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A new app and web portal may help older adults with mild cognitive impairment remember to take medications on time.

Researchers to Test Technology Aimed at Improving Medication Adherence

A team of researchers at the University of Illinois and the University of Arizona will use a $2.5 million grant from the National Institutes of Health to study the effectiveness of digital technology to improve medication adherence among older adults with mild cognitive impairment.

People with mild cognitive impairment who also have hypertension are at higher risk of cognitive decline. Prior research has shown as many as 50 percent of people with mild cognitive impairment do not take medications as prescribed, which can negatively impact physical and cognitive health.

The study’s principal investigator is Raksha Mudar, associate professor of speech and hearing science at the University of Illinois. Dr. Mudar, who studies the effects of normal cognitive aging and mild cognitive impairment (MCI) on functional abilities, said that the “important aspects of this study are that we will adapt the app by getting input from people with MCI and their care partners. We will conduct multiple rounds of usability testing to optimize the app before we examine its efficacy to support medication adherence.”

Co-principal investigator Kathleen Insel, professor in the UArizona College of Nursing, agreed. “We want to preserve quality of life and living well as long as possible,” Insel said. “We know that uncontrolled and undertreated hypertension has a deleterious effect on people’s organs including the brain, even in the absence of stroke. If we can protect people's ability to think and remember, they have the option of staying independent.”

The National Institute of Nursing Research-funded project is titled, “Digital Technology to Support Adherence to Hypertension Medications for Older Adults with Mild Cognitive Impairment.”

The goal is to adapt and evaluate Medication Education, Decision Support, Reminding, and Monitoring System (MEDSReM©), a digital health intervention designed to improve hypertension medication adherence and support self-management of hypertension medication for people with mild cognitive impairment. MEDSReM changes the medication-taking process from one that is dependent on prospective memory to one more dependent on associative processes, which are relatively well preserved in aging and people with mild cognitive impairment.

“The foundation of MEDSReM is very different from the foundation of medication-reminder apps that are available in the marketplace,” Dr. Insel said. “This is not a simple reminding app. You've got to encode the need to take the medication, store it cognitively in memory, and importantly, remember to do it at the time it needs to be done. You also need to pay attention to taking the medication, which becomes more difficult because medication taking becomes a habit and hence, the action of having taken the medication today, may not be well remembered. Therefore, you need to be able to check to see if the medication was taken as intended,”

The researchers will work with Ephibian, a company based in Tucson, Ariz., to adapt the MEDSReM system, which consists of an app and a web portal.

“Previously we tested this as a behavioral intervention, and we improved medication adherence 36 percent among older adults who were taking at least one daily high blood pressure medication,” Dr. Insel said.

Drs. Mudar and Insel will work with an interdisciplinary team at Illinois that includes professor Wendy Rogers of The College of Applied Health Sciences, and Associate Professor Daniel Llano of molecular and Integrative Physiology.

This research is supported by the National Institute of Nursing Research, a division of the National Institutes of Health.

R01 NR020261

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