Developing Educational Materials to Support Older Adults With Hypertension Management

Abstract A comprehensive approach to hypertension management requires medication adherence as well as more general health behavior changes. Our primary objective is to provide evidence-based and tailored education about hypertension, medications, and health self-management strategies with consideration for different stages of behavior change, health literacy, education, disease knowledge, and experience. To facilitate health behavior change, enable information seeking, and increase engagement, the educational materials provide different layers of information, including tips and information in the MEDSReM app, as well as more detailed educational content on the web portal. We will present examples of the materials in different formats to show how they are tailored to ease comprehension, support adherence, and influence behavior change. These educational materials will have broad utility outside of the MEDSReM system, and will also serve as the education-only comparison condition for the randomized controlled trial.

from 134 Chinese dementia caregivers in New York City.Logistic regression models were conducted to test the associations between predisposing, enabling and need factors and the likelihoods of using tangible (home health aide, adult daycare, respite care), educational (lectures and workshops), and psychological (peer support groups and psychological counseling) services.Results: Consistent with prior literature, caregiver's knowledge about services, caring tasks, length of care and burden and care recipient's physical and cognitive deteriorations, were significantly associated with higher possibilities of using multiple types of services among these Chinese American dementia caregivers.Three sociocultural factors, including residing in Chinatowns, availability of alternative family caregivers and diagnosis of cognitive deterioration, were also associated with higher likelihoods of using educational or psychological services.Discussion and Implications: The findings extended the existing literature on service utilization of caregivers by highlighting the importance of distinguishing types of services and the necessity of considering sociocultural factors in future research and practice.

AN INTERDISCIPLINARY COLLABORATION TO IMPROVE HYPERTENSION MEDICATION ADHERENCE FOR OLDER ADULTS
Chair: Jeannie Lee Co-Chair: Wendy Rogers Hypertension is highly prevalent in older adults (74.5% in ≥60 years) with dire consequences, and adherence to hypertension medications is low (approximately 50%).With increased smartphone use among older adults (81% for 60-69 years, 62% for ≥70 years), technology innovations can improve medication adherence.This symposium highlights the efforts of an innovative interdisciplinary team of experts (clinical, cognitive aging, human factors, health technology) to develop and implement the Medication Education, Decision Support, Reminding, and Monitoring (MEDSReM) system to improve hypertension medication adherence for older adults.MEDSReM is a theory-based, integrated mobile application (app) and companion web portal that educates, supports missed dose decisions, reminds, monitors adherence, and incorporates blood pressure feedback.In this symposium, we describe the interdisciplinary development efforts.Insel et al. will present the theory-based intervention, technology translation, and advancement of the MEDSReM system. Lee et al. will describe the interdisciplinary team and describe the work by the decision support subteam that created the medication formulary and generated an algorithm to guide missed-dose decisions based on pharmacology of aging.Rogers et al. will discuss the education subteam's development of educational information about hypertension, medications, and adherence for the MEDSReM system.Mitzner et al. will illustrate the instructional support subteam's efforts to ensure older adults can interact with both the smartphone app and online portal.Lastly, Hale et al. will describe the user testing subteam's usability processes including the integration of blood pressure self-monitoring.These efforts will provide insights for other interdisciplinary teams developing technology interventions for older adults.

FOUNDATIONAL BASIS FOR THE DEVELOPMENT OF MEDSREM
Kathleen Insel, 1 Gilles Einstein, 2 Daniel Morrow, 3 Jeannie Lee, 1 Wendy Rogers, 3 and Tracy Mitzner, 4 1.University of Arizona,Tucson,Arizona,United States,2. Furman University,Greenville,South Carolina,United States,Champaign,Illinois,United States,4. Georgia Institute of technology,Atlanta,Georgia,United States Discovering a composite of measures of executive function/ working memory predicted everyday medication adherence among older adults, led to the development of a behavioral intervention, the Multifaceted Prospective Memory Intervention (MPMI) to improve hypertension medication adherence.The intervention resulted in a 35% improvement in adherence compared to an active education and attention control condition.However, adherence slowly declined over an additional five months of adherence monitoring without the presence of interventionists in the home.We proposed that the use of technology might help individuals maintain the prospective memory strategies, resulting in sustained adherence.An interdisciplinary team was formed to translate the behavioral intervention to technology, resulting in the first version of the MEDSReM system.In this presentation we describe the evolution of the project, from the components of the successful MPMI to the design and initial testing of MEDSReM.These efforts provide general insights about translating interventions into technology tools.

