Age differences in routine formation: the role of automatization, motivation, and executive functions

Abstract

Medication adherence can be vital for one’s health, especially in older adults. However, previous research has demonstrated that medication adherence is negatively affected by age-related cognitive decline. In the current study we investigated whether older adults are able to compensate for this decline by relying more on the formation of efficient, automatized routines. To this end, we directly compared daily (placebo) medication adherence in a healthy sample of 68 younger (18–29 years) and 63 older adults (65–86 years) over a period of 4 weeks. We show that despite an age-related decline in cognitive functions (i.e., poorer working memory, prospective memory, task switching, and goal-directed control), older adults adhered better to a daily pill intake routine than younger adults did and, in line with our hypothesis about increased routine formation, reported higher subjective automaticity of pill intake. Across age groups, automatization of pill intake was related to intake regularity and conscientiousness, but not to individual differences in habit tendency as measured in the lab nor to explicit strategic planning. Crucially, the age-related increase in pill intake adherence was mediated by experienced automatization as well as motivation. These findings demonstrate that intact habitual processes and high motivation aid older adults in successfully forming daily routines.

What is habit and how can it be used to change real‐world behaviour? Narrowing the theory‐reality gap

“…Strategies based on reducing behavioural accessibility or cue exposure may not always be feasible. Inhibition-based strategies depend on sufficient self-regulation to frustrate responses on multiple occasions, so may be unsuitable for people with long-term self-regulatory impairments (van de Vijver et al, 2023).…”

“…Intervention designers should consider whether a habit formation approach is appropriate in a target setting. Where habit formation is unfeasible—for example, among people with unpredictable or unstructured everyday lives (van de Vijver, et al., 2023)—various non‐habit mechanisms may better support lasting behaviour change (Volpp & Loewenstein, 2020). In settings in which context‐consistent repetition of a wanted action is feasible, habit formation should be considered as an intervention approach.…”

“…Strategies based on reducing behavioural accessibility or cue exposure may not always be feasible. Inhibition‐based strategies depend on sufficient self‐regulation to frustrate responses on multiple occasions, so may be unsuitable for people with long‐term self‐regulatory impairments (van de Vijver et al., 2023). Additionally, if momentary self‐control cannot be maintained, an unwanted behaviour becomes more accessible, or cue discontinuation is temporary, a persistent habit association may prompt lapses into long‐inactive habitual behaviours, thereby triggering cognitions and emotions that fatally undermine behaviour change (Ten Broeke & Adriaanse, 2023).…”

Patient-pharmacist relationship dynamics: a mediation analysis of patient characteristics and reported outcomes

“…Furthermore, health characteristics, such as age, health status, and chronic diseases, significantly impact both medication adherence and quality of life (Ge et al, 2019 ; Rolnick et al, 2013 ). For instance, age can influence medication adherence due to variations in cognitive abilities, physical limitations, and evolving healthcare needs across the lifespan (van de Vijver et al, 2023 ). Similarly, the health status of patients, especially those with chronic conditions that may necessitate complex treatment regimens, can influence their ability to adhere to prescribed medications (Chauke et al, 2022 ).…”