Taking Your Medicine

by National Institute of Health

The power of our memory often goes down with age. At the same time, aging often brings complicated medication regimens involving several drugs that need to be taken on different schedules throughout the day. People over 65 consume more prescription and over-the-counter drugs than any other age group, and following a regimen properly can mean the difference between life and death. Dr. Denise Park, an NIH grantee who has dedicated her career to studying the aging mind, says there are many things older people can do to help them follow a complicated medication regimen. She points out that even people who aren't elderly often have trouble sticking to a regimen.

Brain Changes with Age

In looking for ways to help people adhere to their medication regimens, Dr. Park, a professor of psychology and senior research scientist at the University of Michigan in Ann Arbor, has thought a lot about how the brain changes with age. It is well established that our working memory - the ability to process, store and retrieve information - gets slower with age. We have less capacity to absorb new information, and we sometimes have difficulty focusing on the most important aspects of new information we receive. Most of these functions are controlled by the frontal lobes, an area of the brain that shrinks disproportionately with age and operates less efficiently as we get older.

But some things in the brain can improve with age: those things that draw on the knowledge and wisdom that come from experience. Dr. Park calls these world knowledge tasks. "World knowledge tasks go up modestly or remain constant well into the 70's," Dr. Park explains. Older people bring more knowledge, background information, and often more familiarity with health care into a doctor's office. While older people don't tend to process as much information as quickly, research suggests that they can still make medical decisions equal in quality to those of younger people.

Taking Medications

When it comes to following a complicated medication regimen, there are several things you need to be able to do. First, you have to understand the instructions: when to take the medicines and what kinds of restrictions there are on each one, such as taking it with food or avoiding alcohol. You need to be able to plan a schedule, which can be complicated when several medicines are involved, and to understand and remember that schedule. Finally, you need to be able to remember to take each dose. All of these steps are affected in the aging mind.

But just because your memory is slowing down doesn't necessarily mean you'll have trouble taking your medicine. "Older adults do suffer declines in cognitive function," Dr. Park says, "but they have plenty remaining to remember to take a pill in the morning with breakfast." Aging isn't always the best predictor of whether or not someone is going to take their medicines properly, Dr. Park says. She has found that, indeed, people over 78 years old were the least adherent in taking medicines. But those between 60 and 77 followed their medication regimes the best. The big surprise was that middle-aged people did much worse than 60-77 year olds.

The first step in understanding how to help people take their medicines properly is to figure out why these groups have different adherence patterns. Dr. Park believes that the 60-77 year old people feel vulnerable enough about their health to take their medications very seriously, and can still follow complicated regimens. Many people over 78 may have trouble understanding and remembering their regimens, accounting for this group's poor adherence. As for the middle-aged people, they were perfectly capable of following their regimens. But, Dr. Park explains, "We found that people who reported being very busy and having a lot of things going on in their lives were the least adherent, and these were middle-aged people. Their working memory was full of tasks and information, and they often were too distracted to remember to take their medicines."

Dr. Park concludes that people with more stable, less hectic lives follow their medication regimens the best. And older people tend to have more stable, less hectic lives than middle-aged people.

About the Author

NIH is the nation's medical research agency - making important medical discoveries that improve health and save lives. The National Institutes of Health (NIH), a part of the U.S. Department of Health and Human Services, is the primary Federal agency for conducting and supporting medical research.