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