scholarly journals Medication Adherence Behavior and Priorities Among Older Adults With CKD: A Semistructured Interview Study

2010 ◽  
Vol 56 (3) ◽  
pp. 439-446 ◽  
Author(s):  
Dena E. Rifkin ◽  
M. Barton Laws ◽  
Madhumathi Rao ◽  
V.S. Balakrishnan ◽  
Mark J. Sarnak ◽  
...  
Keyword(s):  
Older Adults ◽  
Medication Adherence ◽  
Interview Study ◽  
Semistructured Interview ◽  
Adherence Behavior

Medication Adherence: Expanding the Conceptual Framework

2021 ◽  
Author(s):  
Marie Krousel-Wood ◽  
Leslie S Craig ◽  
Erin Peacock ◽  
Emily Zlotnick ◽  
Samantha O’Connell ◽  
...  
Keyword(s):  
Older Adults ◽  
Medication Adherence ◽  
Conceptual Framework ◽  
Clinical Outcomes ◽  
Implicit Attitudes ◽  
Explanatory Power ◽  
Population Level ◽  
Time Preferences ◽  
Adherence Behavior ◽  
Individual Level

Abstract Interventions targeting traditional barriers to antihypertensive medication adherence (AHMA) have been developed and evaluated, with evidence of modest improvements in adherence. Translation of these interventions into population-level improvements in adherence and clinical outcomes among older adults remains suboptimal. From the Cohort Study of Medication Adherence among Older adults (CoSMO), we evaluated traditional barriers to AHMA among older adults with established hypertension (N=1544; mean age=76.2 years, 59.5% women, 27.9% Black, 24.1% and 38.9% low adherence by proportion of days covered (i.e., PDC<0.80) and the 4-item Krousel-Wood Medication Adherence Scale (i.e., K-Wood-MAS-4≥1), respectively), finding that they explained 6.4% and 14.8% of variance in pharmacy refill and self-reported adherence, respectively. Persistent low adherence rates, coupled with low explanatory power of traditional barriers, suggest that other factors warrant attention. Prior research has investigated explicit attitudes toward medications as a driver of adherence; the roles of implicit attitudes and time preferences (e.g., immediate versus delayed gratification) as mechanisms underlying adherence behavior are emerging. Similarly, while associations of individual-level social determinants of health (SDOH) and medication adherence are well-reported, there is growing evidence about structural SDOH and specific pathways of effect. Building on published conceptual models and recent evidence, we propose an expanded conceptual framework that incorporates implicit attitudes, time preferences and structural SDOH, as emerging determinants that may explain additional variation in objectively and subjectively measured adherence. This model provides guidance for design, implementation and assessment of interventions targeting sustained improvement in implementation medication adherence and clinical outcomes among older women and men with hypertension.

scholarly journals Supporting the Medication Adherence of Older Mexican Adults Through External Cues Provided With Ambient Displays: Feasibility Randomized Controlled Trial

10.2196/14680 ◽  
2020 ◽  
Vol 8 (3) ◽  
pp. e14680
Author(s):  
Ernesto Zárate-Bravo ◽  
Juan-Pablo García-Vázquez ◽  
Engracia Torres-Cervantes ◽  
Gisela Ponce ◽  
Ángel G Andrade ◽  
...  
Keyword(s):  
Older Adults ◽  
Medication Adherence ◽  
Treatment Group ◽  
Repeated Measures ◽  
Control Group ◽  
Adherence Behavior ◽  
Intervention Phase ◽  
Ambient Displays ◽  
Significant Difference ◽  
External Cues

