Executive functioning interacts with complexity of daily life in predicting daily medication management among older adults

Abstract

Objective: Executive functioning (EF) is critical for performance of instrumental activities of daily living, including medication management. Under complex conditions, daily activities require greater EF resources. This study examined if older adults who exhibit weaknesses in EF are at an increased risk for mismanaging their medications under complex contexts.

Method: Participants were 50 non-Hispanic white community-dwelling older adults, ages 60–85. At a baseline visit, EF was assessed using the Push-Turn-Taptap task, and daily life complexity and medication regimen complexity were assessed using a structured interview. Medication management across the subsequent 8 weeks was assessed by weekly pill counts.

Results: A general linear regression using at-home medication management as the dependent variable showed that EF and the interaction between EF and life complexity were significant predictors (both p values < .001). Specifically, life complexity had a deleterious impact on medication management, but only for older adults whose EF performance was in the bottom 22% of the sample. There was no association between medication regimen complexity and accuracy of medication management.

Conclusions: These findings demonstrate that older adults who have even mild EF weaknesses are at an increased risk for mismanaging their medication when leading complex daily lives. These findings add support for the Contextually Valid Executive Assessment (ConVExA) model, which asserts that EF interacts with contextual factors as a predictor of functional outcomes.

Keywords:

• Executive functioning
• medication management
• daily functioning
• older adults
• aging
• neuropsychological assessment
• instrumental activities of daily living
• complexity
• life complexity

Acknowledgements

The authors are grateful to the members of the Executive Lab who assisted with data collection.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

1 Of note, results were virtually the same regardless of whether speed, accuracy, or the combined variable was used in analyses.

2 100% responsibility implies that a person is either fully responsible for self-care and home-care (but not anyone else’s care), or that the responsibilities are shared with others in an even manner such that, for example, the person gets help with 50% of their own care but also provides 50% of spouse’s care.

3 Medication management was negatively skewed. We analyzed the data using both the original variable, and a log-transformed variable, and the results were virtually identical.

Additional information

Funding

The study was funded by the National Academy of Neuropsychology Research Grant that was awarded to Yana Suchy.