Biomedical subjects

Daniel G Morrow

Publications and source records attributed to Daniel G Morrow.

8 recordsLinked to original sources

PubMed2005

Environmental support for older and younger pilots' comprehension of air traffic control information.

We investigated whether expertise mitigates age differences on pilot communication tasks when experts rely on environmental support. Pilots and nonpilots listened to air traffic control messages describing a route through an airspace, during which they referred to a chart of the airspace. The routes were high (waypoint routes anchored to navigational reference points on the chart) or low (vector routes that were not) in contextual support. Participants read back messages and answered questions about aircraft position (which required integration of message and chart information) or altitude (which did not). Pilots more accurately answered questions. The expertise advantage for position, but not altitude, questions was greater for waypoint routes, showing differential use of environmental support by experts. Age did not moderate these effects.

Adult↗

PubMed2005

Improving medication knowledge among older adults with heart failure: a patient-centered approach to instruction design.

PURPOSE: We investigated whether patient-centered instructions for chronic heart failure medications increase comprehension and memory for medication information in older adults diagnosed with chronic heart failure. DESIGN AND METHODS: Patient-centered instructions for familiar and unfamiliar medications were compared with instructions for the same medications from a chain pharmacy (standard pharmacy instructions). Thirty-two adults (age, M = 63.8) read and answered questions about each instruction, recalled medication information (free recall), and then answered questions from memory (cued recall). RESULTS: Patient-centered instructions were better recalled and understood more quickly than the standard instructions. Instructions for the familiar medications also were better recalled. Patient-centered instructions were understood more accurately for the unfamiliar medications, but standard instructions were understood more accurately for the familiar medications. However, the recall measures showed that the advantage of the standard format for familiar medications was short lived. IMPLICATIONS: The findings suggest that the patient-centered format may improve printed medication instructions available in many pharmacies, which should help older adults to better understand how to take their medications.

Aged↗

PubMed2004

A conceptual framework to study medication adherence in older adults.

BACKGROUND: Adults aged > or =50 years often have multiple chronic diseases requiring multiple medications. However, even drugs with well-documented benefits are often not taken as prescribed, for a variety of reasons. OBJECTIVE: The objective of this article was to provide background information about medication adherence and its measurement, the development of the conceptual model for use in adherence research, and supportive intervention strategies such as pharmaceutical care by pharmacists to improve chronic medication use in older adults. METHODS: English-language literature published from 1990 to 2000 was searched on MEDLINE, International Pharmaceutical Abstracts, and AARP Ageline using the terms aged, heart failure, CHF, adherence, chronic heart failure, compliance, and related terms. The authors used their personal files and libraries to obtain seminal literature and textbooks published before 1990. RESULTS: Although the cognitive processes needed to manage and take medications decline with aging, the number of prescription and nonprescription medications consumed increases. Other factors such as vision, hearing, health literacy, disability, and social and financial resources may all complicate the ability of older adults to adhere to the pharmacologic prescription. CONCLUSIONS: Many factors are associated with medication adherence and related health outcomes in older adults. Therefore, strategies to improve adherence will need to be multidimensional, including improvements in pharmacy services that consider age-related factors (eg, declining cognitive and physical functions) as well as a variety of environmental and social factors.

Aged↗

PubMed2004

Patient-centered instructions for medications prescribed for the treatment of heart failure.

BACKGROUND: Chronic heart failure (CHF) is associated with reduced functional capacity and quality of life, particularly among older adults. Complex medication regimens for CHF challenge older patients' ability to adhere to them, in part because of age-related cognitive decline and poor communication about medications. OBJECTIVE: This article describes patient-centered instructions for taking CHF medications that were developed as part of a multifaceted pharmacy-based intervention to improve medication adherence and health-related outcomes among older adults with CHF. The findings of 3 initial validation studies investigating patients' reactions to the instructions are reported. METHODS: Patients' responses to the instructions were measured using focus group (study 1) and questionnaire (studies 2 and 3) techniques. RESULTS: Overall, older adults with CHF in the 3 studies preferred the patient-centered instructions to the standard pharmacy instructions (93.8% in study 1, 65.0% in study 2). In addition, participants' preferences depended on their medication-related goals. A preference for patient-centered instructions reflected a focus on ease of understanding (as supported by the use of large type size, icons, and patient-centered organization), whereas a preference for the standard pharmacy instructions reflected a focus on the amount of information provided about drug interactions (studies 2 and 3). CONCLUSIONS: In the 3 validation studies, older adults with CHF tended to prefer the patient-centered instructions to the standard pharmacy instructions, although the results were not statistically significant in study 2. This suggests that the use of such instructions may improve patients' medication knowledge and their adherence to treatment regimens.

