for Medication Education, Decision Support, Reminding and Monitoring System (MEDSReM) Hypertension is prevalent among older adults. Hypertension increases risk for stroke and myocardial infarction, and can result in end organ damage to the kidneys, retina and brain. Medication adherence is critically important to prevent the deleterious effects of hypertension; yet, adherence is often calculated at only 50%. We developed and tested the Multifaceted Prospective Memory Intervention (MPMI), a behavioral intervention, using theories of prospective memory and aging to improve adherence to antihypertensive medications. The MPMI was tested among older adults (? 65 years of age) and improved adherence by 35%. The MPMI was efficacious over the short term, but after an additional 5 months without the ongoing presence of the interventionists, adherence declined. The purpose of the current study is to create an evidence-based smartphone application and companion website in order to provide continuous use of the efficacious strategies to sustain adherence. We are at an exciting time since among persons with hypertension the potential benefits of improved health can be achieved through improved adherence. The recent SPRINT study (Systolic Blood Pressure Intervention Trial) supports improved outcomes (lower fatal and nonfatal major cardiovascular events and death from any cause) by targeting a lower systolic blood pressure of 120 mm Hg compared to using the previously recommended guideline of 140 mm Hg.2 These outcomes will not be achieved unless we can help people take their medications as prescribed and as intended. Specifically using iterative usability, cognitive walk-through and heuristic evaluation, we will build, test and modify a mobile application (App) and companion website, the Medication Education, Decision Support, Reminding and Monitoring System (MEDSReM). Mobile devices are ubiquitous and can be leveraged to capture the prospective memory strategies and improve adherence. The development of the MEDSReM will be based on the strategies from the MPMI, human factors in aging, preferences, needs and requirements of older adults taking medications using technology and iterative testing to assure usability for older adults. The strategies will be translated to technology and add decision support. Decision support will provide the patient with assistance in taking medications if they have missed a dose. A decision tree will be created with knowledge of pharmacotherapeutic and pharmacokinetics based on the patient's medication time to peak, duration and half-life properties to determine a safe interval for taking missed doses. The final MEDSReM will include a website that can easily be accessed with links in the App for educational support and ongoing coaching. Taking a human factors approach to inform the preferences, needs and requirements for technological support to take medications as intended, and iterative testing for usability of the App and website among older adults, will result in a superior product for the mobile App and website and improve health outcomes. This final product will be field tested and consequent improvement in adherence assessed.
Significance High blood pressure is common among older adults and can lead to poor health including the increased likelihood of stroke and heart disease. Adhering to medications that lower blood pressure is difficult, particularly among older adults who have been shown to experience age-associated declines in cognitive processes that could support medication taking. A previously tested intervention was successful in improving adherence. The aim of this study is to translate the intervention into mobile technology with the goal of sustaining good adherence.
