Changes in functional health, changes in medication beliefs, and medication adherence.

Objective: Medication adherence often lies below recommendations although it is crucial for effective therapies, particularly in older adults with multiple illnesses. Medication beliefs are important factors for individual adherence, but little is known about their origin. We examine whether changes in functional health predict changes in medication beliefs, and whether such changes in beliefs predict subsequent medication adherence. Design: At three points in time over a 6-month period, 309 older adults (65–85 years) with multiple illnesses were assessed. Latent true change modeling was used to explore changes in functional health and medication beliefs. Adherence was regressed on changes in beliefs. Main Outcome Measures: Medication beliefs were measured by the Beliefs About Medicines Questionnaire; medication adherence by the Reported Adherence to Medication Scale. Results: Functional health and medication beliefs changed over time. Increasing physical limitations predicted increases in specific necessity and specific concern beliefs, but not in general beliefs. Changes in specific necessity beliefs predicted intentional adherence lapses, changes in general overuse beliefs predicted unintentional adherence lapses. Conclusions: Medication beliefs partly depend on health-related changes, and changes in beliefs affect individual adherence, suggesting to target such beliefs in interventions and to support older adults in interpreting health changes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Arthroscopic transglenoid multiple suture repair: 2 to 8 year results in 150 shoulders

Although treatment for hypertension is readily available, poor control of hypertension is a major health problem frequently manifested in late life. Researchers believe that one of the major causes of uncontrolled hypertension is failure to take medication as directed. In this preliminary study, the medication-taking behaviors of 48 adults diagnosed with hypertension, ranging in age from 35 to 87, were recorded for 2 months with credit card-sized bar-code scanners. The social-cognitive model (Park, 1992) for understanding medication adherence, which proposes that medication adherence is governed by both beliefs and cognitive factors, was used as a basis for this research. Therefore, measures of health behaviors, attitudes about health and medication taking, and cognitive function were recorded, as well as blood pressure readings. The main findings were that (a) the oldest-old and groups of middle-aged adults were the most nonadherent, whereas the young-old were more likely to adhere than the other age groups; (b) high blood pressure readings predicted adherence to antihypertensive medications; and (c) medication beliefs influenced adherence in some situations.     

Hypnotic discontinuation in chronic insomnia: Impact of psychological distress, readiness to change, and self-efficacy.

Objective: To compare individuals who were successful in discontinuing hypnotic medications against those who were not on measures of insomnia severity, medication withdrawal symptoms, psychological symptoms, perceived health, readiness to change and self-efficacy. Design: Secondary analyses of a randomized clinical trial comparing a hypnotic taper intervention with or without self-help treatment for insomnia. Main Outcome Measures: Self-report measures of insomnia severity, medication withdrawal symptoms, depression and anxiety symptoms, physical and mental health, stages of change, readiness to change, decisional balance, and general and situational self-efficacy. Results: There were no significant differences at baseline between medication-free individuals and those still using sleep medication at the end of a taper intervention. Group differences emerged midway through the 8-week withdrawal program and were accentuated after the intervention; participants who remained medication-free during the next six months had less severe insomnia and anxiety symptoms, a more positive perception of their health and higher self-efficacy to refrain from hypnotic use in various situations. Contrary to expectations, there were no differences between drug-free and nondrug-free participants on both readiness to change and stages of change. Conclusions: Chronic users of hypnotic medications entered a taper intervention with equal levels of psychological distress, health, self-efficacy, and readiness to change. Successful hypnotic discontinuation was associated with overall improvement of insomnia, anxiety and distress symptoms, perceived health and self-efficacy. More intensive and individualized therapeutic attention may be warranted for individuals experiencing worsening of insomnia symptoms, more withdrawal symptoms and psychological distress, and lower self-efficacy during medication discontinuation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of goal-setting and feedback on memory performance and beliefs among older and younger adults.