Aged↗

PubMed2004

Methodology of an ongoing, randomized, controlled trial to improve drug use for elderly patients with chronic heart failure.

BACKGROUND: Medications can improve the functioning and health-related quality of life of patients with chronic heart failure (CHF) and reduce morbidity, mortality, and costs of treatment. However, patients may not adhere to therapy. Patients with complex medication regimens and low health literacy are at risk for nonadherence. OBJECTIVE: The primary goal of this project is to develop and assess a multilevel pharmacy-based program to improve patient medication adherence and health outcomes for elderly CHF patients with low health literacy. METHODS: In this 4-year, controlled trial, patients aged 50 years with a diagnosis of CHF who are being treated at Wishard Health Services (Indianapolis, Indiana) are randomly assigned to pharmacist intervention or usual care. Intervention patients receive 9 months of pharmacist support and 3 months of postintervention follow-up. The intervention involves a pharmacist providing verbal and written education, icon-based labeling of medication containers, and therapeutic monitoring. The pharmacist identifies patients' barriers to appropriate drug use, coaches them on overcoming these barriers, and coordinates medication use issues with their primary care providers. Daily updates of relevant monitoring data are delivered via an electronic medical record system and stored in a personal computer system designed to support pharmacist monitoring and facilitate documentation of interventions. To measure medication adherence objectively, electronic monitoring lids are used on all CHF medications for patients in both study groups. Other assessments include self-reported medication adherence, results of echocardiography (eg, ejection fraction), brain natriuretic peptide concentrations, and health-related quality of life. Health services utilization, refill adherence, and cost data derive from electronic medical records. After completion of this study, the data can be used to assess the effectiveness and cost-effectiveness of our intervention. RESULTS: One hundred twenty-two patients have been assigned to receive the intervention and 192 to receive usual care. CONCLUSIONS: Our study aims to improve patients' knowledge and self-management of their medication and to improve medication monitoring in a multilevel pharmacy-based intervention. By doing so, we intend that the intervention will improve the health outcomes of elderly patients with CHF.

Aged↗

PubMed2004

Age differences in rereading.

Younger and older adults read a series of expository and narrative passages twice in order to answer comprehension questions. Reading time was used to index attentional allocation to word, textbase, and situation model processing and to assess shifts in the allocation policy from the first to the second reading. Older readers' comprehension was at least as good as that of younger readers. Analysis of reading times suggested that for both genres, older adults allocated more attention to situation model features than younger adults did on the first reading, whereas young and old allocated attention similarly to this level of representation on the second reading, suggesting that mature readers may give greater priority to situation model construction when first encountering text. Also, for both genres, older adults showed relatively less facilitation than the young in word-level processing in rereading, suggesting that representation at this level is not as firmly established during reading or decays more quickly for older readers. For narrative texts only, this pattern also obtained for textbase processing. Collectively, these data show that age equivalence in text comprehension at the molar level may be accomplished through different processing routes at the molecular level.

Adolescent↗

PubMed2003

Environmental support promotes expertise-based mitigation of age differences on pilot communication tasks.

The authors investigated whether expertise is more likely to mitigate age declines when experts rely on environmental support in a pilot/Air Traffic Control (ATC) communication task. Pilots and nonpilots listened to ATC messages that described a route through an airspace, while they referred to a chart of the airspace. They read back (repeated) each message and then answered a probe question about the route. In a preliminary study, participants could take notes while listening to the messages and performing the read-back and probe tasks. In Experiment 1, opportunity to take notes was manipulated. Note taking determined when expertise mitigated age differences on the read-back task. With note taking, read-back accuracy declined with age for nonpilots but not for pilots. Without note taking, similar age-related declines occurred for pilots and nonpilots. Benefits of expertise, younger age, and note taking occurred for probe accuracy, but mitigation did not occur. The findings suggest that older adults take advantage of a domain-relevant form of environmental support (note taking) to maintain performance on some complex tasks despite typical age-related declines in cognitive ability.

Adult↗

PubMed2002

Aging and the representation of spatial situations in narrative understanding.

Age differences in the construction of the situation model during text understanding were investigated. Situation model processing was measured in terms of the distance effect, the tendency for readers to process information about objects in a narrative more quickly when the objects are spatially closer to the protagonist than when they are farther away. To examine readers' ability to construct the model directly from the text, the distance effect was contrasted for objects that were either presented in a layout of the narrative setting prior to reading (learned objects) or introduced in the narrative itself (new objects). Both younger and older readers showed strong distance effects for learned objects. When objects had not been learned but were only introduced in the text, however, younger adults did not show a reliable distance effect. Older adults with high levels of comprehension did, lending support to the position that older readers differentially rely on the situation model for effective narrative understanding.

Adolescent↗