Multifaceted Prospective Memory Intervention to Improve Medication Adherence.
Multifaceted Prospective Memory Intervention to Improve Medication Adherence.
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DOI：
10.1111/jgs.14032
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发表时间：
2016-03
影响因子：
6.3
通讯作者：
Hepworth JT
中科院分区：
文献类型：
--
作者：
Insel KC;Einstein GO;Morrow DG;Koerner KM;Hepworth JT
Older adults do not take medication as prescribed, diminishing the benefits of treatment and increasing costs to individuals and society. A multifaceted prospective memory intervention for improving adherence to antihypertensive medication was tested and assessed if executive function/working memory processes moderated intervention effects. A two group longitudinal randomized control trial was used. The sample consisted of community-based older adults (≥ 65 years of age) without signs of dementia or symptoms of severe depression who were self-managing prescribed medication. Following four weeks of initial adherence monitoring using a medication event monitoring system (MEMS®), individuals with 90% or less adherence were randomly assigned to groups. The prospective memory intervention was designed to provide strategies that switch older adults from relying on executive function/working memory processes (that show effects of cognitive aging) to mostly automatic associative processes (that are relatively spared with normal aging) for remembering to take one’s medications. Strategies included establishing a routine, establishing cues strongly associated with medication taking actions, performing the action immediately upon thinking about it, using a medication organizer, and imagining medication taking to enhance encoding and improve cuing. There was significant improvement in adherence for the intervention group (57% at baseline to 78% post intervention), but most of these gains were lost after 5 months. The control condition started at 68%, was stable during the intervention, but dropped to 62%. Executive function/working memory moderated the intervention effect, with the intervention producing greater benefit for those with lower executive function/working memory. The intervention improved adherence, but the benefits were not sustained. Further research is needed to determine how to sustain the substantial initial benefits.