This research examined the impact of goal-setting conditions on memory beliefs and performance among older and younger adults. After baseline recall and assessment of beliefs, participants were assigned to goal-setting, goals plus feedback, or control. Then, additional recall trials were followed by repeated memory beliefs assessments. For both younger and older adults, performance, motivation, and self-efficacy were affected positively by goal-setting. The impact of goals plus feedback was mixed and varied as a function of age and dependent measure. Success rates for reaching memory goals, which were low for the older adults, may have been a factor in these results. Adults' self-set recall goals were predicted initially by baseline performance and self-efficacy. On the final trial, goals were predicted by last trial performance, self-efficacy, and control beliefs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An overview of mental health services for the elderly

Psychiatric distress is substantially prevalent among elderly individuals, particularly in the primary care and institutional settings, where most older persons receive mental health care. Barriers to care from providers include negative attitudes and stigmatization and poor recognition by general health care professionals. When psychiatric disorders are recognized, the intensity and duration of treatment provided is generally below standards for adequacy. Further research can determine the impact of patient, caregiver, and provider factors on treatment provision and on patient adherence to treatment. Assessment of factors influencing the treatment process are needed to ensure that treatments provided in the real world approximate the efficacy established in controlled clinical trials.     

The temporal relationship between alcohol consumption and HIV-medication adherence: A multilevel model of direct and moderating effects.

Previous studies documenting an association between alcohol use and HIV medication nonadherence, have been unable to distinguish between-persons characteristics from within-person characteristics representing the temporally linked effects of alcohol. Hierarchical Linear Modeling (HLM) explored within- and between-person predictors of adherence during the past 14 days, as well as factors that moderate the event-level effects of alcohol consumption among 272 HIV-positive men and women with alcohol problems. On days in which participants drank, they had almost 9 times higher odds of medication nonadherence, with each drink increasing the odds by 20%. The cognitive and alcohol factors had significant between-person effects on adherence. Individuals with strong and rigid beliefs about the importance of strict medication adherence were significantly more affected by each dose of alcohol, while individuals with more alcohol use and problems were less affected by each drink. Regimen complexity increased the effects of having 1 or more drinks. These results highlight the importance of promoting medication adherence among alcohol-using adults, especially among patients with complex regimens or with high confidence and positive attitudes toward HIV medication. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Medication adherence in rheumatoid arthritis patients: older is wiser

OBJECTIVES: To create a profile of individuals nonadherent to their medications in an age-stratified sample (ages 34-84) of community-dwelling rheumatoid arthritis patients. The relative contributions of age, cognitive function, disability, emotional state, lifestyle, and beliefs about illness to nonadherence were assessed. DESIGN: A direct observation approach was used in conjunction with structural equation modeling. All participants were administered a preliminary assessment battery. Medications were then transferred to vials with microelectronic caps that recorded medication events for all medications for the next 4 weeks. PARTICIPANTS AND SETTING: A volunteer sample of 121 community-dwelling rheumatoid arthritis (RA) patients were recruited from newspaper ads, posters, and via informal physician contact from private rheumatology practices in Atlanta and Athens, Georgia. Written verification of the RA diagnosis and a disease severity rating were obtained from personal physicians before patients were enrolled in the study. Patients were tested in a private physician's office, and their medication adherence was monitored electronically for a month in their every-day work and home settings. MEASUREMENTS AND RESULTS: Structural equation modeling techniques were used to develop a model of adherence behavior. Cognitive and psychosocial measures were used to construct latent variables to predict adherence errors. The model of medication adherence explained 39% of the variance in adherence errors. The model demonstrated that older adults made the fewest adherence errors, and middle-aged adults made the most. A busy lifestyle, age, and cognitive deficits predicted nonadherence, whereas coping with arthritis-related moods predicted adherence. Illness severity, medication load, and physical function did not predict adherence errors. Omission of medication accounted for nearly all errors. CONCLUSION: Despite strong evidence for normal, age-related cognitive decline in this sample, older adults had sufficient cognitive function to manage medications. A busy lifestyle and middle age were more determinant of who was at risk of nonadherence than beliefs about medication or illness. Thus, practicing physicians should not assume that older adults have insufficient cognitive resources to manage medications and that they will be the most likely to make adherence errors. Very busy middle-aged adults seem to be at the greatest risk of managing medications improperly.     

Beliefs and attitudes about bupropion: Implications for medication adherence and smoking cessation treatment.

