Supporting the Medication Adherence of Older Mexican Adults Through External Cues Provided With Ambient Displays

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

Download Full-text

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 (<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

Download Full-text

External ambient cues to mediate the involvement of family caregivers in the management of older adults’ medications: a qualitative study (Preprint)

10.2196/preprints.16500 ◽

2019 ◽

Author(s):

Marcela D. Rodríguez ◽

Juan-Pablo Garcia-Vazquez ◽

Angel G. Andrade

Keyword(s):

Older Adults ◽

Medication Adherence ◽

Qualitative Study ◽

Family Caregivers ◽

Prospective Memory ◽

Family Members ◽

Lessons Learned ◽

Qualitative Assessment ◽

Medication Regimen ◽

External Cues

BACKGROUND The most common reasons for the lack of adherence among older adults is the forgetfulness due to the multiple cognitive processes associated with prospective memory involved in remembering to follow a medication regimen. Problems with prospective memory increase the demands for care. Therefore, family members play an essential role in supporting patients in activities that involve: helping with medication adherence, transmitting knowledge about medications, and helping to refill their prescriptions. To address some of these medication problems, we designed a Medication Ambient Display (MAD) to support education, motivation, and measurement of medication-taking behaviors in older adults. The functionality of MAD consists of providing external cues to convey information through abstract and stylized representations of older adults’ medication adherence. Specifically, MAD is placed as a portrait in the elderly’s home. It shows a virtual birdcage to raise elders’ consciousness about their responsibility for caring for their health, in a similar way that they gladly take care of their pets OBJECTIVE This study aimed to assess the effect of MAD’s external cues on the involvement of family members in the management of medications for the elderly. METHODS We conducted a qualitative study consisting of semi-structured interviews with older adults and their relatives identified as informal caregivers. The study lasted ten (10) weeks. We visited participants weekly to collect data about: older adults’ medication problems, help received, and their perception about older adults’ medication adherence. The first five (5) weeks of the study was used to establish baseline data to understand the involvement of relatives on medication management activities. Afterward, we introduced MAD to be used for the successive five (5) weeks. RESULTS We found that new patterns of interaction among older adults and their relatives arose while using MAD. Participants perceived that MAD reinforced the care functions of family caregivers. For instance, it made them aware of older adults' medication adherence and encouraged youngest family members to help older adults. CONCLUSIONS We identified that the external cues provided through ambient displays did not overwhelm family members, but motivated their social connectedness with older adults. We conclude this paper with a set of lessons learned from this qualitative assessment, which may help designers to develop assistive technology for older adults.

Download Full-text