INTERDISCIPLINARY TEAM FOR MEDSREM-2 AND DECISION SUPPORT THROUGH PHARMACOLOGY OF AGING PRINCIPLES
Jeannie Lee, 1 Kathleen Insel, 1 J. Nicholas, 2 and Amani Albadawi, 2 1.University of Arizona, Tucson, Arizona, United States, 2. University of Arizona College of Pharmacy, Tucson, Arizona, United States The interdisciplinary team members with distinct and complementary expertise working collaboratively to advance MEDSReM to MEDSReM-2 will be introduced.The decision support functionality in MEDSReM-2 application (app) is to guide older users on making decisions about missed doses.MEDSReM-2 medication formulary was created to include safe hypertension medications for older adults.Pharmacology of aging, including Pharmacokinetic and Pharmacodynamic principles, along with published studies and expert peer reviews, were used to create an algorithm for safe window of time to take the missed medications.We will present the processes for developing the decision support algorithm for the MEDSReM-2 App and how this guide will be communicated to the users to inform their decision making about missed doses.Interdisciplinary collaboration including pharmacy, nursing, cognitive aging, and technology development that was crucial for designing and implementing decision support within the MEDSReM-2 app for older users will be shared.A comprehensive approach to hypertension management requires medication adherence as well as more general health behavior changes.Our primary objective is to provide evidence-based and tailored education about hypertension, medications, and health self-management strategies with consideration for different stages of behavior change, health literacy, education, disease knowledge, and experience.To facilitate health behavior change, enable information seeking, and increase engagement, the educational materials provide different layers of information, including tips and information in the MEDSReM app, as well as more detailed educational content on the web portal.We will present examples of the materials in different formats to show how they are tailored to ease comprehension, support adherence, and influence behavior change.These educational materials will have broad utility outside of the MEDSReM system, and will also serve as the education-only comparison condition for the randomized controlled trial.Appropriate instruction is critical for ensuring the MEDSReM-2 system (i.e., smartphone app, blood pressure monitor, online portal) will be easily and effectively used and will, therefore, be more likely to be adopted.We will present our iterative processes for developing instructional support for MEDSReM 2 using human factors design principles (e.g., task analyses, comparative analyses, expert evaluation of mock-ups with screen flows).The instructional supports include user manuals, videos, as well as instructions within the MEDSReM 2 app.We will also highlight design principles used to empower the user and the benefits of using an interdisciplinary approach (i.e., gerontology, cognitive psychology, educational psychology, design, community health) to develop instructional support for older adult users.

USABILITY EVALUATION METHODS USED TO ENSURE THE USABILITY OF THE MEDSREM-2 SYSTEM
Timothy Hale, 1 Carson Smith, 2 Mimi Trinh, 2 and Wendy Rogers, 2 1.University of Illinois Urbana-Champaign, University of Illinois Urbana-Champaign, Illinois, United States, 2. University of Illinois Urbana-Champaign, Champaign, Illinois, United States A key objective of the MEDSReM-2 study is to promote medication taking decisions and improve adherence to hypertensive medications for older adults.New functionalities include enhanced decision-support algorithms for missed medications, automated entry of blood pressure measurements, improved data visualizations, and an easyto-use online web portal.In support of these enhancements, the User Testing subteam is tasked with providing ongoing evaluation and feedback on the usability of early design concepts, prototypes, beta software, wireless blood pressure monitors, and instructional materials.The overall project comprises multiple working teams, whose efforts must be coordinated.We will describe the challenges of working with these interdisciplinary teams and the usability evaluation methods used to support the needs of each team in creating the enhanced MEDSReM-2 system that is easy-to-use and effective in helping older adults improve their hypertension medication adherence.These processes inform the research and design efforts of other technology interventions.

BUILDING AND USING DATA RESOURCES FOR RESEARCH ON JOB CHARACTERISTICS, HEALTH, AND RETIREMENT
Chair: Amanda Sonnega Discussant: Gwen Fisher A growing literature seeks to understand the relationship between the experience of work and important later-life outcomes.Rich longitudinal measurement of both sides of this equation in datasets such as the Health and Retirement Study (HRS) have made this research possible.These data take the form of self-reported experiences of work (such as physical demands, job flexibility, job satisfaction etc.).Increasingly, researchers are looking to add potentially complementary information on the work environment available in the Occupational Information Network (O*NET) database through a linkage using occupation and industry codes in the survey data.The session talks will describe research conducted using O*NET linked with HRS data as well as ongoing work to create a new data resource that will allow other researchers to undertake research with O*NET-HRS linked data.Each presentation will include some discussion of both the value and limits of using the linkage to O*NET.Carpenter will provide a detailed description a new project linking the 2019 O*NET data to the HRS for public use.This presentation explains the types of variables that will be made available in the O*NET-HRS occupation project and will provide examples for how the measures can be used in longitudinal HRS studies.Using O*NET-HRS linked data, Carr will present on work examining the role of preretirement job complexity in alternative retirement paths and cognitive performance.Helppie-McFall will used the linked data to discuss the role of mismatch between demands of work and workers' ability to meet those demands in retirement decisions.

CREATING A PUBLIC DATA RESOURCE: THE HRS-O*NET LINKAGE
Rebekah Carpenter, 1 Dawn Carr, 1 Brooke Helppie-McFall, 2 and Julia Beckel, 3 1.Florida State University, Tallahassee, Florida, United States, 2. University of Michigan,Ann Arbor,Michigan,United States,3. Colorado State University,Fort Collins,Colorado,United States Few longitudinal studies provide detailed information about the characteristics of the jobs older workers engage in, limiting the ability to evaluate the potential consequences of extended working lives.In this session, we introduce a new project linking the 2019 O*NET taxonomy and corresponding data to the Health and Retirement Study for public use.We describe the procedures taken to develop an O*NET linkage to be released to HRS users in the form of a publicly Wendy Rogers, 1 Qiong Nie, 2 Maurita Harris, 2 Stacy Al-Saleh, 3 and Ysabel Beatrice Floresca, 1 1.University of Illinois Urbana-Champaign, Champaign, Illinois, United States, 2. University of Illinois at Urbana Champaign, Tracy Mitzner, 1 Maurita Harris, 2 Kenneth Blocker, 3 and Mimi Trinh, 4 1.Georgia Institute of technology, Atlanta, Georgia, United States, 2. University of Illinois at Urbana Champaign, Champaign, Illinois, United States, 3. University of Illinois at Urbana-Champaign, Champaign, Illinois, United States, 4. University of Illinois Urbana-Champaign, Champaign, Illinois, United States