Beliefs about medication are associated with treatment adherence and outcome. This is a secondary analysis of the role of beliefs and attitudes about bupropion in treatment adherence and smoking cessation outcomes using data from a smoking cessation trial of open-label sustained-release (SR) bupropion therapy reported previously (Toll et al., 2007). Positive beliefs and attitudes were positively correlated with intentions, desire, confidence, and motivation to quit smoking; expectation of quitting success; perceived benefits of quitting; and perceived disadvantages of smoking. Positive beliefs were also associated with greater medication adherence, an increased likelihood of completing treatment and being continuously abstinent, and a delayed latency to smoking lapse. These findings provide preliminary support that positive beliefs and attitudes about bupropion are associated with positive attitudes toward quitting, better treatment adherence, and potentially better treatment response. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attitudes toward depression among rehabilitation participants with acute stroke: Evidence of an age cohort effect.

Purpose/Objective: Depression is commonplace after acute stroke and is associated with increased morbidity and mortality. No data exist regarding attitudes about depression among older persons with acute stroke and their potential impact on self-report of depressive symptoms. The objective of this study was to determine if attitudes toward depression affect depression symptom reporting. Research Method/Design: Cross-sectional using data from an inpatient rehabilitation unit. Seventy-two people with acute stroke were surveyed regarding their attitudes toward depression as part of a larger battery assessing their cognitive and emotional functioning. Results: Both age and cognitive status were significant predictors of attitudes toward depression. Older participants expressed significantly more negative attitudes about depression and seeking professional help compared with younger participants. Those with higher cognitive scores held more positive attitudes. However, attitudes about depression were unrelated to participants' responses on self-report measures of depression. Conclusions/Implications: Participants with stroke who were older were more likely to report negative attitudes about depressive symptoms than were younger participants. However, these attitudes do not appear to represent a barrier to their ability to accurately report the presence and severity of depressive symptoms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Awareness of illness in schizophrenia and outpatient treatment adherence

We present a brief measure of awareness of illness in schizophrenia and test whether awareness is related to perceived need for and adherence to outpatient psychiatric treatment. A prospective design assessed treatment adherence, awareness of the signs and symptoms of schizophrenia, symptoms, neurocognitive status, and substance abuse at baseline and 6-month follow-up in 89 persons with schizophrenia. Results indicate that persons with greater awareness perceived greater need for outpatient treatment and evidenced better adherence to outpatient treatment when adherence and awareness were measured concurrently. Awareness was not related to adherence at 6-month follow-up. In addition, neurocognitive impairment was associated with lower overall adherence to treatment when reported by collaterals at baseline and 6-month follow-up. Neurocognitive impairment was, however, associated with higher self-reported adherence to medication, which suggests that neurocognitive status may bias adherence reporting in persons with schizophrenia.     

Childhood abuse and current health problems among older adults: The mediating role of self-efficacy.

Objectives: Child abuse has negative consequences on health functioning and the self-concept. Prior studies have garnered support for these relationships in younger adults; yet few studies have looked at the effects of abuse on health in older adults and the psychosocial variables, specifically self-efficacy, that may influence the abuse-health relationship. Methods: Data obtained from the Physical Health and Disability Study were used to explore the impact of child abuse on current medical problems among older adults who were screened on physical disability status (N = 1396, Mean age = 67, SD = 10.2). The study was conducted in South Florida and used a multiethnic sample that is representative of the general population in this area. Results: Child abuse was associated with the number of current medical problems and disability. Child abuse was also related to lower self-efficacy, and self-efficacy explained the relationship between abuse and the number of health problems. Conclusions: There are far-reaching effects of child abuse on older adults' health and self-concept. Health care providers and gerontologists need to be aware that child abuse is a lifelong risk factor for increased disability and specific health problems, especially among the elderly. Future research should examine treatments designed to increase self-efficacy, especially among those who experienced child abuse, and observe any positive effects on health functioning. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Self-efficacy beliefs and change in cognitive performance: MacArthur studies on Successful Aging.

Data from a cohort of relatively high functioning, older men and women were used to test the hypothesis that stronger self-efficacy beliefs predict better maintenance of cognitive performance. Structural equation modeling revealed that stronger baseline instrumental efficacy beliefs predicted better verbal memory performance at follow-up among men but not among women, controlling for baseline verbal memory score and sociodemographic and health status characteristics. For both men and women there were no significant associations between either type of self-efficacy beliefs and measures of nonverbal memory, abstraction, or spatial ability. Consistent with previous research showing relationships between baseline cognitive performance and change in self-efficacy beliefs, better abstraction ability was also predictive of increases in instrumental efficacy beliefs among the men. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hope, self-efficacy, and functional recovery after knee and hip replacement surgery.

