AGING, ARTHRITIS AND MEDICATION ADHERENCE

本建议重点关注老年人的服药依从性行为。 类风湿和骨性关节炎患者。尽管有可用的药物 它们不能治愈这两种类型的关节炎，它们可以减缓疾病的进展， 减轻疼痛，甚至可以防止残疾。因此，遵守行为 都是需要理解的重要因素。不坚持服药的估计 关节炎患者的比例高得惊人--高达60%。直到最近 微电子监测设备的问世，粘附性的测量 行为是不可靠的，基于口头估计或药片计数。在……里面 除了测量不可靠的问题外，很少有人注意到 重视认知能力因素与非依从性的关系。 这是令人惊讶的，因为理解和理解上的问题 记住一种药物治疗方案会导致不坚持，尤其是 可能会经历与年龄相关的理解力下降的老年人 和记忆过程。这项建议的总体目标是理解 与年龄相关的理解和记忆问题对 用药不依从性及有效认知形式的确定 旨在提高遵从性的干预措施。这项提议的具体目的是 具体如下：(1)新型微电子设备将用于记录 首次在关节炎患者中准确地观察依从性行为 与更传统的措施相比。(1-2年级)；(2)完整 理解类风湿黏附行为的理论框架 和骨关节炎患者将开发，使用由 莱文塔尔和卡梅隆(1987)。该模型将侧重于认知能力。 变量除了莱文塔尔和卡梅隆建议的变量外， 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)一系列认知假体 或将开发和测试旨在(A) 提高对药物信息的理解；(B)提供记忆支持 (C)提供前瞻性记忆 帮助--记得在正确的时间服药(3-5岁)。 (4)将从以下日期起收集两个月的详细、具体的遵从性数据 每个受试者，这将允许描述不遵守模式， 这些模式在药物类型、疾病状态、剂量等方面的区别 时间表，以及这些贵重物品与认知的关系 能力变量和信念变量--非常有用的信息 执业临床医生(3-5年级)。(5)最后，两者之间的关系 类风湿患者坚持药物治疗与主观幸福感的关系 骨关节炎患者将直接接受调查(2-3年级)--AN 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.