Digital Technology to Support Adherence to Hypertension Medications for Older Adults with Mild Cognitive Impairment

摘要 轻度认知损害(MCI)的特征是一个或多个认知功能的轻度损害 与不服用处方药的风险增加有关。高血压在以下人群中流行 患有MCI(PwMCI)和不坚持药物治疗的人会增加认知加速的风险 通过脑血管疾病下降。在普华永道中，依从性通常只有46%或更低。此外， 新冠肺炎大流行导致这些人与护理伙伴(朋友、家人和 医护人员)协助药物管理，发现发展自我的迫切需要 管理工具。我们之前已经开发了一个基于理论的移动健康(MHealth)系统，名为 药物教育、决策支持、提醒和监测(MEDSReM)，以支持在 认知正常的老年人，可以适应PwMCI。现有的研究还没有评估过 MHealth自我管理工具支持PwMCI高血压用药依从性的好处。按顺序 为了让这种数字干预措施受益，它们必须经过精心设计/调整，以满足独特的 PwMCI的功能和限制。以用户为中心的技术已被证明可以促进独立性 通过补偿丧失的认知技能来获得自主性。在这项提案中，我们准备解决独特的 基于以用户为中心的设计，在PwMCI的高危人群中使用数字技术的需求 药物教育、决策支持、提醒和监控记忆的发展(MEDSReM-M) 系统，进行迭代可用性测试，以针对PwMCI优化系统，并检查其有效性 支持高血压患者坚持用药。在目标1中，使用MEDSReM的促进者和障碍将是 通过采访普华永道及其护理合作伙伴确定，在向他们展示自我管理系统后 指导MEDSReM-M的发展。然后使用启发式评估和认知演练，以及 通过与PwMCI的迭代可用性测试，我们将针对PwMCI测试、重新设计和优化系统。在……里面 目的2我们将进行一项随机对照试验，包括100PwMCI，以测试MEDSReM-M的疗效 相对于标准化的教育控制组的结果，包括坚持高血压 药物、血压、自决(能力和自主性)和技术接受。我们 然后将测试3个月内服药依从性变化率的预测值，以告知未来的大型- 扩展部署。采用人的因素方法来确定技术需求和要求 支持按计划服药，并在PwMCI中迭代测试MEDSReM-M的可用性 随之而来的RCT，将导致一个数字健康干预系统，它有可能减少 与心血管风险相关的认知能力下降，节省医疗费用，促进自主性和 在这一弱势群体中的生活质量。

Abstract Mild cognitive impairment (MCI) is characterized by mild impairment in one or more cognitive functions and is associated with an increased risk for failure to take prescribed medications. Hypertension is prevalent among persons with MCI (PwMCI) and nonadherence to medications increases the risk of accelerated cognitive decline through cerebrovascular disease. Adherence is often only 46% or lower among PwMCI. Further, the COVID-19 pandemic has resulted in the isolation of these individuals from care partners (friends, family, and healthcare workers) who assist with medication management, uncovering the urgent need for developing self- management tools. We have previously developed a theory-based mobile health (mHealth) system called Medication Education, Decision Support, Reminding, and Monitoring (MEDSReM) to support adherence in cognitively normal older adults, which can be adapted for PwMCI. No existing studies have evaluated the benefits of mHealth self-management tools to support hypertension medication adherence for PwMCI. In order for such digital interventions to be beneficial, they have to be carefully designed/adapted to meet the unique capabilities and limitations of PwMCI. User-centered technology has been shown to promote independence and autonomy by compensating for lost cognitive skills. In this proposal, we are poised to address the unique needs for digital technology use in this at-risk population of PwMCI based on user-centered design to guide the development of Medication Education, Decision Support, Reminding, and Monitoring-Memory (MEDSReM-M) system, conduct iterative usability testing to optimize the system for PwMCI, and examine the efficacy to support hypertension medication adherence. In Aim 1, facilitators and barriers for use of MEDSReM will be identified by interviewing PwMCI and their care partners, after they are shown the self-management system to guide the development of MEDSReM-M. Then using heuristic evaluations and cognitive walkthroughs, and through iterative usability testing with PwMCI, we will test, redesign, and optimize the system for PwMCI. In Aim 2 we will conduct a randomized controlled trial involving 100 PwMCI to test the effects of MEDSReM-M relative to an standardized educational control group on outcomes including adherence to hypertension medications, blood pressure, self-determination (competence and autonomy), and technology acceptance. We will then test predictors of the rate of change in medication adherence over 3 months to inform future large- scale deployment. Taking a human factors approach to identify needs and requirements for technological support to take medications as intended, and iterative testing for the usability of MEDSReM-M among PwMCI with a consequent RCT, will result in a digital health intervention system that has the potential to reduce cognitive decline associated with cardiovascular risks, save healthcare dollars, and promote autonomy and quality of life in this vulnerable population.