Daniel G. Morrow

Medication instruction design: younger and older adult schemas for taking medication

We examined whether older and younger adults share a schema for taking medication and whether instructions are better recalled when they are organized to match this schema. Experiment 1 examined age differences in schema organization. Participants sorted medication items (e.g., purpose, dose, possible side effects) according to similarity and then ordered the items to create a preferred instruction set. Cluster analysis of the sort and order data showed that younger and older adults share a schema for taking medication. Secondary regression analyses found that verbal ability (i.e., vocabulary scores) predicted individual differences in schema organization. In Experiment 2 participants recalled instructions that were either compatible with this schema in terms of grouping and order of items or were presented in nonpreferred orders. Younger participants remembered more information than did older participants, but both age groups better remembered and preferred the more schema-compatible instructions. Secondary analyses showed that recall was also positively related to verbal ability. Along with our earlier research, this study suggests that older and younger adults possess a schema for taking medication and that instructions that are compatible with this schema provide an environmental support that improves memory for medication information.

Repetition Improves Older and Younger Adult Memory for Automated Appointment Messages

Automated telephone messaging systems have dramatically expanded communication about health service appointments, but few studies have directly investigated these messages. The present study investigated whether message repetition (1, 2, or 3 presentations) and listener age (mean age = 71 or 19 years) improved memory for automated appointment messages. Repetition improved older and younger adult memory for appointment information. Moreover, 2 presentations reduced age differences in accuracy of answering questions about the messages. This was not the case for free recall, suggesting that older adults differentially benefited from repetition only when provided with additional retrieval support. These findings show that older as well as younger adults benefit from at least 1 repetition of appointment messages. Actual or potential applications of this research include the use of repetition to improve comprehension of automated telephone messages.

Using icons to convey medication schedule information

We examined older adult comprehension and memory for medication schedules conveyed by different types of visual icons as well as text. Three icons were compared: a timeline, a pair of 12 h clocks (one for AM and one for PM hours) and a 24 h clock. In Experiment 1, older and younger participants paraphrased and then recalled schedules that were conveyed by the three icons or by text. Text and timeline schedules were paraphrased more accurately than either clock icon. Paraphrase errors suggested that subjects had trouble integrating schedule information across the two 12 h clocks. Analysis of paraphrase times showed that the text schedule was paraphrased most quickly, followed by the timeline, the 24 h clock and the 12 h clock. No differences were found for the accuracy of recalling the icon and text schedules. Experiment 2 examined free and cued recall after limited study time by older adults. Because text superiority in Experiment 1 may have reflected greater familiarity with text than with icons, recall was examined across four trials in Experiment 2. Text was recalled most accurately, followed by the timeline, the 24 h clock and the 12 h clock. Study-test trials did not influence recall. Text schedules may have been generally more effective than the icons because of their greater familiarity. The timeline may have been the most effective icon because it was more compact and familiar than the clock icons used in the study. The findings suggest that including such icons in medication instructions requires training.

Medication Schemas and Memory for Automated Telephone Messages

The present study investigated whether older and younger adults use a schema to organize and remember spoken reminder messages for taking medication. Previous research has shown that older and younger adults share preferences for organizing printed instructions for taking medication, suggesting a shared schema. Older and younger participants in Experiment 1 of the present study used a similar schema to organize medication reminder messages. This finding suggests that the medication schema generalizes across communication purpose (to remind or to instruct) as well as across patient age. Medication reminder messages were better understood and remembered when organized to match this schema, whether the reminders were presented as automated telephone messages (Experiment 2) or in printed form (Experiment 3). Schema-compatible organization especially helped people draw inferences from the messages, suggesting that organization helps older and younger adults construct a situation model of the medication-taking task from the messages. Potential applications of organized messages include increasing the impact of automated systems for delivering health services002E

Improving Consultations between Health-Care Professionals and Older Clients: Implications for Pharmacists

