Adherence to medication is the single most important strategy to prevent high blood pressure and its subsequent deleterious and costly effects including stroke, heart failure and cognitive decline. Adherence is a significant problem in hypertension with estimates of only 50 percent appropriately adhering to their prescribed medications. Hypertension is also an asymptomatic chronic illness and therefore one without internal memory cues to medication taking. Hypertension is prevalent among older adults who have been shown to experience declines in cognitive processes that otherwise might compensate for the lack of internal cues to support adherence. The purpose of the proposed study is to test the effect of an in-home, tailored, multifaceted prospective memory intervention on adherence to antihypertensive medication for adults 65 years of age and older. The intervention is grounded in recent empirical and theoretical developments in the area of prospective memory and focuses on enhancing medication adherence through the use of relatively well-preserved cue- driven and automatic processes. Older adults who are self-managing at least one antihypertensive agent and are adherent to this medication less than or equal to 90 percent following 4 weeks of baseline monitoring, will be randomly assigned to one of two groups. One group will receive the intervention consisting of 4 phases: establishing a relationship, education, implementation of multifaceted strategies to improve prospective remembering and weekly reinforcement sessions for 3 weeks. The education comparison group will only receive part of the first and second phase of the intervention, establishing a relationship and education and will be visited for an additional 3 weeks similar to the visits for the intervention group, but will not receive strategy training. Adherence will be determined using Medication Electronic Monitoring. It is hypothesized that the intervention group will have greater overall adherence and that the relationship between overall adherence and executive function/working memory will be smaller than for the education comparison group because the intervention reduces the need for high levels of executive function to achieve adherence. Patterns of adherence will be assessed across a six-month period. A major public health consequence of this study is limiting disabilities among older adults because hypertension is associated with cognitive decline and cardiovascular and cerebrovascular disease including stroke. While this intervention is being tested with older adults, the intervention has broad implications for improving adherence in other populations.

Public Health Relevance

Taking medications as prescribed is the single most important way to prevent the effects of high blood pressure. This study addresses the important public health problem of high blood pressure by testing an intervention to help people take medications as prescribed. If we can improve the way people take blood pressure medicines, we can improve the quality of life for older adults and decrease health care costs.

National Institute of Health (NIH)
National Institute of Nursing Research (NINR)
Research Project (R01)
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Nursing Science: Adults and Older Adults Study Section (NSAA)
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Huss, Karen
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University of Arizona
Schools of Nursing
United States
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Insel, Kathie C; Einstein, Gilles O; Morrow, Daniel G et al. (2016) Multifaceted Prospective Memory Intervention to Improve Medication Adherence. J Am Geriatr Soc 64:561-8
McHenry, Judith C; Insel, Kathleen C; Einstein, Gilles O et al. (2015) Recruitment of Older Adults: Success May Be in the Details. Gerontologist 55:845-53
Insel, Kathleen C; Einstein, Gilles O; Morrow, Daniel G et al. (2013) A multifaceted prospective memory intervention to improve medication adherence: design of a randomized control trial. Contemp Clin Trials 34:45-52