Objective: To test hypothesized relations between hope and self-efficacy for rehabilitation to depression and functional ability reported by individuals receiving joint replacement surgery. Study Design: Community-dwelling older adults (N = 100) from an orthopaedic clinic were administered measures of hope, self-efficacy for rehabilitation, pain, depression, body mass index (BDI), and mental status 1 month prior to their joint replacement surgery. These measures were completed by 62 participants 6 weeks after surgery. Demographic, health information, and functional outcome measures were obtained by medical personnel pre- and postsurgery. Main Outcome Measures: Functional outcome measures (Harris Hip and Knee Society Scores) and depressive symptomatology. Results: Hope was significantly predictive of presurgery depression, but it was not predictive of depression or functional ability after surgery. Higher levels of self-efficacy were predictive of lower postsurgery depression scores. Conclusions: Results imply that social-cognitive constructs may have utility in the prediction of emotional adjustment before and after joint surgery, but they may have limited value in anticipating functional abilities following these surgeries. Theoretical and clinical implications are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The role of health beliefs in the regimen adherence and metabolic control of adolescents and adults with diabetes mellitus.

The current study examined the role of health beliefs in diabetic regimen adherence and metabolic control. The subjects were 143 insulin-dependent diabetic outpatients, including 54 from a university juvenile diabetes care clinic with a mean age of 18 and 89 from a private practice clinic with a mean age of 37. Subject age and knowledge about diabetes were statistically controlled for in the multiple regression equations used to analyze the data. Overall, health beliefs accounted for a statistically significant portion of the variance in both self-reported adherence and metabolic control, as measured by level of glycosylated hemoglobin. For older patients from the private practice clinic, the most important aspects of health beliefs related to both reported adherence and metabolic control were those associated with the perceived benefits of adhering to the diabetic regimen. For younger patients from the university clinic, although perceived costs figured most prominently in their reports of adherence, perceived severity and susceptibility were the most important health beliefs associated with their actual levels of metabolic control. These findings suggest that health beliefs may play an important role in diabetic regimen adherence and metabolic control. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relations among age, exercise, and psychological variables in a community sample of women.

Age, exercise status, and their interaction were examined in relation to self-motivation, exercise self-efficacy, and attitudes toward exercise among a community sample of women aged 20 to 85 years. Random digit telephone dialing yielded 121 participants, stratified by age and exercise status. Age was negatively related to attitudes toward exercise and exercise self-efficacy but was unrelated to self-motivation. Age also interacted with exercise status; the belief that exercise would be enjoyable and beneficial decreased with increasing age only among nonexercisers. Finally, exercisers were significantly more self-motivated, had greater exercise self-efficacy, and had more positive attitudes toward exercise than did nonexercisers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predicting medication adherence and employment status following kidney transplant: The relative utility of traditional and everyday cognitive approaches.

Objective: The authors investigated the utility of both traditional and everyday cognitive measures in predicting medication adherence and employment status among kidney transplant recipients. In addition, the role of noncognitive predictors was examined. Method: Cognitive measures of processing speed, memory, everyday problem solving, executive functioning, and questionnaires assessing mood, medication adherence, and employment status were individually administered to 108 kidney transplant recipients. Because the eligibility criteria differed for the two analyses, there were 103 participants in the medication adherence analyses and 94 participants in the employment analyses. Stepwise hierarchical regression and sequential binomial logistic regression analyses were conducted for continuous and dichotomous outcome measures, respectively. Results: Findings indicate that both poorer performance on the everyday problem-solving test and a higher number of depressive symptoms were predictive of poorer self-reported medication adherence (R2 = .19, p R2 = .29, ps     

Patterns, correlates, and barriers to medication adherence among persons prescribed new treatments for HIV disease.

