Digital Technology to Support Adherence to Hypertension Medications for Older Adults with Mild Cognitive Impairment

数字技术支持患有轻度认知障碍的老年人坚持高血压药物治疗

• 批准号: 10363162
• 负责人: KATHLEEN C INSEL
• 金额: $ 84.47万
• 依托单位: UNIVERSITY OF ARIZONA
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-05-04 至 2025-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10363162
• 关键词: Activities of Daily Living; Address; Adherence; Adoption; Adult; Age; Android; Antihypertensive Agents; Attention; Blood Pressure; COVID-19 pandemic; COVID-19 pandemic effects; Caring; Cerebrovascular Disorders; Chronic; Cognition; Cognitive; Collaborations; Communities; Competence; Control Groups; Dementia; Deterioration; Development; Dose; Drug Prescriptions; Education; Educational Intervention; Elderly; Ensure; Evaluation; Failure; Family; Friends; Future; Health; Health Personnel; Health Professional; Health system; Healthcare; Heart failure; Human; Hypertension; Impaired cognition; Impairment; Individual; Intervention; Interview; Learning Skill; Medication Management; Memory; Monitor; Myocardial Infarction; Outcome; Persons; Pharmaceutical Preparations; Population; Populations at Risk; Quality of life; Randomized Clinical Trials; Randomized Controlled Trials; Reminder Systems; Risk; Self Determination; Self Management; Self Medication; Standardization; Stroke; Structure; Support System; System; Technology; Testing; Time; Vulnerable Populations; Walking; base; cardiovascular risk factor; cognitive ability; cognitive function; cognitive skill; comorbidity; dementia risk; design; digital; digital health; digital intervention; digital treatment; efficacy evaluation; efficacy study; experience; group intervention; heuristics; high risk; improved; mHealth; mHealth self-management; medication compliance; medication nonadherence; mild cognitive impairment; predictive test; preservation; procedural memory; prospective memory; rate of change; remote monitoring; support tools; theories; tool; usability; user centered design; web portal

Abstract Mild cognitive impairment (MCI) is characterized by mild impairment in one or more cognitive functions and is associated with an increased risk for failure to take prescribed medications. Hypertension is prevalent among persons with MCI (PwMCI) and nonadherence to medications increases the risk of accelerated cognitive decline through cerebrovascular disease. Adherence is often only 46% or lower among PwMCI. Further, the COVID-19 pandemic has resulted in the isolation of these individuals from care partners (friends, family, and healthcare workers) who assist with medication management, uncovering the urgent need for developing self- management tools. We have previously developed a theory-based mobile health (mHealth) system called Medication Education, Decision Support, Reminding, and Monitoring (MEDSReM) to support adherence in cognitively normal older adults, which can be adapted for PwMCI. No existing studies have evaluated the benefits of mHealth self-management tools to support hypertension medication adherence for PwMCI. In order for such digital interventions to be beneficial, they have to be carefully designed/adapted to meet the unique capabilities and limitations of PwMCI. User-centered technology has been shown to promote independence and autonomy by compensating for lost cognitive skills. In this proposal, we are poised to address the unique needs for digital technology use in this at-risk population of PwMCI based on user-centered design to guide the development of Medication Education, Decision Support, Reminding, and Monitoring-Memory (MEDSReM-M) system, conduct iterative usability testing to optimize the system for PwMCI, and examine the efficacy to support hypertension medication adherence. In Aim 1, facilitators and barriers for use of MEDSReM will be identified by interviewing PwMCI and their care partners, after they are shown the self-management system to guide the development of MEDSReM-M. Then using heuristic evaluations and cognitive walkthroughs, and through iterative usability testing with PwMCI, we will test, redesign, and optimize the system for PwMCI. In Aim 2 we will conduct a randomized controlled trial involving 100 PwMCI to test the effects of MEDSReM-M relative to an standardized educational control group on outcomes including adherence to hypertension medications, blood pressure, self-determination (competence and autonomy), and technology acceptance. We will then test predictors of the rate of change in medication adherence over 3 months to inform future large- scale deployment. Taking a human factors approach to identify needs and requirements for technological support to take medications as intended, and iterative testing for the usability of MEDSReM-M among PwMCI with a consequent RCT, will result in a digital health intervention system that has the potential to reduce cognitive decline associated with cardiovascular risks, save healthcare dollars, and promote autonomy and quality of life in this vulnerable population.

抽象的 轻度认知障碍（MCI）的特征是一种或多种认知功能中的轻度障碍，是 与未服用处方药的风险增加有关。高血压很普遍 MCI（PWMCI）和不遵守药物的人会增加认知的风险 通过脑血管疾病下降。 pwmci中的依从性通常只有46％或较低。此外， Covid-19-大流行导致这些人与护理伙伴（朋友，家人和 医疗保健工人）协助药物管理，发现迫切需要发展自我的需求 管理工具。我们以前已经开发了一种基于理论的移动健康（MHealth）系统称为 用药教育，决策支持，提醒和监测（MEDSREM）支持依从性 认知正常的老年人，可以适用于PWMCI。现有研究没有评估 MHealth自我管理工具的好处支持PWMCI的高血压药物依从性。为了 为了使这种数字干预措施有益，必须精心设计/适应以满足独特的 PWMCI的功能和局限性。以用户为中心的技术已被证明可以促进独立性 和自主权通过弥补失去的认知技能。在此提案中，我们准备解决独特的 基于以用户为中心的设计，在这种高危PWMCI中使用数字技术的需求，以指导 开发药物教育，决策支持，提醒和监测记忆（MEDSREM-M） 系统，进行迭代可用性测试以优化PWMCI系统，并检查功效 支持高血压药物依从性。在AIM 1中，使用MedsRem的促进者和障碍将是 通过采访PWMCI及其护理合作伙伴来确定，在向他们展示了自我管理系统到 指导MedsRem-M的发展。然后使用启发式评估和认知演练，以及 通过PWMCI的迭代可用性测试，我们将测试，重新设计和优化PWMCI系统。在 AIM 2我们将进行一项随机对照试验，涉及100个PWMCI来测试MEDSREM-M的影响 相对于一个标准化的教育控制小组，有关遵守高血压的结果 药物，血压，自决（能力和自主权）和技术接受。我们 然后将测试3个月内药物依从性变化率的预测指标，以告知未来的大型 比例部署。采取人为因素的方法来确定技术的需求和需求 支持服用预期的药物，并迭代测试PWMCI中MedsRem-M的可用性 随之而来的RCT将导致数字健康干预系统，有可能减少 与心血管风险相关的认知下降，节省医疗保健资金，并促进自主权和 这个脆弱人群的生活质量。