Medication Adherence Functional Capacity in the Aging Population: Development of an Ecologically Validated Assessment

老年人群的药物依从性功能能力：生态验证评估的开发

• 批准号: 9979547
• 负责人: Catherine Sumida
• 金额: $ 6.88万
• 依托单位: WASHINGTON STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-05-15 至 2023-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9979547
• 关键词: Activities of Daily Living; Adherence; Aging; Antibiotic Resistance; Behavior; Chronic Disease; Clinic; Clinical; Clinical assessments; Cognition; Cognitive; Communities; Data; Decision Making; Development; Devices; Diagnostic; Disease Resistance; Elderly; Emergency department visit; Episodic memory; Failure; Goals; Health; Health Care Costs; Individual; Information Resources Management; Instruction; Intervention; Knowledge; Laboratories; Literature; Measurement; Measures; Mentorship; Monitor; Movement; Neuropsychology; Outcome; Participant; Patient Self-Report; Patients; Performance; Personal Satisfaction; Pharmaceutical Preparations; Policies; Population; Prevention; Problem Solving; Process; Public Health; Publishing; Reporting; Research; Research Personnel; Research Project Grants; Risk; Sampling; Surgeon; Testing; Thinness; Treatment Cost; Work; aging population; base; clinical implementation; cognitive ability; cognitive change; comorbidity; disability; experience; forgetting; improved; innovation; medication compliance; medication nonadherence; meetings; mortality; novel; performance based measurement; pill; processing speed; prospective memory; sensor; standardize measure; tool

The aging population is the largest consumer base of prescribed medications, with 40% of older adults managing 5 or more drugs. However, approximately 50% of these prescribed medications are not taken as directed. Repercussions from nonadherence in the aging population include an annual $100 to $289 billion dollars in health care costs, inaccurate efficacy results for clinical drug trials and significant public health issues like increased rates of comorbid diseases and anti-biotic resistance. The long-term objective of this project is to build a quick, reliable and ecological valid clinical assessment to capture cognitive-related nonadherence risk and to develop tailored interventions to reduce nonadherence. The primary objective of this application is to test four medication adherence components hypothesized to be contributors of cognitive-related medication nonadherence in older adults and, therefore, necessary for inclusion in such a clinical assessment of functioning (i.e., performance-based measure). Building on my prior work, the approach will be to examine relationships between real-world adherence and performance-based measures of medication knowledge, management, prospective memory and compensatory strategy problem-solving abilities (Aims 1-3). In addition, the proposed research will demonstrate how each performance-based measure independently captures aspects of real-world medication adherence above and beyond known neuropsychological correlates (Aim 1-3). Finally, performance-based measures that best predict real-world medication adherence will be identified by using hierarchical regressions to analyze the relationships between the performance-based measures and real-world medication adherence (Aim 4). A quick ecologically valid assessment for cognitive- related nonadherence is expected to provide the research and clinical community a tool to identify medication nonadherence risk. The approach is innovative because it will (a) monitor and measure medication adherence using the participant’s everyday medication devices (i.e., using Estimotes, thin attachable movement sensors); (b) examine the relationship between medication performance-based measures and real-world adherence; and (c) utilize novel medication performance-based measures to examine abilities thought to be critical to supporting real-world adherence (i.e., prospective memory and compensatory strategy problem-solving, unexamined aspects of medication adherence). A measure of medication functional capacity is significant because it extends medication nonadherence measurements beyond self-reports and captures real-world cognitive-related medication nonadherence risk. Therefore, this measure has the potential to aid in diagnostic decision making and identifying specific medication functional deficits that could be targeted with interventions. Given the significant burden of cognitive-related medication nonadherence, this measure is expected to have a downstream impact on reducing national rates of preventable disability and mortality, emergency room visits, comorbid chronic diseases and health care costs.

老龄化人口是处方药最大的消费群体，其中老年人占 40% 管理 5 种或更多药物 然而，这些处方药中大约有 50% 没有按规定服用。 人口老龄化造成的不遵守规定造成的影响包括每年 100 至 2890 亿美元。 美元的医疗保健费用、临床药物试验的不准确疗效结果以及重大的公共卫生问题 例如合并症和抗生素耐药性的增加 该项目的长期目标是 建立快速、可靠且生态有效的临床评估，以捕获与认知相关的不依从风险 并制定量身定制的干预措施以减少不依从性。 测试四种药物依从性成分，这些成分被开发为认知相关药物的贡献者 老年人的不依从性，因此有必要纳入这样的临床评估 以我之前的工作为基础，方法是检查功能（即基于绩效的衡量标准）。 现实世界的依从性和基于绩效的药物知识测量之间的关系， 管理、前瞻性记忆和补偿策略解决问题的能力（目标 1-3）。 此外，拟议的研究将展示每个基于绩效的衡量标准如何独立 捕捉现实世界药物依从性的各个方面，超越已知的神经心理学相关性 （目标 1-3）最后，最能预测实际用药依从性的基于绩效的衡量标准将是。 通过使用分层回归来分析基于绩效的关系之间的关系来确定 措施和现实世界的药物依从性（目标 4）。 相关的不依从性有望为研究和临床界提供识别药物的工具 该方法具有创新性，因为它将 (a) 监测和测量药物依从性。 使用参与者的日常用药设备（即使用 Estimotes、薄型可连接运动传感器）； (b) 检查基于药物表现的衡量标准与现实世界依从性之间的关系； (c) 利用新的基于药物表现的措施来检查被认为对治疗至关重要的能力 支持现实世界的坚持（即前瞻性记忆和补偿策略解决问题， 药物功能能力的衡量非常重要 因为它将药物不依从性测量扩展到自我报告之外并捕获真实世界 因此，该措施有可能有助于诊断。 决策并确定可以针对的特定药物功能缺陷 考虑到认知相关药物不依从造成的重大负担，该措施是 预计将对降低国家可预防残疾和死亡率产生下游影响， 急诊室就诊、合并慢性疾病和医疗保健费用。