New treatments for HIV can improve immune functioning and decrease mortality. However, lapses in adherence may render these complex regimens ineffective. Sixty-three men and 9 women on highly active antiretroviral therapy completed measures of medication adherence, psychological characteristics, and barriers to adherence. HIV viral load, a health outcome measure of virus amount present in blood, was also obtained. The sample was 36% African American and 56% Caucasian, with 35% reporting disability. Nearly one third of patients had missed medication doses in the past 5 days, and 18% had missed doses weekly over the past 3 months. Frequency of missed doses was strongly related to detectable HIV viral loads. Depression, side-effect severity, self-efficacy, and social support distinguished patients with good and poor adherence. Barriers also varied with adherence level. Implications for interventions promoting HIV treatment adherence are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A prospective study of adjustment to hemodialysis

OBJECTIVE: To examine (a) changes in subjects' self-care self-efficacy over time and (b) the relationship of subjects' self-care self-efficacy with adjustment to hemodialysis. DESIGN: A longitudinal design was used to study changes in self-care self-efficacy and associations between self-care self-efficacy and measures of adjustment: health status, mood distress, symptom distress, dialysis stress, and perceived adherence to fluid restriction. SAMPLE/SETTING: Subjects were recruited from 8 settings in the Northeast where outpatient hemodialysis treatment was administered. Sixty-four subjects were recruited to the study. Twenty-eight subjects completed 3 occasions of data collection. METHODS: Data were collected on three occasions: (a) baseline-within 100 days of beginning treatment; (b) 4 months after beginning treatment; and (c) 8 months after beginning treatment. Eta-squared, a measure of practical significance, is reported for four factors of the self-care self-efficacy measure on each of the three occasions. Associations between self-care self-efficacy and measures of adjustment were examined by means of Pearson correlations. RESULTS: Eta-squared estimates showed generally positive changes occurring over time in subjects' self-care self-efficacy, health status, mood distress, symptom distress, dialysis stress, and perceived adherence to fluid restriction. Changes were more positive at 4-months than at 8-months after enrollment. Significant correlations (p < .05) occurred between self-care self-efficacy and mood states, health status, symptom distress, and perceived adherence to fluid restrictions. Correlations occurred more frequently between self-care self-efficacy and mood states than between self-care self-efficacy and other measures of adjustment. CONCLUSIONS: The study provided pilot data suggesting that hemodialysis patients' self-care self-efficacy and measures of adjustment change over time. Patients who had increased confidence in self-care strategies (self-efficacy) were associated with having more positive mood states, health status, and perceived adherence to fluid restrictions and less symptom distress. Interventions designed to increase patients' self-care self-efficacy may yield positive results. Nurses are in an excellent position to give efficacy enhancing feedback that may promote patients' adjustment.     

Factors predicting the use of technology: Findings from the center for research and education on aging and technology enhancement (create).

The successful adoption of technology is becoming increasingly important to functional independence. The present article reports findings from the Center for Research and Education on Aging and Technology Enhancement (CREATE) on the use of technology among community-dwelling adults. The sample included 1,204 individuals ranging in age from 18-91 years. All participants completed a battery that included measures of demographic characteristics, self-rated health, experience with technology, attitudes toward computers, and component cognitive abilities. Findings indicate that the older adults were less likely than younger adults to use technology in general, computers, and the World Wide Web. The results also indicate that computer anxiety, fluid intelligence, and crystallized intelligence were important predictors of the use of technology. The relationship between age and adoption of technology was mediated by cognitive abilities, computer self-efficacy, and computer anxiety. These findings are discussed in terms of training strategies to promote technology adoption. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Patterns and predictors of mental health service use and mental illness among older and younger adults in the United States.

The present study examined patterns of serious mental illness (SMI), specific mental health syndromes, and service use among older (65+) and younger (18-64) adults throughout the United States, and the extent to which various factors predict SMI and the use and magnitude of mental health treatment. Despite recent developments designed to improve mental healthcare access and treatment for older adults, older individuals were found to receive outpatient mental healthcare at very low rates. Compared to younger adults, older adults were three times less likely to report receiving treatment. Although prevalence estimates for SMI and specific syndromes were markedly lower among older than younger adults, older individuals most in need of care were highly unlikely to report receiving treatment. Findings point to the importance of perceived need in mental healthcare use. Significantly, however, those older adults that made it into services typically reported benefiting considerably from treatment, at least as much as all other age groups. Several predisposing, enabling, and need factors related to mental illness and service use were identified that have important implications for how we plan for, design, and deliver mental health services to older and younger Americans. (PsycINFO Database Record (c) 2010 APA, all rights reserved)