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

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.

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Time Variability of Pain Medication Adherence: An Observational Study (Preprint)

10.2196/preprints.23714 ◽

2020 ◽

Author(s):

Marcia Shade ◽

Kyle Rector ◽

Kevin Kupzyk

Keyword(s):

Older Adults ◽

Medication Adherence ◽

Monitoring System ◽

Self Efficacy ◽

Medication Use ◽

Pain Medication ◽

Medication Event Monitoring System ◽

Pain Severity ◽

Event Monitoring ◽

Pain Medications

BACKGROUND Pain is difficult to manage in older adults. Pain management in older adults has been recommended to include both nonpharmacologic and pharmacologic strategies. Unfortunately, nonadherence to pain medication is more prevalent than any other chronic disease treatment. Technology-based reminders have some benefit for medication adherence but is biased because behavior has been verified by self-report. OBJECTIVE The purpose of this study was to describe objective medication adherence and latency of medication use in a subsample of older adults that used a voice assistant reminder to take scheduled pain medications. METHODS This observational feasibility study was conducted in the homes of community-dwelling older adults. Of the 15 older adults using voice assistant reminders for pain medications, we randomly selected a subsample of participants to use a medication event monitoring system to observe medication adherence. We collected demographics, self-reported health history, and pain medication name, dose, and dose frequency. Baseline data were collected on pain severity and interference using the Brief Pain Inventory-SF; concern and necessity beliefs about pain medications using the Beliefs About Medicines Questionnaire; self-confidence in managing pain with the PROMIS Self-Efficacy for Managing Symptoms and medication adherence with a Medication Event Monitoring System. RESULTS Participants used pain medications to alleviate pain severity ranging from moderate to severe. Each participant had varying beliefs about pain medicines and self-efficacy in managing pain symptoms. Overall latency was 55 minutes. The absolute latency (before or after reminder) varied among the participants; the shortest average time was 17 minutes and the longest was 4.5 hours. Our results found that 15% of the pain medications were taken within 5 minutes over 60% were taken within 30 minutes. CONCLUSIONS Voice assistant reminders may help cue patients to take medications, but the timing of use may vary. It may be helpful to monitor the absolute timing of scheduled medication use as a part of medication adherence behaviors in older adults especially when frequent dosing is prescribed. CLINICALTRIAL Adherence, Pain Medications, Older Adults, Reminders, mHealth, Voice Assistants

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Voice Assistant Reminders and the Latency of Scheduled Medication Use in Older Adults With Pain: Descriptive Feasibility Study (Preprint)

10.2196/preprints.26361 ◽

2020 ◽

Author(s):

Marcia Shade ◽

Kyle Rector ◽

Kevin Kupzyk

Keyword(s):

Older Adults ◽

Medication Adherence ◽

Monitoring System ◽

Feasibility Study ◽

Medication Use ◽

Medication Event Monitoring System ◽

Event Monitoring ◽

Pain Medications ◽

Absolute Latency ◽

The Absolute

BACKGROUND Pain is difficult to manage in older adults. It has been recommended that pain management in older adults should include both nonpharmacologic and pharmacologic strategies. Unfortunately, nonadherence to pain medication is more prevalent than nonadherence to any other chronic disease treatment. Technology-based reminders have some benefit for medication adherence, but adherence behavior outcomes have mostly been verified by self-reports. OBJECTIVE We aimed to describe objective medication adherence and the latency of medication use after a voice assistant reminder prompted participants to take pain medications for chronic pain. METHODS A total of 15 older adults created a voice assistant reminder for taking scheduled pain medications. A subsample of 5 participants were randomly selected to participate in a feasibility study, in which a medication event monitoring system for pain medications was used to validate medication adherence as a health outcome. Data on the subsample’s self-assessed pain intensity, pain interference, concerns and necessity beliefs about pain medications, self-confidence in managing pain, and medication implementation adherence were analyzed. RESULTS In the 5 participants who used the medication event monitoring system, the overall latency between voice assistant reminder deployment and the medication event (ie, medication bottle cap opening) was 55 minutes. The absolute latency (before or after the reminder) varied among the participants. The shortest average time taken to open the cap after the reminder was 17 minutes, and the longest was 4.5 hours. Of the 168 voice assistant reminders for scheduled pain medications, 25 (14.6%) resulted in the opening of MEMS caps within 5 minutes of the reminder, and 107 (63.7%) resulted in the opening of MEMS caps within 30 minutes of the reminder. CONCLUSIONS Voice assistant reminders may help cue patients to take scheduled medications, but the timing of medication use may vary. The timing of medication use may influence treatment effectiveness. Tracking the absolute latency time of medication use may be a helpful method for assessing medication adherence. Medication event monitoring may provide additional insight into medication implementation adherence during the implementation of mobile health interventions.

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Medication Adherence: Expanding the Conceptual Framework

American Journal of Hypertension ◽

10.1093/ajh/hpab046 ◽

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.

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

American Journal of Kidney Diseases ◽

10.1053/j.ajkd.2010.04.021 ◽

2010 ◽

Vol 56 (3) ◽

pp. 439-446 ◽

Cited By ~ 74

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

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

JMIR mhealth and uhealth ◽

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

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

Global Journal of Health Science ◽

10.5539/gjhs.v8n5p39 ◽

2015 ◽

Vol 8 (5) ◽

pp. 39 ◽

Cited By ~ 10

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

OBJECTIVE: 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. METHODS: 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. RESULTS: 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 > 0.05), necessity beliefs (17.13 ± 4.31 vs. 17.10 ± 4.29; p > 0.05), or concern beliefs (11.70 ± 3.73 vs. 11.68 ± 3.77; p > 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 < 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. CONCLUSION: 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.

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

10.2196/preprints.14680 ◽

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 (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. CLINICALTRIAL ClinicalTrials.gov NCT04289246; https://tinyurl.com/ufjcz97

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