title: Multifaceted Prospective Memory Intervention to Improve Medication Adherence.
abstract: OBJECTIVE
  To test whether a multifaceted prospective memory intervention improved adherence to antihypertensive medications and to assess whether executive function and working memory processes moderated the intervention effects.
  
  
  METHODS
  Two-group longitudinal randomized control trial.
  
  
  METHODS
  Community.
  
  
  METHODS
  Individuals aged 65 and older without signs of dementia or symptoms of severe depression who were self-managing prescribed medication.
  
  
  METHODS
  After 4 weeks of initial adherence monitoring using a medication event monitoring system, individuals with 90% or less adherence were randomly assigned to groups.
  
  
  METHODS
  The prospective memory intervention was designed to provide strategies that switch older adults from relying on executive function and working memory processes (that show effects of cognitive aging) to mostly automatic associative processes (that are relatively spared with normal aging) for remembering to take medications. Strategies included establishing a routine, establishing cues strongly associated with medication taking actions, performing the action immediately upon thinking about it, using a medication organizer, and imagining medication taking to enhance encoding and improve cuing.
  
  
  RESULTS
  There was significant improvement in adherence in the intervention group (57% at baseline to 78% after the intervention), but most of these gains were lost after 5 months. The control condition started at 68% and was stable during the intervention, but dropped to 62%. Executive function and working memory moderated the intervention effect, with the intervention producing greater benefit for those with lower executive function and working memory.
  
  
  CONCLUSIONS
  The intervention improved adherence, but the benefits were not sustained. Further research is needed to determine how to sustain the substantial initial benefits.
authors.affiliation: College of Nursing, University of Arizona, Tucson, Arizona.
authors.forename: Kathie C
authors.initials: KC
authors.lastname: Insel
authors.affiliation: Department of Psychology, Furman University, Greenville, South Carolina.
authors.forename: Gilles O
authors.initials: GO
authors.lastname: Einstein
authors.affiliation: Department of Educational Psychology, University of Illinois, Urbana, Illinois.
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Morrow
authors.affiliation: College of Nursing, University of Arizona, Tucson, Arizona.
authors.forename: Kari M
authors.initials: KM
authors.lastname: Koerner
authors.affiliation: College of Nursing, University of Arizona, Tucson, Arizona.
authors.forename: Joseph T
authors.initials: JT
authors.lastname: Hepworth
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003463:Cues; D056344:Executive Function; D005260:Female; D006801:Humans; D007092:Imagination; D007858:Learning; D008137:Longitudinal Studies; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D061212:Memory, Episodic; D012646:Self Administration / Q000523:psychology*
keywords: elderly; hypertension; intervention; medication adherence; prospective memory