Background Problems with prospective memory, which refers to the ability to remember future intentions, cause deficits in basic and instrumental activities of daily living, such as taking medications. Older adults show minimal deficits when they rely on mostly preserved and relatively automatic associative retrieval processes. On the basis of this, we propose to provide external cues to support the automatic retrieval of an intended action, that is, to take medicines. To reach this end, we developed the Medication Ambient Display (MAD), a system that unobtrusively presents relevant information (unless it requires the users’ attention) and uses different abstract modalities to provide external cues that enable older adults to easily take their medications on time and be aware of their medication adherence. Objective This study aimed to assess the adoption and effect of external cues provided through ambient displays on medication adherence in older adults. Methods A total of 16 older adults, who took at least three medications and had mild cognitive impairment, participated in the study. We conducted a 12-week feasibility study in which we used a mixed methods approach to collect qualitative and quantitative evidence. The study included baseline, intervention, and postintervention phases. Half of the participants were randomly allocated to the treatment group (n=8), and the other half was assigned to the control group (n=8). During the study phases, research assistants measured medication adherence weekly through the pill counting technique. Results The treatment group improved their adherence behavior from 80.9% at baseline to 95.97% using the MAD in the intervention phase. This decreased to 76.71% in the postintervention phase when the MAD was no longer being used. Using a one-way repeated measures analysis of variance and a post hoc analysis using the Tukey honestly significant difference test, we identified a significant statistical difference between the preintervention and intervention phases (P=.02) and between the intervention and postintervention phases (P=.002). In addition, the medication adherence rate of the treatment group (95.97%) was greater than that of the control group (88.18%) during the intervention phase. Our qualitative results showed that the most useful cues were the auditory reminders, followed by the stylized representations of medication adherence. We also found that the MAD’s external cues not only improved older adults’ medication adherence but also mediated family caregivers’ involvement. Conclusions The findings of this study demonstrate that using ambient modalities for implementing external cues is useful for drawing the attention of older adults to remind them to take medications and to provide immediate awareness on adherence behavior. Trial Registration ClinicalTrials.gov NCT04289246; https://tinyurl.com/ufjcz97

scholarly journals Change in Medication Adherence and Beliefs in Medicines Over Time in Older Adults

2015 ◽  
Vol 8 (5) ◽  
pp. 39 ◽  
Author(s):  
Elizabeth Unni ◽  
Olayinka O Shiyanbola ◽  
Karen B Farris
Keyword(s):  
Older Adults ◽  
Medication Adherence ◽  
Adherence Behavior ◽  
Improve Medication Adherence ◽  
Lower Baseline ◽  
Item Scale ◽  
Over Time ◽  
Lower Adherence ◽  
Predictors Of Change

<p><strong>OBJECTIVE:</strong> The temporal component of medication adherence is important while designing interventions to improve medication adherence. Thus, the objective of this study was to determine how medication adherence and beliefs in medicines change over time in older adults.</p> <p><strong>METHODS:</strong> A two-year longitudinal internet-based survey among adults 65+ years was used to collect data on medication adherence (Morisky 4-item scale) and beliefs in medicines (Beliefs about Medicines Questionnaire). Paired t-test and one-way ANOVA determined if a change in beliefs in medicines and medication adherence over time was significant. A multiple linear regression was used to determine the significant predictors of change in medication adherence over time.</p> <p><strong>RESULTS:</strong> 436 respondents answered both baseline and follow-up surveys. Among all respondents, there was no significant change in adherence (0.58 ± 0.84 vs. 0.59 ± 0.84; p &gt; 0.05), necessity beliefs (17.13 ± 4.31 vs. 17.10 ± 4.29; p &gt; 0.05), or concern beliefs (11.70 ± 3.73 vs. 11.68 ± 3.77; p &gt; 0.05) over time. For older adults with lower baseline adherence, there was a statistically significant improvement in adherence (1.45 ± 0.70 vs. 0.99 ± 0.97; p &lt; 0.05); but no change in beliefs in medicines over time. The significant predictors of change in medication adherence over time were baseline adherence and baseline concern beliefs in medicines.</p> <p><strong>CONCLUSION:</strong> With baseline adherence and baseline concern beliefs in medicines playing a significant role in determining change in adherence behavior over time, especially in individuals with lower adherence, it is important to alleviate medication concerns at the beginning of therapy for better adherence.</p>

scholarly journals Supporting the Medication Adherence of Older Mexican Adults Through External Cues Provided With Ambient Displays: Feasibility Randomized Controlled Trial (Preprint)

