Improving Hypertension Medication Adherence for Older Adults

项目总结/摘要 血压（BP）药物在减少不受控制的不良后果方面非常有效。 高血压和最佳的依从性可减少心力衰竭、中风和心肌梗死， 认知功能高血压在老年人中尤其普遍（约67%），但血压调节的益处 许多老年人没有意识到这一点，因为不依从率约为50%，导致生活质量下降， 医疗保健费用（美国每年2900亿美元）。我们发展了基于理论的多面前瞻记忆 干预（MPMI），这显着提高了老年人对BP药物的依从性， 一旦护理支持被移除，就无法维持。因此，我们开发了药物教育，决策 支持、提醒和监测系统（MEDSReM）移动的应用程序（App），用于更换药物 从依赖于执行功能和认知过程的努力过程中获益， 年龄，到定制的，线索驱动的联想过程，主要是保留与年龄。MEDSReM-2将 利用技术进步，将其他功能集成到MEDSReM，包括电子 血压监测，并提供有关药物依从性和血压之间关系的反馈。我们将 测试MEDSReM-2的有效性，并期望循证和多维方法将 提高感知能力和自主性，从而提高和持续用药依从性， 自我管理至少一种高血压的非依从性老年人（≥ 65岁）的血压水平改善 药目标1：推进MEDSReM-2的设计，这是一个集成的移动的应用程序， 提供教育、决策支持、提醒和监控，以纳入有关依从性的反馈 BP的措施。这一目标将包括实施和测试新的功能（例如，电子BP 监测、标签的光学图像捕获以自启动应用程序、扩展的决策支持），以及用户- 测试过的教学协议目标2：通过一个 随机对照试验（RCT），以评估疗效以及个体依从性和系统模式 随着时间的推移使用。我们将筛选448名老年高血压患者，确定224名不依从者，随机分配至 6-月干预研究。主要结局将是依从性改善（n=112）与教育 对照组（n=112）。次要结局将是BP、自主性和能力以及移动终端熟练程度。 我们将研究个人参与者和可持续发展主持人的依从性随时间的变化， 评估MEDSReM-2使用模式，以评估与改善依从性和BP管理相关的因素。 这些目标的顺利实现，将形成一个以理论为基础、以技术为强化的综合性自我教育体系。 该管理系统支持老年人的高血压药物依从性和血压管理。 MEDReM-2将通过更大的个人自主权和能力来促进自我管理， 降低高血压相关风险，节省医疗费用，促进老年人独立生活。

PROJECT SUMMARY / ABSTRACT Blood pressure (BP) medications are remarkably effective in reducing adverse outcomes of uncontrolled hypertension, and optimal adherence reduces heart failure, stroke, and myocardial infarction, and maintains cognitive function. Hypertension is especially prevalent in older adults (~67%), but BP mediation benefits are unrealized for many older adults, as nonadherence is ~50%, leading to decreased quality of life and high health care costs ($290 billion/year in US). We developed the theory-based Multifaceted Prospective Memory Intervention (MPMI), which significantly improved older adults' adherence to BP medications, but benefits did not sustain, once nursing support was removed. We thus developed the Medication Education, Decision Support, Reminding, and Monitoring System (MEDSReM) mobile application (App), which changes medication taking from an effortful process dependent on executive functions and cognitive processes that decline with age, to customized, cue-driven associative processes that are mostly preserved with age. MEDSReM-2 will capitalize on technological advances to integrate additional functionalities to MEDSReM including electronic BP monitoring and provide feedback about the relationship between medication adherence and BP. We will test the efficacy of MEDSReM-2, and expect that the evidence-based and multi-dimensional approach will increase perceived competence and autonomy, resulting in higher and sustained medication adherence and improved BP levels for nonadherent older adults (≥ 65 years), who self-manage at least one hypertension medication. The aims are: Aim 1: Advance the design of MEDSReM-2, an integrated mobile application that provides education, decision support, reminders, and monitoring to incorporate feedback on adherence related to BP measures. This aim will include implementing and testing new functionalities (e.g., electronic BP monitoring, optical image capture of labels to self-start the App, expanded decision support), as well as user- tested instructional protocols. Aim 2: Determine the efficacy and scalability of MEDSReM-2 through a randomized controlled trial (RCT) to assess efficacy as well as individual patterns of adherence and system use over time. We will screen 448 older people with hypertension to identify 224 nonadherent, randomized to a 6-month intervention study. The primary outcome will be improved adherence (n=112) versus an education control (n=112). Secondary outcomes will be BP, autonomy and competence, and mobile device proficiency. We will examine change in adherence over time in individual participants and moderators of sustainability, and evaluate MEDSReM-2 use patterns to assess factors related to improved adherence and BP management. Successful completion of these aims will result in a theory-based, technology-enhanced comprehensive self- management system that supports hypertension medication adherence and BP management for older adults. MEDReM-2 will foster self-management, through greater personal autonomy and competence, with potential to reduce hypertension-associated risks, save healthcare dollars, and promote independent living of older adults.