Presentation
DH2 - Advancing Technological Support for Older Adults With Mild Cognitive Impairment for Medication Self-Management
SessionPoster Session 2
DescriptionThe increasing population of older adults has led to a rise in the number of people with mild cognitive impairment who face challenges managing their medications. Studies suggest that medication adherence rates for individuals with cognitive impairment can be as low as 46% particularly for asymptomatic chronic conditions such as hypertension. In the case of hypertension, medication nonadherence can exacerbate cognitive decline because high blood pressure causes both cerebrovascular inflammation and injury.
To address medication nonadherence among older adults, we developed a theory-based Multifaceted Prospective Memory Intervention. The goal of this intervention was to improve medication adherence by transforming the process of medication taking from one dependent on self-initiated processes to one that relies on associative processes known to remain relatively intact with aging. The intervention incorporates several strategies: educating patients about hypertension and the importance of taking prescribed medications, collaboratively setting clear medication goals, employing implementation intentions, providing timely reminders, supporting the execution of medication-taking, and monitoring if medications were taken as intended. We assessed the benefits for older adults with age-associated cognitive change for the intervention delivered in person by a nurse with weekly follow-up visits over an additional three weeks. Medication adherence was then monitored over five months. Although the intervention showed a 36% improvement in adherence at the end of the initial four weeks, a gradual decline in adherence was noted over the additional five months once nursing support was no longer available.
This finding prompted the creation of a mobile health (mHealth) system called Medication Education, Decision Support, Reminding, and Monitoring System MEDSReM© that could provide aspects of the intervention. Leveraging technology to support adherence strategies was a way to sustain the positive benefit in improved medication adherence. The challenge has been to include each of the strategies that taken together improved medication adherence, in a user-friendly application that would be ubiquitous in the person’s environment. A smartphone application was chosen as the delivery method for this intervention because people generally keep their phones nearby and hence, the reminder function would be present in the environment at the designated time the individual has chosen to take his/her daily medication, an important feature in medication adherence. Improved functionality and efficacy are currently being tested in an ongoing clinical trial.
We have further adapted the mHealth system specially for older adults with cognitive impairment – Medication Education, Decision Support, Reminding and Monitoring System – Memory (MEDSReM-M©). We conducted cognitive walk-throughs, heuristic analyses, and usability tests specifically for this user group. Currently, MEDSReM-M© is being tested in a randomized clinical trial.
To illustrate the value of a human-factors based development approach for medication adherence, we will describe the iterative design process for specific contexts and users. Few prior studies have examined mHealth tools for hypertension medication adherence for older adults generally, or especially for those with cognitive impairment. The goal of this work is to enable older adults to manage their medications more independently, reducing reliance on care partners and healthcare systems, each of which increase the cost of providing care from both human and monetary resources. We will outline the steps involved in identifying a gap between existing digital health tools to improve medication adherence for older adults with cognitive impairment and emerging techniques to leverage technology for this population and describe the process of modification.
To address medication nonadherence among older adults, we developed a theory-based Multifaceted Prospective Memory Intervention. The goal of this intervention was to improve medication adherence by transforming the process of medication taking from one dependent on self-initiated processes to one that relies on associative processes known to remain relatively intact with aging. The intervention incorporates several strategies: educating patients about hypertension and the importance of taking prescribed medications, collaboratively setting clear medication goals, employing implementation intentions, providing timely reminders, supporting the execution of medication-taking, and monitoring if medications were taken as intended. We assessed the benefits for older adults with age-associated cognitive change for the intervention delivered in person by a nurse with weekly follow-up visits over an additional three weeks. Medication adherence was then monitored over five months. Although the intervention showed a 36% improvement in adherence at the end of the initial four weeks, a gradual decline in adherence was noted over the additional five months once nursing support was no longer available.
This finding prompted the creation of a mobile health (mHealth) system called Medication Education, Decision Support, Reminding, and Monitoring System MEDSReM© that could provide aspects of the intervention. Leveraging technology to support adherence strategies was a way to sustain the positive benefit in improved medication adherence. The challenge has been to include each of the strategies that taken together improved medication adherence, in a user-friendly application that would be ubiquitous in the person’s environment. A smartphone application was chosen as the delivery method for this intervention because people generally keep their phones nearby and hence, the reminder function would be present in the environment at the designated time the individual has chosen to take his/her daily medication, an important feature in medication adherence. Improved functionality and efficacy are currently being tested in an ongoing clinical trial.
We have further adapted the mHealth system specially for older adults with cognitive impairment – Medication Education, Decision Support, Reminding and Monitoring System – Memory (MEDSReM-M©). We conducted cognitive walk-throughs, heuristic analyses, and usability tests specifically for this user group. Currently, MEDSReM-M© is being tested in a randomized clinical trial.
To illustrate the value of a human-factors based development approach for medication adherence, we will describe the iterative design process for specific contexts and users. Few prior studies have examined mHealth tools for hypertension medication adherence for older adults generally, or especially for those with cognitive impairment. The goal of this work is to enable older adults to manage their medications more independently, reducing reliance on care partners and healthcare systems, each of which increase the cost of providing care from both human and monetary resources. We will outline the steps involved in identifying a gap between existing digital health tools to improve medication adherence for older adults with cognitive impairment and emerging techniques to leverage technology for this population and describe the process of modification.
Authors
Event Type
Poster Presentation
TimeTuesday, April 14:45pm - 6:15pm EDT
LocationFrontenac Foyer