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.