The Pillbox Test: An Ecological Measure of Executive Functioning and Estimate of Medication Management Abilities

Zartman, Andrea L.; Hilsabeck, Robin C.; Guarnaccia, Charles A.; Houtz, Andrew

doi:10.1093/arclin/act014

Cited by 43 publications

(42 citation statements)

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“…Even in the absence of more impaired function, normative age-related declines can become problematic as they can produce significant difficulties in performing instrumental activities of daily living, especially those which require strong reasoning skills (Willis et al, 2006). For instance, deficits in reasoning performance often limit the ability to solve problems that require linear thinking, such as following step-by-step instructions for the dosing of prescription medications (Zartman, Hilsabeck, Guarnaccia, & Houtz, 2013). …”

mentioning

confidence: 99%

Depressive symptoms and inductive reasoning performance: Findings from the ACTIVE reasoning training intervention.

Parisi¹,

Franchetti²,

Rebok³

et al. 2014

Psychology and Aging

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Within the context of the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study, we examined the longitudinal association of baseline depressive symptoms on inductive reasoning performance over a ten-year period between the reasoning training and control conditions (N = 1,375). At baseline, 322 participants (23%) reported elevated depressive symptoms, defined by a score ≥ 9 on the Center for Epidemiological Studies Depression scale (12-item). Differences in baseline depressive status were not associated with immediate post-training gains or with subsequent annual change in reasoning performance, suggesting that the presence of elevated baseline depressive symptoms does not impact the ability to benefit from reasoning training.

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mentioning

confidence: 99%

Depressive symptoms and inductive reasoning performance: Findings from the ACTIVE reasoning training intervention.

Parisi¹,

Franchetti²,

Rebok³

et al. 2014

Psychology and Aging

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“…Stilley et al [58] has also shown attention/psychomotor speed are cognitive domains that most consistently predict medication adherence. Executive function is also considered to be a good predictor of everyday functioning and includes behaviors such as purposive action/self-regulation, planning/attention, volition/inhibition, and effective performance/self-monitoring [59]. In 2013, Zartman et al [60] developed the “Pillbox Test” to assess executive function.…”

Section: Discussionmentioning

confidence: 99%

ClereMed: Lessons Learned From a Pilot Study of a Mobile Screening Tool to Identify and Support Adults Who Have Difficulty With Medication Labels

Grindrod¹,

Gates²,

Dolovich³

et al. 2014

JMIR mHealth uHealth

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BackgroundIn order to take medications safely and effectively, individuals need to be able to see, read, and understand the medication labels. However, one-half of medication labels are currently misunderstood, often because of low literacy, low vision, and cognitive impairment. We sought to design a mobile tool termed ClereMed that could rapidly screen for adults who have difficulty reading or understanding their medication labels.ObjectiveThe aim of this study was to build the ClereMed prototype; to determine the usability of the prototype with adults 55 and over; to assess its accuracy for identifying adults with low-functional reading ability, poor ability on a real-life pill-sorting task, and low cognition; and to assess the acceptability of a touchscreen device with older adults with age-related changes to vision and cognition.MethodsThis pilot study enrolled adults (≥55 years) who were recruited through pharmacies, retirement residences, and a low-vision optometry clinic. ClereMed is a hypertext markup language (HTML)-5 prototype app that simulates medication taking using an iPad, and also provides information on how to improve the accessibility of prescription labels. A paper-based questionnaire included questions on participant demographics, computer literacy, and the Systems Usability Scale (SUS). Cognition was assessed using the Montreal Cognitive Assessment tool, and functional reading ability was measured using the MNRead Acuity Chart. Simulation results were compared with a real-life, medication-taking exercise using prescription vials, tablets, and pillboxes.ResultsThe 47 participants had a mean age of 76 (SD 11) years and 60% (28/47) were female. Of the participants, 32% (15/47) did not own a computer or touchscreen device. The mean SUS score was 76/100. ClereMed correctly identified 72% (5/7) of participants with functional reading difficulty, and 63% (5/8) who failed a real-life pill-sorting task, but only 21% (6/28) of participants with cognitive impairment. Participants who owned a computer or touchscreen completed ClereMed in a mean time of 26 (SD 16) seconds, compared with 52 (SD 34) seconds for those who do not own a device (P<.001). Those who had difficulty, struggled with screen glare, button activation, and the “drag and drop” function.ConclusionsClereMed was well accepted by older participants, but it was only moderately accurate for reading ability and not for mild cognitive impairment. Future versions may be most useful as part of a larger medication assessment or as a tool to help family members and caregivers identify individuals with impaired functional reading ability. Future research is needed to improve the sensitivity for measuring cognitive impairment and on the feasibility of implementing a mobile app into pharmacy workflow.

