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

数字技术支持患有轻度认知障碍的老年人坚持高血压药物治疗

• 批准号: 10363162
• 负责人: KATHLEEN C INSEL
• 金额: $ 84.47万
• 依托单位: UNIVERSITY OF ARIZONA
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-05-04 至 2025-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10363162
• 关键词: Activities of Daily Living; Address; Adherence; Adoption; Adult; Age; Android; Antihypertensive Agents; Attention; Blood Pressure; COVID-19 pandemic; COVID-19 pandemic effects; Caring; Cerebrovascular Disorders; Chronic; Cognition; Cognitive; Collaborations; Communities; Competence; Control Groups; Dementia; Deterioration; Development; Dose; Drug Prescriptions; Education; Educational Intervention; Elderly; Ensure; Evaluation; Failure; Family; Friends; Future; Health; Health Personnel; Health Professional; Health system; Healthcare; Heart failure; Human; Hypertension; Impaired cognition; Impairment; Individual; Intervention; Interview; Learning Skill; Medication Management; Memory; Monitor; Myocardial Infarction; Outcome; Persons; Pharmaceutical Preparations; Population; Populations at Risk; Quality of life; Randomized Clinical Trials; Randomized Controlled Trials; Reminder Systems; Risk; Self Determination; Self Management; Self Medication; Standardization; Stroke; Structure; Support System; System; Technology; Testing; Time; Vulnerable Populations; Walking; base; cardiovascular risk factor; cognitive ability; cognitive function; cognitive skill; comorbidity; dementia risk; design; digital; digital health; digital intervention; digital treatment; efficacy evaluation; efficacy study; experience; group intervention; heuristics; high risk; improved; mHealth; mHealth self-management; medication compliance; medication nonadherence; mild cognitive impairment; predictive test; preservation; procedural memory; prospective memory; rate of change; remote monitoring; support tools; theories; tool; usability; user centered design; web portal

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.

摘要 轻度认知障碍（MCI）的特征在于一种或多种认知功能的轻度障碍， 与不服用处方药的风险增加有关。高血压在以下人群中普遍存在： MCI（PwMCI）患者和不依从药物治疗的患者会增加加速认知功能障碍的风险。 因脑血管疾病而衰退。PwMCI患者的依从性通常仅为46%或更低。此夕h COVID-19大流行导致这些人与护理伙伴（朋友、家人和 医疗保健工作者）谁协助药物管理，发现迫切需要发展自我， 管理工具。我们以前开发了一个基于理论的移动的健康（mHealth）系统，称为 药物教育、决策支持、提醒和监测（MEDSReM），以支持依从性 认知正常的老年人，这可以适应PwMCI。现有研究尚未评估 移动健康自我管理工具的好处，以支持PwMCI的高血压药物依从性。为了 为了使这种数字干预措施有益，必须仔细设计/调整，以满足独特的 PwMCI的能力和局限性。以用户为中心的技术已被证明可以促进独立性 和自主性来弥补失去的认知能力。在这份提案中，我们准备解决独特的 基于以用户为中心的设计，在PwMCI高危人群中使用数字技术的需求， 开发药物教育、决策支持、提醒和引导记忆（MEDSReM-M） 系统，进行迭代可用性测试，以优化系统的PwMCI，并检查有效性， 支持高血压药物治疗依从性。在目标1中，使用MEDSReM的促进因素和障碍将 通过采访PwMCI及其护理伙伴确定，在向他们展示自我管理系统后， 指导MEDSReM-M的开发。然后使用启发式评估和认知步行， 通过与PwMCI的迭代可用性测试，我们将为PwMCI测试、重新设计和优化系统。在 目的2：我们将进行一项涉及100例PwMCI的随机对照试验，以测试MEDSReM-M的效果 相对于标准化教育对照组的结局，包括对高血压的依从性 药物，血压，自我决定（能力和自主权）和技术接受。我们 然后，将测试3个月内药物依从性变化率的预测因素，以告知未来的大型 规模部署。采取人为因素办法，确定技术需求和要求， 支持按预期服药，并在PwMCI中对MEDSReM-M的可用性进行迭代测试 与随后的随机对照试验，将导致数字健康干预系统，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， 这一弱势群体的生活质量。