by Judy Purdy
Taking the right pill at the right time -- every time -- is tough enough at any age.
That's why for nearly a decade UGA psychology professor Denise Park has studied how memory, especially in the elderly, affects how well patients adhere to doctor-prescribed regimens.
"Whether you take medications as prescribed is a complex behavior with lots of factors," said Park, who directs the Southeastern Center for Applied Cognitive Aging. "I look at very basic processes such as what normal memory function is and how much decline is normal with age."
The consequences of not following doctor's orders can be dire. "Medication adherence is a very serious issue," Park said. "Obviously, misuse of medication can be life threatening."
Park's research on medication adherence confirms that old- old adults -- people 75 and older -- make more medicine-related mistakes and are considerably less adherent over time than others.
"Old-old adults have poorer comprehension and more difficulties organizing and integrating unfamiliar medication information," Park said. " [Their mistakes] are primarily omission mistakes."
But make no mistake about this: The old old aren't the only ones who forget to take medicine. With funding from the National Institute on Aging and the AARP Andrus Foundation, Park studied medication patterns among adults ages 35-65, 65-75 and 75 and older who have hypertension. She found that while young-old adults performed well, middle-aged folks needed to improve their memory for pill popping.
Nonadherence among middle-aged patients may be a result of "busyness and beliefs," Park said. "They are very obligated and they're on cognitive overload all the time, whereas people in their 60s, typically 60 to 75, have the cognitive skill to be adherent, and they feel very vulnerable. Thus they have a belief system about illness consistent with a desire to adhere."
Park now speculates that beliefs play a large role in medication adherence, and she has initiated several new studies to test this idea.
"For the very old, cognition becomes more important; whereas, for younger adults beliefs are more important," she said. "If the doctor tells you that you have illness X and you don't believe it, maybe you'll be polite and take the prescription, then deep six it as soon as you get out the door. Obviously, you're not going to adhere to that medication because your cognitions about your illness are not compatible with what you're being told to do."
In a new study, Park will measure beliefs and knowledge among hypertensive elderly African Americans and then relate these to medication adherence to determine what predicts nonadherence.
"It is believed that nonadherence in this group is very high, but nobody really knows," she said. "African Americans are much more susceptible to hypertension, which is a silent illness. You can't tell when your blood pressure is up -- you don't feel sick -- so you don't take your meds. We want to find out if this is an at-risk population for nonadherence, and if so, why."
Park plans to use her data to develop a profile of people most likely to skip their medications, as well as to design effective intervention techniques involving memory aids that improve medication adherence.
In another medication adherence study she first compared beliefs and behaviors among elderly people who have two very different diseases that share similar symptoms: rheumatoid arthritis and osteoarthritis.
"The meaning of adherence in these two illnesses is very different although some of the symptoms are the same," she said. "Rheumatoid arthritis is quite serious and it is critical that patients take their medications to slow the course of the disease. If they don't, they'll get worse. On the other hand, there are no meds to slow the progression of osteoarthritis so the only reason to take the meds is to alleviate pain."
Park also wants to learn whether a high level of medication adherence improves quality of life -- mobility, depression and social engagement, for instance -- as well as knowledge of and beliefs about these two diseases.
"The belief is that people with rheumatoid arthritis who adhere are functionally better. Are they? Do they get out more? Do they do more? We are hoping to compare what variables predict adherence and also look at the quality of life for people who do versus don't adhere," Park said. "If, for instance, people with osteoarthritis who don't adhere have a better quality of life than people who do, that tells us something about the value of these painkillers."
A spoonful of sugar may help some medicine go down, but Park wants to help people, especially the elderly, remember to take it in the first place. She has already shown that the elderly adhere better when using over-the-counter pill containers combined with individualized medication charts. Now she is exploring even more effective memory aids such as bottle caps that beep when it's time to take a pill.
And her research may help patients get better -- in more ways than one.