Medication nonadherence is a pervasive, multidimensional problem among elders. It is often caused by poor communication practices and age-related declines in cognitive abilities. We plan to improve communication through Expanded Medication Instructions, which should effectively complement labels because they are more complete and can be well-organized. The proposed research will expand our work on the organization of expanded instructions. Drawing on current theories of instruction processing, we will examine the influence of instruction organization on how well older and young readers understand and remember medication instructions (and their awareness of these benefits), and on how well they adhere to medication schedules. We will also examine if the effects of these instructional factors depend on medication (schedule complexity) and motivation factors. We will test if medication instructions that are compatible with readers' schemas for taking medication are more effective than less compatible instructions. The experiments measure the mental representation of medication information, comprehension and recall of instructions, self-assessment of comprehension and recall, and preferences for these instructions. We also test if compatible expanded instructions are more effective than labels in promoting adherence. Experiment 1 examines young and older subjects' schemas for taking medication. Experiment 2 examines if instructions with text formats that are compatible with the schema(s) are understood most easily and remembered most accurately. Experiments 3-4 examine if instructions with explicit formats are most effective. Experiment 5 examines the influence of visual-graphic as well as text formats on instruction comprehension and memory. The final two experiments directly compare prescription labels and expanded instructions. Experiment 6 examines how well these instructions convey multiple medication schedules. Experiment 7 tests if expanded instructions are more effective in promoting adherence to complex schedules. The experiments should converge to show that instructions are more easily processed when they explicitly signal the organization that matches the reader's task schema. They should lead to more effective medication instructions, which in turn should improve adherence, so that elders can lead independent lives for a longer time.

National Institute of Health (NIH)
National Institute on Aging (NIA)
Research Project (R01)
Project #
Application #
Study Section
Human Development and Aging Subcommittee 3 (HUD)
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
Decision Systems
Los Altos
United States
Zip Code
Guimaraes, Patricia; Frisina, Susan T; Mapes, Frances et al. (2006) Progestin negatively affects hearing in aged women. Proc Natl Acad Sci U S A 103:14246-9
Morrow, D G; Hier, C M; Menard, W E et al. (1998) Icons improve older and younger adults' comprehension of medication information. J Gerontol B Psychol Sci Soc Sci 53:P240-54
Morrow, D G; Leirer, V O; Andrassy, J M et al. (1998) The influence of list format and category headers on age differences in understanding medication instructions. Exp Aging Res 24:231-56
Morrow, D G; Stine-Morrow, E A; Leirer, V O et al. (1997) The role of reader age and focus of attention in creating situation models from narratives. J Gerontol B Psychol Sci Soc Sci 52:P73-80
Morrow, D (1997) Improving consultations between health-care professionals and older clients: implications for pharmacists. Int J Aging Hum Dev 44:47-72
Morrow, D G; Leirer, V O; Andrassy, J M et al. (1996) Medication instruction design: younger and older adult schemas for taking medication. Hum Factors 38:556-73
Yesavage, J A; Dolhert, N; Taylor, J L (1994) Flight simulator performance of younger and older aircraft pilots: effects of age and alcohol. J Am Geriatr Soc 42:577-82
Morrow, D; Leirer, V; Altieri, P et al. (1994) When expertise reduces age differences in performance. Psychol Aging 9:134-48
Taylor, J L; Yesavage, J A; Morrow, D G et al. (1994) The effects of information load and speech rate on younger and older aircraft pilots' ability to execute simulated air-traffic controller instructions. J Gerontol 49:P191-200
Taylor, J L; Dolhert, N; Morrow, D et al. (1994) Acute and 8-hour effects of alcohol (0.08% BAC) on younger and older pilots' simulator performance. Aviat Space Environ Med 65:718-25