Utilizing a cognitive engineering approach to conduct a hierarchical task analysis to understand complex older adult decision-making during over-the-counter medication selection

BACKGROUND

Adults aged 65+ (older adults) disproportionately consume 30% of over-the-counter (OTC) medications and are largely responsible for making OTC treatment decisions because providers lack awareness of their consumption. These treatment decisions are complex: older adults must navigate age-related body/cognitive changes, developed comorbidities, and complex medication regimens when selecting the right OTC. Yet little is known about how older adults make such decisions.

OBJECTIVES

This study characterizes older adults' cognitive decision-making process when seeking to self-medicate with OTCs from their community pharmacy, and demonstrates how hierarchical task analysis (HTA) can be used to evaluate a pharmacy intervention's impact on their decision-making.

METHODS

A pre-/post-implementation approach, using a think-aloud interview process, was conducted with older adults within a community pharmacy setting as they completed a hypothetical scenario to treat either pain, sleep, or cough/cold/allergy symptoms. HTA developed a conceptualization of older adult decision-making regarding OTC selection and use before/after Senior Section implementation.

RESULTS

An HTA constructed from 12 purposefully-selected interviews (pre-n = 9/post-n = 3), consisting of 8 goals/15 sub-goals. While selecting an OTC, older adults considered quantity, cost, form, regimen, safety, strength, appropriateness of OTC safety, generic/name-brand, past experiences, and ingredients. The intervention reduced by half the number of factors considered.

IMPLICATIONS

Older adult decision-making is more complex than just selecting OTC medication from a pharmacy shelf. HTA-informed decision profiles can provide pharmacists critical insights into safety issues that older adults may not be considering (e.g., factors related to safety, strength, or appropriateness of OTC for symptoms) so that pharmacists can support their decision-making.

Explaining the causal links between illness management and symptom reduction: Development of an evidence-based patient education strategy

OBJECTIVE

To determine whether explaining the causal links between illness management and symptom reduction would help younger and older adults learn and apply health information.

METHOD

Ninety younger and 51 older adults read about a fictitious disease with or without explanations about the cause-and-effects (causal information) of illness management. A knowledge test (applied vs. factual items) was administered immediately and 1-week following the presentation of health booklets. Reading comprehension, working memory and health literacy were assessed as covariate variables.

RESULTS

Younger adults outperformed older individuals on the applied and factual items at both time points. After controlling for covariates, causal information facilitated the comprehension and application of health information for younger but not older adults. Reading comprehension was the best predictor of test performance in the older sample.

CONCLUSIONS

Providing an explanation of why illness management is effective for reducing symptomatology can help improve knowledge and application of health information for younger individuals. For older adults, lowering the verbal demands of patient education materials may be a better way to help them learn new health information.

PRACTICE IMPLICATIONS

Use of causal information as a teaching strategy in patient education may enhance individuals' ability to learn about and implement self-care strategies.

The Effects of Age, Priming, and Working Memory on Decision-Making

In the current study, we examined the effects of priming and personality on risky decision-making while playing the Game of Dice Task (GDT). In the GDT, participants decide how risky they wish to be on each trial. In this particular study prior to playing the GDT, participants were randomly assigned to one of three priming conditions: Risk-Aversive, Risk-Seeking, or Control. In the Risk-Seeking condition, a fictional character benefitted from risky behavior while in the Risk-Aversive condition, a fictional character benefitted from exercising caution. Although not explicitly stated in the instructions, participants need to make “safe” rather than risky choices to optimize performance on the GDT. Participants were also given Daneman and Carpenter’s assessment of working memory task. Interestingly, although older adults self-reported being more cautious than younger adults on the Domain Specific Risk Attitude scale (DOSPERT), older adults made riskier decisions than younger adults on the GDT. However, after controlling for working memory, the age differences on the GDT became insignificant, indicating that working memory mediated the relation between age and risky decisions on the GDT.