Exploring Older Adults’ Internalizations and Misconceptions Regarding Antihypertensive Medication Management
TimeThursday, April 152:00pm - 3:00pm EDT
LocationPatient Safety Research and Initiatives
DescriptionHypertension, or high blood pressure, is one of the most prevalent chronic conditions affecting adults over the age of 65, with nearly 80% diagnosed with the disease (Muntner et al., 2018). Antihypertensive medications are prescribed to reduce the likelihood of negative consequences and to help maintain blood pressure at healthier levels. Still, over 50% of older adults do not have the condition well controlled (Farley, Dalal, Mostashari, & Frieden, 2010). The primary contributor to this lack of control is thought to be lack of proper medication adherence, defined as “whether patients take their medications as prescribed…as well as whether they continue to take a prescribed medication” (Fryar, Ostchega, Hales, Zhang, & Kruszon-Moran, 2017; Ho, Bryson, & Rumsfeld, 2009, p. 3028). However, the reasons underlying this nonadherence remain unspecified.
An important characteristic of hypertension is that it is mostly asymptomatic, meaning it does not usually cause perceptible symptoms to alert a person when their blood pressure is elevated, hence being colloquially deemed “the silent killer.” This lack of symptoms may contribute to the fact that about 50% of new patients stop taking their antihypertensive medications within one year (Vrijens et al., 2008). Ensuring older adults can successfully adhere to their antihypertensive medication regimens is vital in guaranteeing they experience the potential positive health outcomes (Ho et al., 2009). However, this population has been found to experience more difficulty in performing self-management actions compared to younger adults, for a variety of age-related factors (e.g., Park, Willis, Morrow, Diehl, & Gaines, 1994). Sustained adherence, especially for an asymptomatic disease such as hypertension, requires people to remember to ingest the correct doses of the medications at specific times each day. They must understand the condition, its characteristics, and how best to manage the disease to support medication management. Moreover, this activity needs to be routinized to ensure they follow their recommended regimen.
An influential model proposed by Leventhal, Nerenz, & Steele (1984) is the Common Sense Model of Illness Representation (also known as the Illness Representation Model) in which an illness is characterized by knowledge about the disease and informs a self-generated illness representation which then influences how people attempt to cope with the illness. Disease knowledge acts as the “input” to their illness representation and impacts how they approach the disease’s management. Misinformation can lead to counterproductive behaviors that do not support proper disease management. For example, if people believe hypertension has perceptible symptoms, they may be more likely to believe that their condition is in a better state than it truly is, disregarding their prescribed antihypertensive medications and allowing the disease to proceed uncontrolled. Thus, there is value in investigating the knowledge older adults with hypertension possess regarding the disease and its characteristics, as misconceptions might be contributing to their poor disease management. Such an assessment can inform and help guide the design of interventions, technology support tools, and educational approaches that may improve older adults’ understanding of hypertension and its management, potentially improving medication management specifically and disease status generally.
We were specifically interested in how older adults’ approaches to managing their hypertension might be informed by the five components that comprise one’s cognitive illness representation per the Illness Representation Model. These components include how an individual perceives the cause, consequences, control, identity [e.g., symptoms], and timeline of the disease. Essentially, how do opinions and potential misconceptions regarding these components represent how individuals internalize and approach the management of their hypertension? For example, misconceptions regarding perceived causes may lead an older adult to focus on mitigating these assumed factors rather than taking a holistic approach to hypertension management including medication management, improved diet, and increased exercise (e.g., Duwe et al., 2014). Additionally, if older adults view the disease as relatively inconsequential – when it is objectively the opposite – they may feel less inclined to follow prescribed regimens.
In sum, a high percentage of older adults do not have good adherence for antihypertensive medications. We need to better understand how they are approaching their medication management, and their knowledge about the disease. To improve this understanding, we conducted an in-depth assessment of what 40 older individuals diagnosed with hypertension know about their disease and the strategies they are using (if any) to manage it. We designed a semi-structured interview to assess the aforementioned factors from the illness representation model that are purportedly important; namely, cause, consequences, control, identity, and timeline. We then evaluated what participants shared about the disease and its characteristics, as well as where they believe this information was primarily sourced, with the assistance of a subject matter expert (i.e., PhD-level nurse).
Overall, we found that nearly 25% of total responses regarding what participants believed they knew about hypertension were either inaccurate or improbable. If someone is to properly manage their disease, it is imperative that they accurately understand its characteristics so they may make beneficial decisions. Moreover, the majority of the older adults in the current study expressed that they had learned about the disease from either their own research or from social sources such as their friends or family instead of from their physician or related healthcare professionals. Thus, misinformation may be spread through conversations or other sources (e.g., web sites, news articles) by those who incorrectly believe they understand the disease. In sum, these misconceptions may reflect why there is a high prevalence of issues with effectively controlling hypertension for older adults, as well as supports the need to ensure that older adults with hypertension are able to access accurate and understandable information about the disease and its management so they may effectively manage their blood pressure. These findings informed the need for applying human factors principles to improve the delivery of disease information so older adults more effectively grasp the characteristics and management needs of hypertension, as well as informed the potential for dedicated technological intervention that can reduce the prevalence of misconceptions held by this population and support them in managing their prescribed medications.