The complementary utility of cognitive testing and the medication management ability assessment in older adults.

Abstract

Objective: Older adults are susceptible to cognitive declines that may limit independence. Though neuropsychologists opine about risk of functional decline, the degree to which cognitive testing and in-office simulations approximate everyday behavior is unclear. We assessed the complementary utility of cognitive testing and the face-valid Medication Management Ability Assessment (MMAA) to predict medication management among older adults. Method: This was a retrospective study of 234 older adults (age = 72 ± 7.7 years; 59% women) who completed the MMAA during outpatient neuropsychological evaluations. Based on comprehensive clinical assessment, most participants (n = 186) were independent in medication management, while 48 received assistance. Demographically adjusted composite scores were derived for attention/processing speed (A/PS), executive functioning (EF), visuospatial/constructional ability (VC), language, and memory domains. Univariate differences in cognition were examined across Assisted versus Independent groups. Logistic regression assessed which cognitive domains independently predicted group status. The incremental value of the MMAA was assessed, holding uniquely associated cognitive test scores constant. Results: Those receiving assistance with medication management performed worse across all neurocognitive domains and the MMAA compared with independent counterparts. EF was the only unique cognitive predictor of medication management status. When modeled alone, EF and MMAA performance correctly classified 79.5% and 80.8% of cases, respectively. When modeled together, both were independently associated with medication management status and correctly classified 83.3% of cases. Conclusions: EF uniquely predicted medication management status beyond other cognitive domains. The MMAA provided complementary predictive utility. Concurrent interpretation of executive functioning and MMAA performance is advised when assessing older adults suspected of medication mismanagement.

Pitfalls in research on ecological validity of novel executive function tests: A systematic review and a call to action.

“…become reintegrated in the community after brain injury (Keller et al, 2023), perform instrumental activities of daily living at home (IADLs; , and manage medications (e.g., Anderson & Birge, 2016;Hallowell et al, 2022) and finances (Hoskin et al, 2005). Additionally, scores on traditional EF tests have been shown to correlate with scores on laboratory-based IADL tasks (e.g., Mitchell & Miller, 2008b), and with scores on rating scales of IADL functioning (e.g., Alosco et al, 2014;Best et al, 2015;Boyle et al, 2002;Chiu et al, 2018;de Paula et al, 2015;Marshall et al, 2011; for reviews, see also Chaytor & Schmitter-Edgecombe, 2003;Overdorp et al, 2016).…”

“…In clinical neuropsychology, ecological validity (EV) has traditionally been conceptualized as a test’s ability to predict functioning in daily life (Long, 1996; Sbordone, 1996). Accordingly, scores on traditional performance-based tests 1 of executive functions (EF) have demonstrated that they are ecologically valid in that they predict a variety of objective real-world outcomes, including the abilities to maintain employment (see Kalechstein et al, 2003, for review), succeed in academic settings (Soto et al, 2020), drive safely (for reviews, see Bieliauskas, 2005; Depestele et al, 2020; Egeto et al, 2019; Ranchet et al, 2012), live independently (Suchy et al, 1997), become reintegrated in the community after brain injury (Keller et al, 2023), perform instrumental activities of daily living at home (IADLs; Brothers & Suchy, 2022), and manage medications (e.g., Anderson & Birge, 2016; Hallowell et al, 2022) and finances (Hoskin et al, 2005). Additionally, scores on traditional EF tests have been shown to correlate with scores on laboratory-based IADL tasks (e.g., Kraybill & Suchy, 2011; Mitchell & Miller, 2008b), and with scores on rating scales of IADL functioning (e.g., Alosco et al, 2014; Best et al, 2015; Boyle et al, 2002; Chiu et al, 2018; de Paula et al, 2015; Marshall et al, 2011; for reviews, see also Chaytor & Schmitter-Edgecombe, 2003; Overdorp et al, 2016).…”