2019 ◽  
Author(s):  
Ernesto Zárate-Bravo ◽  
Juan-Pablo García-Vázquez ◽  
Engracia Torres-Cervantes ◽  
Gisela Ponce ◽  
Ángel G Andrade ◽  
...  
Keyword(s):  
Older Adults ◽  
Medication Adherence ◽  
Treatment Group ◽  
Repeated Measures ◽  
Control Group ◽  
Adherence Behavior ◽  
Intervention Phase ◽  
Ambient Displays ◽  
Significant Difference ◽  
External Cues

BACKGROUND Problems with prospective memory, which refers to the ability to remember future intentions, cause deficits in basic and instrumental activities of daily living, such as taking medications. Older adults show minimal deficits when they rely on mostly preserved and relatively automatic associative retrieval processes. On the basis of this, we propose to provide external cues to support the automatic retrieval of an intended action, that is, to take medicines. To reach this end, we developed the Medication Ambient Display (MAD), a system that unobtrusively presents relevant information (unless it requires the users’ attention) and uses different abstract modalities to provide external cues that enable older adults to easily take their medications on time and be aware of their medication adherence. OBJECTIVE This study aimed to assess the adoption and effect of external cues provided through ambient displays on medication adherence in older adults. METHODS A total of 16 older adults, who took at least three medications and had mild cognitive impairment, participated in the study. We conducted a 12-week feasibility study in which we used a mixed methods approach to collect qualitative and quantitative evidence. The study included baseline, intervention, and postintervention phases. Half of the participants were randomly allocated to the treatment group (n=8), and the other half was assigned to the control group (n=8). During the study phases, research assistants measured medication adherence weekly through the pill counting technique. RESULTS The treatment group improved their adherence behavior from 80.9% at baseline to 95.97% using the MAD in the intervention phase. This decreased to 76.71% in the postintervention phase when the MAD was no longer being used. Using a one-way repeated measures analysis of variance and a post hoc analysis using the Tukey honestly significant difference test, we identified a significant statistical difference between the preintervention and intervention phases (<i>P</i>=.02) and between the intervention and postintervention phases (<i>P</i>=.002). In addition, the medication adherence rate of the treatment group (95.97%) was greater than that of the control group (88.18%) during the intervention phase. Our qualitative results showed that the most useful cues were the auditory reminders, followed by the stylized representations of medication adherence. We also found that the MAD’s external cues not only improved older adults’ medication adherence but also mediated family caregivers’ involvement. CONCLUSIONS The findings of this study demonstrate that using ambient modalities for implementing external cues is useful for drawing the attention of older adults to remind them to take medications and to provide immediate awareness on adherence behavior. CLINICALTRIAL ClinicalTrials.gov NCT04289246; https://tinyurl.com/ufjcz97

scholarly journals VERIFICATION OF PAIN MEDICATION ADHERENCE IN OLDER ADULTS USING INTERACTIVE VOICE REMINDERS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S926-S926
Author(s):  
Marcia Shade ◽  
Kyle Rector ◽  
Kevin Kupzyk
Keyword(s):  
Older Adults ◽  
Medication Adherence ◽  
Pain Medication ◽  
Descriptive Statistics ◽  
Pain Severity ◽  
Monitoring Systems ◽  
Adherence Behavior ◽  
Event Monitoring ◽  
Pain Diary ◽  
Pain Medications