Consultations between pharmacists and many clients are now federally mandated in the United States, but guidelines have not been developed for communication in this context. This article reviews research on communication between clients and health-care professionals in order to help develop recommendations for consultations between pharmacists and older clients. The review is organized around a collaborative approach to health communication, which identifies strategies by which speakers and listeners work together to achieve mutually defined goals. This approach is used to analyze cognitive processes underlying communication during pharmacist consultations. This review suggests that miscommunication often reflects a breakdown in collaboration between health-care professionals and clients. Recommendations are developed to improve collaboration, including suggestions for initiating consultations, presenting easy to understand messages, and monitoring to ensure that the messages are mutually understood. Most important, successful collaboration requires tailoring strategies to individual clients rather than basing communication on general assumptions about clients.

Expertise and Aging in Pilot Communication: The Role of Environmental Support

We examined whether expertise reduced age differences on a pilot communication task. Young, middle-aged, and older pilots, and nonpilots of similar age and general cognitive ability, listened to recorded ATC messages that described a route through an airspace, while referring to a map of the airspace. They read back the ATC instructions (e.g., to change heading) and then answered a probe question about the aircrafts position. Morrow et al. (1999) used a similar procedure and did not find that expertise reduced age differences in readback accuracy. In the present study, participants were also allowed to take notes while listening to the messages. Contrary to the earlier study, pilots readbacks were virtually perfect regardless of age, while readback accuracy declined with age for nonpilots. Note-taking may have provided environmental support that reduced working memory demands imposed by the communication task, which differentially benefitted older pilots. This suggests that cognitive aids such as note-taking is an important part of pilots expertise.

Environmental Support and Age-Sensitive Design:

Researchers who focus on agerelated design issues find themselves at the nexus of two large-scale developments in our society: The ever increasing pace of technological change and an aging population. One couequence of these developments is that older adults frequently find that they must rely on technology to accomplish daily tasks related to work, health, finances and entertainment. Research related to age-sensitive design of technology must be grounded in theories from both the cognitive aging and human factors literature. At the same time, this research can help develop these theories by testing them in complex domains. The present symposium explores connections between the construct of environmental support from cognitive aging theory and its use as a tool in age-sensitive design. According to the environmental support hypothesis (Craik & Jennings, 1992), age differences in performance should be reduced when task requirements are externalized. In this case, older adults can rely on support from the environment rather than having to selfinitiate mental processes, so that age-related declines in processing are circumvented. While this approach has been used to predict when age differences in memory will occur, the environmental support construct also has important implications for how to facilitate older adults’ use of technology to perform everyday tasks. Neil Charness will introduce the topic of environment support and provide a framework for the symposium. Jan Graafman will describe a procedure for simulating the cognitive and sensory effects of aging, which may provide an important tool for stimulating researchers to think about how to improve environmental support aspects of technology. The remaining talks provide case studies for how the construct has been used to improve older adults’ use of technology to perform daily tasks. Dan Morrow will discuss how to improve the impact of automated telephone systems on older adults’ performance of dally health care tasks. Regan Campbell, Wendy Rogers, and Dan Fisk will discuss the importance of the video channel as a form of enviromnenral support that compensates for age-related memory declines in performing medical tasks. Sara Czaja will describe her work on improving computer tasks in the workplace for older adults by introducing forms of environment support to reduce information retrieval demands. Finally, James Fozard will discuss the implications of these projects for environmental support, gerontechnology, and lifespan psychology.

Designing automated telephone messages for older adults

Automated telephone messaging is used to remind patients about appointments, monitor health status, and to provide other health services. Previous research has documented that these systems improve health services delivery to patients, but little attention has been paid to the messages. Well designed messages increase the potential of these systems to provide environmental support for older adults performance of daily health activities such as appointment attendance. Our research builds on theories that point to the importance of tailoring health information to patients needs and abilities, and theories that predict improved comprehension when messages are compatible with listeners knowledge. Our goal is to design the content, organization, and presentation of automated health appointment messages so that they provide environmental support for older adults. We review several studies that have implications for both improving automated health communication and refining the construct of environmental support.