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“…Our update of the literature search (to December 2013) identified additional tools [31, 35-39], of which three met the inclusion criteria of the 2009 review [35, 38]. Published tools fell into two broad categories: those that used the person’s own medicines as the basis for assessment (n=3) [40-42], and those that used a simulated medicine regimen (n=14) [7] [35, 38, 39, 43-52]. In contrast, most unpublished, unvalidated tools used in clinical practice use a person’s own medicines [13].…”

Section: Identifying Impaired Capacity To Manage Medicinesmentioning

confidence: 99%

“…They could also serve an additional function as cognitive screening tools, since they have all demonstrated associations with performance on cognitive screening tests such as the MMSE [12]. In fact some medicines management assessment tools were initially developed as cognitive screening tools [38, 47]. …”

Section: Identifying Impaired Capacity To Manage Medicinesmentioning

confidence: 99%

Ability of older people with dementia or cognitive impairment to manage medicine regimens: a narrative review

Elliott¹,

Goeman²,

Beanland

et al. 2015

CCP

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Impaired cognition has a significant impact on a person’s ability to manage their medicines. The aim of this paper is to provide a narrative review of contemporary literature on medicines management by people with dementia or cognitive impairment living in the community, methods for assessing their capacity to safely manage medicines, and strategies for supporting independent medicines management. Studies and reviews addressing medicines management by people with dementia or cognitive impairment published between 2003 and 2013 were identified via searches of Medline and other databases. The literature indicates that as cognitive impairment progresses, the ability to plan, organise, and execute medicine management tasks is impaired, leading to increased risk of unintentional non-adherence, medication errors, preventable medication-related hospital admissions and dependence on family carers or community nursing services to assist with medicines management. Impaired functional capacity may not be detected by health professionals in routine clinical encounters. Assessment of patients’ (or carers’) ability to safely manage medicines is not undertaken routinely, and when it is there is variability in the methods used. Self-report and informant report may be helpful, but can be unreliable or prone to bias. Measures of cognitive function are useful, but may lack sensitivity and specificity. Direct observation, using a structured, standardised performance-based tool, may help to determine whether a person is able to manage their medicines and identify barriers to adherence such as inability to open medicine packaging. A range of strategies have been used to support independent medicines management in people with cognitive impairment, but there is little high-quality research underpinning these strategies. Further studies are needed to develop and evaluate approaches to facilitate safe medicines management by older people with cognitive impairment and their carers.

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The Pillbox Test: An Ecological Measure of Executive Functioning and Estimate of Medication Management Abilities

Cited by 43 publications

References 43 publications

Depressive symptoms and inductive reasoning performance: Findings from the ACTIVE reasoning training intervention.

Depressive symptoms and inductive reasoning performance: Findings from the ACTIVE reasoning training intervention.

ClereMed: Lessons Learned From a Pilot Study of a Mobile Screening Tool to Identify and Support Adults Who Have Difficulty With Medication Labels

Ability of older people with dementia or cognitive impairment to manage medicine regimens: a narrative review

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