Background/Objectives Older adults do not take medication as prescribed, diminishing the benefits of treatment and increasing costs to individuals and society. A multifaceted prospective memory intervention for improving adherence to antihypertensive medication was tested and assessed if executive function/working memory processes moderated intervention effects. Design A two group longitudinal randomized control trial was used. Setting and Participants and Measurements The sample consisted of community-based older adults (≥ 65 years of age) without signs of dementia or symptoms of severe depression who were self-managing prescribed medication. Following four weeks of initial adherence monitoring using a medication event monitoring system (MEMS®), individuals with 90% or less adherence were randomly assigned to groups. Intervention The prospective memory intervention was designed to provide strategies that switch older adults from relying on executive function/working memory processes (that show effects of cognitive aging) to mostly automatic associative processes (that are relatively spared with normal aging) for remembering to take one’s medications. Strategies included establishing a routine, establishing cues strongly associated with medication taking actions, performing the action immediately upon thinking about it, using a medication organizer, and imagining medication taking to enhance encoding and improve cuing. Results There was significant improvement in adherence for the intervention group (57% at baseline to 78% post intervention), but most of these gains were lost after 5 months. The control condition started at 68%, was stable during the intervention, but dropped to 62%. Executive function/working memory moderated the intervention effect, with the intervention producing greater benefit for those with lower executive function/working memory. Conclusion The intervention improved adherence, but the benefits were not sustained. Further research is needed to determine how to sustain the substantial initial benefits.
Prejudice, discrimination, and negative stereotypes based on age (ageism) are long-standing and strongly implicated in poor health outcomes and limited access to health care for older adults. Recent writings suggest the COVID-19 pandemic raised the specter of ageism to an entirely new level. Do these observations reflect an exaggeration of “usual” ageism or a unique manifestation of intergenerational tension rooted in resentments of younger people concerning COVID-related disruptions in their lives believed to be primarily a function of older people’s vulnerability to the disease phenomenon? To address this question, the purpose of this study was to develop and test an instrument to measure ageist tendencies associated with the COVID-19 pandemic. Scale items, written to reflect attitudes about paternalism, inconvenience, and sacrifice, were assessed for content validity. Then the 12-item scale was administered to 227 undergraduate and graduate students in the health and social sciences. Analysis showed items have strong internal consistency and concurrent and discriminant validity. Importantly the scale explained unique variance over and above other standard measures of ageism. Ageism is deeply embedded in global and U.S. culture and strongly related to negative outcomes. This scale will assist researchers investigating the ageist consequences of the current pandemic and help us to monitor what could be long-term residual ageist effects of the COVID pandemic.
This study investigated the occurrence of undesirable weight change (UDWC) and reduced sleep quality (RSQ), and major factors associated with these changes during COVID-19 pandemic amongst university older employees (age 50+). Participants (n = 846) were recruited throughout campus and completed an online survey. Summary statistics were used to describe characteristics of the study participants and frequency and level of UDWC and RSQ. Proportional odds models were used to assess major factors associated with UDWC and RSQ. The results showed 416 (43.2%) participants reported UDWC and 474 (49.2%) RSQ. Age was inversely, and obesity positively associated with UDWC and RSQ. With each 5-year increase in age, the OR (95% CI) was 0.87 (0.78, 0.97) for reporting UDWC and 0.90 (0.81, 1.00) for reporting RSQ. Obese individuals were significantly more likely to report a worse UDWC and RSQ (OR (95% CI) = 1.58 (1.18, 2.11) and 1.56 (1.16, 2.10) respectively).
The interdisciplinary team members with distinct and complementary expertise working collaboratively to advance MEDSReM to MEDSReM-2 will be introduced. The decision support functionality in MEDSReM-2 application (app) is to guide older users on making decisions about missed doses. MEDSReM-2 medication formulary was created to include safe hypertension medications for older adults. Pharmacology of aging, including Pharmacokinetic and Pharmacodynamic principles, along with published studies and expert peer reviews, were used to create an algorithm for safe window of time to take the missed medications. We will present the processes for developing the decision support algorithm for the MEDSReM-2 App and how this guide will be communicated to the users to inform their decision making about missed doses. Interdisciplinary collaboration including pharmacy, nursing, cognitive aging, and technology development that was crucial for designing and implementing decision support within the MEDSReM-2 app for older users will be shared.
Discovering a composite of measures of executive function/working memory predicted everyday medication adherence among older adults, led to the development of a behavioral intervention, the Multifaceted Prospective Memory Intervention (MPMI) to improve hypertension medication adherence. The intervention resulted in a 35% improvement in adherence compared to an active education and attention control condition. However, adherence slowly declined over an additional five months of adherence monitoring without the presence of interventionists in the home. We proposed that the use of technology might help individuals maintain the prospective memory strategies, resulting in sustained adherence. An interdisciplinary team was formed to translate the behavioral intervention to technology, resulting in the first version of the MEDSReM system. In this presentation we describe the evolution of the project, from the components of the successful MPMI to the design and initial testing of MEDSReM. These efforts provide general insights about translating interventions into technology tools.
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