Medication Adherence Functional Capacity in the Aging Population: Development of an Ecologically Validated Assessment

老年人群的药物依从性功能能力：生态验证评估的开发

• 批准号: 9979547
• 负责人: Catherine Sumida
• 金额: $ 6.88万
• 依托单位: WASHINGTON STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-05-15 至 2023-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9979547
• 关键词: Activities of Daily Living; Adherence; Aging; Antibiotic Resistance; Behavior; Chronic Disease; Clinic; Clinical; Clinical assessments; Cognition; Cognitive; Communities; Data; Decision Making; Development; Devices; Diagnostic; Disease Resistance; Elderly; Emergency department visit; Episodic memory; Failure; Goals; Health; Health Care Costs; Individual; Information Resources Management; Instruction; Intervention; Knowledge; Laboratories; Literature; Measurement; Measures; Mentorship; Monitor; Movement; Neuropsychology; Outcome; Participant; Patient Self-Report; Patients; Performance; Personal Satisfaction; Pharmaceutical Preparations; Policies; Population; Prevention; Problem Solving; Process; Public Health; Publishing; Reporting; Research; Research Personnel; Research Project Grants; Risk; Sampling; Surgeon; Testing; Thinness; Treatment Cost; Work; aging population; base; clinical implementation; cognitive ability; cognitive change; comorbidity; disability; experience; forgetting; improved; innovation; medication compliance; medication nonadherence; meetings; mortality; novel; performance based measurement; pill; processing speed; prospective memory; sensor; standardize measure; tool

The aging population is the largest consumer base of prescribed medications, with 40% of older adults managing 5 or more drugs. However, approximately 50% of these prescribed medications are not taken as directed. Repercussions from nonadherence in the aging population include an annual $100 to $289 billion dollars in health care costs, inaccurate efficacy results for clinical drug trials and significant public health issues like increased rates of comorbid diseases and anti-biotic resistance. The long-term objective of this project is to build a quick, reliable and ecological valid clinical assessment to capture cognitive-related nonadherence risk and to develop tailored interventions to reduce nonadherence. The primary objective of this application is to test four medication adherence components hypothesized to be contributors of cognitive-related medication nonadherence in older adults and, therefore, necessary for inclusion in such a clinical assessment of functioning (i.e., performance-based measure). Building on my prior work, the approach will be to examine relationships between real-world adherence and performance-based measures of medication knowledge, management, prospective memory and compensatory strategy problem-solving abilities (Aims 1-3). In addition, the proposed research will demonstrate how each performance-based measure independently captures aspects of real-world medication adherence above and beyond known neuropsychological correlates (Aim 1-3). Finally, performance-based measures that best predict real-world medication adherence will be identified by using hierarchical regressions to analyze the relationships between the performance-based measures and real-world medication adherence (Aim 4). A quick ecologically valid assessment for cognitive- related nonadherence is expected to provide the research and clinical community a tool to identify medication nonadherence risk. The approach is innovative because it will (a) monitor and measure medication adherence using the participant’s everyday medication devices (i.e., using Estimotes, thin attachable movement sensors); (b) examine the relationship between medication performance-based measures and real-world adherence; and (c) utilize novel medication performance-based measures to examine abilities thought to be critical to supporting real-world adherence (i.e., prospective memory and compensatory strategy problem-solving, unexamined aspects of medication adherence). A measure of medication functional capacity is significant because it extends medication nonadherence measurements beyond self-reports and captures real-world cognitive-related medication nonadherence risk. Therefore, this measure has the potential to aid in diagnostic decision making and identifying specific medication functional deficits that could be targeted with interventions. Given the significant burden of cognitive-related medication nonadherence, this measure is expected to have a downstream impact on reducing national rates of preventable disability and mortality, emergency room visits, comorbid chronic diseases and health care costs.

老龄化人口是处方药的最大消费群体，40%的老年人 管理5种或更多药物。然而，这些处方药中约有50%没有被当作 指导。在老龄化人口中，不遵守规定的费用包括每年1000亿至2890亿美元 医疗保健成本，临床药物试验的疗效结果不准确以及重大的公共卫生问题 比如并发症和抗生素耐药性的增加。该项目的长期目标是 建立一个快速、可靠和生态有效的临床评估，以捕获认知相关的不依从风险 并制定有针对性的干预措施，以减少不遵守。本申请的主要目的是 测试假设为认知相关药物的贡献者的四个药物依从性成分 老年人不依从，因此，有必要纳入此类临床评估， 功能（即，基于性能的测量）。在我之前工作的基础上，方法将是检查 真实世界的依从性和基于性能的药物知识测量之间的关系， 管理、前瞻记忆和补偿策略问题解决能力（目标1-3）。在 此外，拟议的研究将展示如何每一个基于性能的措施独立 捕捉现实世界中药物依从性的各个方面，这些方面超出了已知的神经心理学相关因素 (Aim第1-3段）。最后，最能预测现实世界药物依从性的基于绩效的指标将被 通过使用分层回归分析基于性能的 措施和现实世界的药物依从性（目标4）。一个快速的生态有效的评估认知- 相关的不依从性有望为研究和临床社区提供一种识别药物的工具 不遵守风险。该方法是创新的，因为它将（a）监测和测量药物依从性 使用参与者的日常用药装置（即，使用Estimotes，薄的可附接运动传感器）; (b)检查基于药物性能的措施和现实世界的依从性之间的关系; (c)利用新的药物性能为基础的措施，以检查被认为是至关重要的能力， 支持真实世界的遵守（即，前瞻记忆和补偿策略解决问题， 药物依从性的未检查方面）。药物功能能力的测量是重要的 因为它将药物非依从性测量扩展到自我报告之外， 认知相关药物不依从风险。因此，这项措施有可能有助于诊断 决策和识别特定的药物功能缺陷，可以针对 干预措施。考虑到认知相关药物不依从性的重大负担，该措施是 预计将对降低国家可预防的残疾率和死亡率产生下游影响， 急诊室就诊、共病慢性病和医疗保健费用。