Everyday Memory

The picture of how everyday memory declines with age is quite different when one studies memory in a naturalistic context. In a series of studies Park and colleagues have examined how accurately older adults remember to take medications, using microelectronic monitors to record the date and time that medication was taken. Park et al. (1992) reported that adults age sixty to seventy-seven made almost no medication errors whatsoever over a one-month period, even though they were taking a minimum of three different medications. In contrast, the oldest adults in the study, age seventy-eight to ninety, made significantly more errors but were helped measurably by the introduction of memory charts and medication organizers. In a subsequent lifespan study of adults age thirty-five to seventy-five who were taking hypertension medications, Morrell et al. found that adults aged sixty-five to seventy-five made the fewest medication errors of any age group and almost never forgot to take their hypertension medication. They hypothesized that the reason for this high level of adherence is that older adults have sufficient cognitive resources to take medication, and also have health beliefs and a schedule that are congruent with taking medication accurately.

In a later study, a complex array of cognitive, psychosocial, and contextual variables were used to understand medication adherence in a sample of rheumatoid arthritis patients who were taking many medications (Park et al. 1999). These patients were given a large battery of cognitive tests and completed questionnaires about their health beliefs, lifestyle, stress level, and perceived self-efficacy. These variables were used in structural equation models to predict adherence. In this study, 47 percent of the older adults (ages fifty-five to eighty-four) made no errors in taking their medication over a one-month period, whereas the middle-aged participants (ages thirty-four to fifty-four) had a significantly higher overall rate of nonadherence. The single best predictor of nonadherence was reporting a busy lifestyle that was high in environmental demands. Beliefs about health, anxiety, and depression were not strong predictors of adherence. Although age did not predict nonadherence, individuals who were low in cognitive ability at any age were also more likely to be non-adherent.