Anthony A. Sterns

Randomized Controlled Feasibility Trial of Two Telemedicine Medication Reminder Systems for Older Adults with Heart Failure

We conducted a feasibility study of a telehealth intervention (an electronic pill box) and an m-health intervention (an app on a smartphone) for improving medication adherence in older adults with heart failure. A secondary aim was to compare patient acceptance of the devices. The participants were 60 adults with HF (65% male). Their average age was 69 years and 83% were Caucasian. Patients were randomized using a 2 × 2 design to one of four groups: pillbox silent, pillbox reminding, smartphone silent, smartphone reminding. We examined adherence to 4 medications over 28 days. The overall adherence rate was 78% (SD 35). People with the telehealth device adhered 80% of the time and people with the smartphone adhered 76% of the time. Those who received reminders adhered 79% of the time, and those with passive medication reminder devices adhered 78% of the time, i.e. reminding did not improve adherence. Patients preferred the m-health approach. Future interventions may need to address other contributors to poor adherence such as motivation.

Adherence to Antidepressant Medications: A Randomized Controlled Trial of Medication Reminding in College Students

Abstract Objectives: To determine if medication reminding via smartphone app increases adherence to antidepressant medications in college students. Participants: College students (N = 57) enrolled at a state-funded institution who had a current prescription for an antidepressant and regularly used a smartphone device. Methods: Participants were randomized to either a reminder group or a control group. Both groups were asked to complete a survey and undergo a manual pill count at the beginning of the study and 30 days later. Results: There was a strong trend suggesting that the use of a medication reminder app was beneficial for adherence to antidepressant medication regimens. Factors influencing medication adherence in college students included health beliefs, use of illicit drugs, and type of professional care received. Conclusions: Use of a medication reminder may increase adherence to antidepressant medications in college students.

Geospatial Study of Psychiatric Mental Health-Advanced Practice Registered Nurses (PMH-APRNs) in the United States

OBJECTIVE The objectives of this study were to identify geographic regions with shortages of psychiatric mental health-advanced practice registered nurses (PMH-APRNs), describe rural-urban differences in the distribution of PMH-APRNs, and discuss implications of the uneven geographic distribution. METHODS The data source was a complete listing, provided by the American Nurses Credentialing Center, of the employment zip codes of certified PMH-APRNs during 2007 (N=10,452). Geographic information science techniques and spatial statistics were used to conduct a cluster analysis of the spatial distribution of PMH-APRNs. RESULTS After adjustment for population on the basis of U.S. census reports, statistically significant clusters of counties with high and low density of PMH-APRNs, an indicator of uneven accessibility, were identified. Rural-urban differences in the distribution were also illustrated. CONCLUSIONS The interdisciplinary approach, including both mapping and statistical analyses, identified shortage areas and provided the groundwork for directing future education, clinical practice, and public policy initiatives.

Bridging the Intergenerational Gap in Therapeutic Activity Delivery Between Younger Professional Caregivers and Older Adults Living With Dementia

Many older individuals have cohort-specific knowledge that may not be known by young caregivers. By providing familiar information, using Montessori principles that key into the remaining abilities of those with dementia, it is possible for the younger caregivers to successfully facilitate satisfying, interactive programs. Forty activity directors and staff, age 25–50, in long-term care settings interacted with residents age 56–100 in groups of 10 or more in both an activity intervention and standard activities. The younger caregivers indicated positive responses to the activity intervention and demonstrated increases in positive attitudes toward cognitively impaired, elderly residents, which was due to the intervention that provides the structure and materials to overcome both the skills gap and intergenerational knowledge gap for those staff that have them.

Improving the psychosocial environment in long term care for people with dementia

The present study were conducted an ethnomedicinal survey amongst the Manipuri and Khasia ethnic healers of the area and noted that their formulations contain a number of medicinal plants not usually used by traditional healers in other regions of Bangladesh. Methods: Information was collected after obtaining informed consent with the help of a semi-structured questionnaire and guided field-walk method, where the informant pointed out the various medicinal plants and described their uses to treat all forms of brain disorders. All medicinal plants were photographed, collected, identified, and vouchers were stored at the Bangladesh National Herbarium; under the author’s collector series. Results: Information on forty-nine medicinal plant species are grown and consumed as summer, rainy, winter, and spring seasons because there are six seasons in Bangladesh, distributed in forty-nine genera and thirty-six families. It was further noted that leafs formed the major plant part used followed by roots and whole plant. Conclusions: It was clearly observed that medicinal plants from Lawacherra Rain Forest did have a positive healing effect upon many brain disorders cases. It was also shown to produce some encouraging effects in terms of several important factors like: delaying the brain disorders progression, pain reduction, enhancing the immune response & life expectancy, and over all well-being of the patients.

Development of a model group cognitive therapeutic intervention for those living with Alzheimer's disease and related disorders

Background: The Memory Magic Program was developed as a group activity for persons with dementia. Using cognitive learning principles and human factors research, we designed the activity to successfully engage a group of up to 20 individuals, with a broad range of cognitive and physical capabilities, for 60 minutes, with a single staff person. Methods: The design process began with testing of a number of design parameters incorporated into 4 distinct prototypes. We used these prototypes to determine which feature set and supporting structure was the most ergonomically sound and would best accommodate visual and perceptual deficits common to aging and dementia. As a result of the pilot testing, a prototype design for the activity was developed and models constructed. In parallel, engaging content was also designed for the therapy. The models and content were tested in long term care, adult day care, and assisted living settings. Results: Results indicate that The Memory Magic Program elicited more positive engagement, improved affect, and a reduction of negative behaviours in a group of 24 participants. The results were then replicated in a second study in 9 additional settings with 133 individuals. Conclusions: Using careful ergonomic design, and building around the principles of supporting remaining abilities and utilizing content with multiple cognitive tasks, group cognitive therapeutic interventions can be designed that will successfully engage the broad range of cognitive capabilities for persons living with ADRD in a single group. Such activities provide improvements in the quality of life needed in person centered therapy along with the efficiency of group activities.