Abstract Adherence to analgesics needs to be monitored to ensure optimal pain management and avert adverse events among older adults. mHealth reminders may encourage adherence behavior, but it is unclear if medication use ensues following the reminder. The purpose of this study was to trial the use of medication event monitoring to verify the initiation of scheduled pain medication after an mHealth reminder. Methods: N=15 adults 55 and older created Google Assistant reminders to take their scheduled pain medication and write in a pain diary. A sub sample of n= 5 participants used a Medication Event Monitoring System Cap with their scheduled pain medications over 4 weeks. Data were collected on demographics, pain severity, and medication adherence. Descriptive statistics were performed. Results: Five women with ages ranging from 56-80 years, reported pain in multiple body locations. Pain severity on average was rated at 4 and at its worst 7; with pain relief ranging from 50-90%. Adherence percentages ranged from 82% to 100%. The overall latency was M = 55 min, SD = 100 min. The average latencies varied among the 5 participants; the shortest average time was 17 minutes and the longest average time was 4.5 hours. Only 15% of pain medications were taken within 5 minutes and 64% within 30 minutes of the interactive voice assistant reminder. Conclusions: It is important to ensure a behavioral intervention promotes the desired outcome. Medication event monitoring systems may help to identify non adherent behaviors when using mHealth interventions to promote pain medication adherence.

scholarly journals Innovative Approaches to Inclusive Design for Technology to Support Aging With Disability: Examples From TechSAge

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 599-599
Author(s):  
Tracy Mitzner ◽  
Anne Ordway
Keyword(s):  
Older Adults ◽  
Research And Development ◽  
Health Management ◽  
Exercise Program ◽  
Target Population ◽  
Interview Study ◽  
Inclusive Design ◽  
Adults With Disabilities ◽  
Engineering Research ◽  
Expert Interview

Abstract Technology research and development often exclude older adults with disabilities from participating in the design process. As a result, technologies may not be useful or usable by older adults with diverse abilities. This symposium, featuring projects at the TechSAge Rehabilitation Engineering Research Center, highlights ongoing efforts toward inclusive design, representing unique approaches to engage older adults with disabilities and their stakeholders in the research and development of technology supports. First, Mitzner et al., will describe the development of an online, group Tai Chi intervention, and the integral involvement of older adults with mobility disabilities, the exercise program developers, and technology partner in all steps of the process. Exploring the potential of voice-activated assistants, like Amazon Alexa, to support health management activities of older adults with mobility disabilities, Kadlyak et al. will present findings from a needs assessment of the target population and user testing in the lab and home environments. Koon et al. will present findings from a subject matter expert interview study with caregivers and medical professionals designed to identify the scope of activity challenges among people aging with long-term mobility and sensory disabilities that should be explored in more depth through our future interview study with the target population. Sanford et al., will describe a student design competition and hackathon that incorporates immersive experiences with people aging with disabilities to inspire innovative design concepts that respond to the needs of real people. NIDILRR Project Officer, Anne Ordway, will serve as the discussant.

Exploring Older Adults’ Internalizations And Misconceptions Regarding Antihypertensive Medication Management

2021 ◽  
Vol 10 (1) ◽  
pp. 304-308
Author(s):  
Kenneth A. Blocker ◽  
Wendy A. Rogers
Keyword(s):  
Older Adults ◽  
Medication Adherence ◽  
Antihypertensive Medication ◽  
Medication Management ◽  
Illness Representation ◽  
Effective Management ◽  
Structured Interviews ◽  
Antihypertensive Medications ◽  
Hypertension Knowledge ◽  
Management Behaviors

Hypertension, or high blood pressure, is an asymptomatic cardiovascular condition common with increasing age that must be controlled with proper management behaviors, such as adherence to prescribed antihypertensive medications. Unfortunately, older adults may struggle with consistent and effective management of this medication specifically and the disease generally, which can lead to poorer health outcomes. The goal of the study was to investigate older adults’ antihypertensive medication management using the Illness Representation Model as a lens to identify potential misconceptions that may contribute to medication management. We conducted semi-structured interviews with 40 older adults regarding management routines, hypertension knowledge, perceived nonadherence contributors, and perspectives related to their illness. We identified numerous misconceptions regarding hypertension knowledge, disease severity, as well as perceived adherence performance that may contribute to challenges older adults face with maintaining antihypertensive medication adherence. Moreover, these findings inform the need for and design of effective educational tools for improving antihypertensive medication adherence.

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