 1998; 24:231-56. [PMID: 9642551 DOI: 10.1080/036107398244238] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
We examined whether instructions are better understood and remembered when they contain organizational cues. Our previous research found that older and younger adults organize medication information in similar ways, suggesting that they have a schema for taking medication. In the present study, list formats (vs. paragraphs) emphasized the order of information and category headers emphasized the grouping of information specified by this schema. Experiment 1 examined whether list and header cues improve comprehension (answer time and accuracy) and recall for adults varying in age and working memory capacity (measured by a sentence span task). List instructions were better understood and recalled than paragraphs, and reduced age differences in answer time and span differences in accuracy. Headers reduced paragraph comprehension for participants with lower levels of working memory capacity, presumably because they were not salient cues in the paragraphs. Experiment 2 investigated if headers were more effective when more saliently placed in paragraphs and lists, and if list and header cues helped readers draw inferences from the instructions. List formats again reduced age differences in comprehension, especially reducing the time needed to draw inferences about the medication. While headers did not impair comprehension, these cues did impair recall. The present study suggests that list-organized instructions provide an environmental support that improves both older and younger adult comprehension and recall of medication information.
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Affiliation(s)
- D G Morrow
- Department of Psychology, University of New Hampshire, Durham 03824, USA
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Morrow D. Improving consultations between health-care professionals and older clients: implications for pharmacists. Int J Aging Hum Dev 1997; 44:47-72. [PMID: 9131381 DOI: 10.2190/gqx9-f4uj-5rq2-n1yd] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Consultations between pharmacists and many clients are now federally mandated in the United States, but guidelines have not been developed for communication in this context. This article reviews research on communication between clients and health-care professionals in order to help develop recommendations for consultations between pharmacists and older clients. The review is organized around a collaborative approach to health communication, which identifies strategies by which speakers and listeners work together to achieve mutually defined goals. This approach is used to analyze cognitive processes underlying communication during pharmacist consultations. This review suggests that miscommunication often reflects a break-down in collaboration between health-care professional and clients. Recommendations are developed to improve collaboration, including suggestions for initiating consultations, presenting easy to understand messages, and monitoring to ensure that the messages are mutually understood. Most important, successful collaboration requires tailoring strategies to individual clients rather than basing communication on general assumptions about clients.
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Affiliation(s)
- D Morrow
- Department of Psychology, University of New Hampshire, Durham 03824, USA
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Barr RA, Johnson KW, Miranda M. Research Translation in Gerontology: A Behavioral and Social Perspective Introduction to the Special Issue. J Appl Gerontol 1994. [DOI: 10.1177/073346489401300101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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