AGING, ARTHRITIS AND MEDICATION ADHERENCE

本提案的重点是药物依从性行为， 类风湿和骨关节炎患者。 虽然现有的药物 不能治愈任何一种形式的关节炎，它们确实减缓了疾病的进展， 减少疼痛，甚至可以预防残疾。 因此， 是很重要的 不依从药物治疗的估计 关节炎患者的发病率高得惊人--高达60%。 直到最近的 微电子监测设备的出现， 行为是不可靠的，并基于口头估计或药丸计数。 在 除了测量不可靠的问题外， 认知能力因素与不依从的关系。 这是令人惊讶的，因为这可能是在理解和 记住药物治疗方案有助于不依从，特别是 在可能经历与年龄相关的理解力下降的老年人中， 和记忆过程。 本提案的总体目标是了解 与年龄相关的理解和记忆问题对 药物治疗不依从性，并确定有效的认知形式， 干预措施，以提高依从性。 该提案的具体目标是 具体如下：（1）新型微电子器件将用于记录 首次在关节炎患者中准确地观察到遵守行为， 与传统的方法相比。(Year（1 - 2）;（2）一个完整的 了解类风湿性关节炎患者依从行为的理论框架 和骨关节炎患者将被开发，使用由 Leventhal和卡梅隆（1987年）。 该模型将侧重于认知能力 除了Leventhal和卡梅隆提出的变量之外， 包括年龄、患者信念、社会支持和疾病因素，使用 结构方程模型（3 - 5年级）。(3)一系列认知假肢 或将制定和测试干预措施，其目的是： 改善对药物信息理解;（B）提供记忆支持 用于药物信息;（c）提供前瞻性记忆 帮助-记得在正确的时间服用药物（3 - 5年）。 (4)详细的、具体的依从性数据将在两个月内收集， 每个主题，这将允许描述不依从模式， 药物类型、疾病状态、剂量的这些模式的区分 时间表，以及这些价值的关系，认知 能力变量和信念变量--这些信息对 执业临床医生（3 - 5年级）。(5)最后， 类风湿性关节炎患者的药物治疗依从性和主观幸福感 和骨关节炎患者将直接进行调查（第2 - 3年）- 重要但被忽视的话题

The present proposal focuses on the medication adherence behaviors of rheumatoid and osteoarthritis patients. Although available medications cannot cure either form of arthritis, they do slow disease progression, decrease pain, and may even prevent disability. Thus, adherence behaviors are important to understand. Estimates of nonadherence to medications for arthritis patients are alarmingly high- as much as 60%. Until the recent advent of microelectronic monitoring devices, the measurement of adherence behaviors was unreliable and based on verbal estimates or pill counts. In addition to problems with unreliable measurement, little attention had been paid to the relationship of cognitive ability factors to nonadherence. This is surprising, because it is likely that problems in understanding and remembering a medication regimen contribute to nonadherence, particularly in elderly adults who may experience age-related declines in comprehension and memory processes. The general goal of this proposal is to understand the contribution of age-related comprehension and memory problems to medication nonadherence and to determine effective forms of cognitive interventions to improve adherence. The specific aims of the proposal are as follows: (1) Novel microelectronic devices will be used to record adherence behaviors accurately in arthritis patients for the first time and compared to more traditional measures. (Year 1-2); (2) A complete theoretical framework for understanding adherence behaviors in rheumatoid and osteoarthritis patients will be developed, using the model proposed by Leventhal and Cameron (1987). The model will focus on cognitive ability variables in addition to variables suggested by Leventhal and Cameron which include age, patient beliefs, social support and disease factors, using structural equation models (Years 3-5). (3) A range of cognitive prostheses or interventions will be developed and tested that are designed to (a) improve comprehension of medication information; (b) provide memory support for the medication information; (c) provide prospective memory assistance--remembering to take medication at the right time (Year 3-5). (4) Detailed, specific adherence data will be collected for two months from each subject, which will permit the description of nonadherence patterns, the differentiation of these patterns for drug type, disease state, dosage schedules, as well as the relationship of these valuables to cognitive ability variables and belief variables--information of great use to practicing clinicians (Year 3-5). (5) Finally, the relationship between adherence to a medication regimen and subjective well-being for rheumatoid and osteoarthritis patients will be investigated directly (Year 2-3)--an important but neglected topic.