Imagery helps older people remember medical advice

ANN ARBOR—A healthy dose of imagination helps older people remember to take medications and follow other medical advice, according to a new study in the June 2004 issue of Psychology and Aging.

Researchers Linda Liu of the University of Michigan Institute for Social Research (ISR) and Denise Park of the University of Illinois at Urbana-Champaign found that older adults who spent a few minutes picturing how they would test their blood sugar were 50 percent more likely to actually do these tests on a regular basis than those who used other memory techniques. The research was supported by the National Institute on Aging (NIA), a part of the National Institutes of Health.

“This is not an expensive or time-consuming strategy that requires a great deal of training,” said Liu, an assistant research scientist at the ISR, the world’s largest academic survey research organization. “By spending a few minutes thinking ahead about how they will integrate a behavior into their daily routine and imagining how they will achieve their goals, older people are much more likely to be successful at accomplishing what otherwise could be a daunting task.”

For the study, Liu and Park taught 31 non-diabetic volunteers to do home blood glucose tests. The researchers chose individuals who didn’t have diabetes in order to simulate the learning conditions faced by someone who is newly diagnosed with a disease. In addition, because the blood glucose monitors recorded time and date-stamps each time a test was conducted, it allowed the researchers to collect very accurate data. The participants, ages 60 to 81, were randomly assigned to one of three groups and told to monitor their blood sugar levels four specific times daily. They were not allowed to use timers, alarms or other devices.

Those in the implementation group, defined by the investigators as an “imagination” intervention, spent one 3-minute session visualizing exactly what they would be doing and where they would be the next day when they were scheduled to test their blood sugar levels. Those in the “rehearsal” group repeatedly recited aloud the instructions for testing their blood. Finally, those in the “deliberation” group were asked to write a list of pros and cons for testing blood sugar.

Over the next three weeks, participants in the implementation group remembered 76 percent of the time to test their blood sugar at the right times of the day compared to an average of 46 percent in the other two groups. Those in the implementation group were far less likely to go an entire day without testing than those in the other two groups. Although the effects observed in this study were large, NIA scientists note, further studies will be needed to replicate the findings more generally.

“Getting older people to remember to take their medications and conduct self-monitoring tests is a huge issue,” Park said. “Although many strategies have been tried, none appears to be as potent or as simple as using one’s own imagination. This study shows it’s a powerful and incredibly inexpensive technique with potentially lasting effects.”

Park suspects that using imagination may be more effective than other techniques because it relies on automatic memory, a primitive component of memory that doesn’t decline with age. Using this technique, you might, for example, imagine taking your pills right after you drink your morning glass of orange juice. The next day at breakfast, taking a sip of orange juice will automatically cue you to take your medication.

“It’s not an explicit thought,” Park said. “It’s not as if you think, ‘Ah, ha! I remember to take my pills now.’ It’s more that the orange juice provides an unconscious prompt to, ‘Take your meds, take your meds.'”

“It’s wonderful to be able to approach the issue of medical adherence from the standpoint that our minds are healthy and that adherence does not necessarily have to decline with age,” Liu said. “Although obviously there are changes that occur as individuals age, we can focus on recruiting processes such as imagery and automatic memory that remain relatively intact instead.”

Established in 1948, the Institute for Social Research (ISR) is among the world’s oldest survey research organizations, and a world leader in the development and application of social science methodology. ISR conducts some of the most widely-cited studies in the nation, including the Survey of Consumer Attitudes, the National Election Studies, the Monitoring the Future Study, the Panel Study of Income Dynamics, the Health and Retirement Study, the Columbia County Longitudinal Study and the National Survey of Black Americans. ISR researchers also collaborate with social scientists in more than 60 nations on the World Values Surveys and other projects, and the Institute has established formal ties with universities in Poland, China, and South Africa. Visit the ISR Web site at http://www.isr.umich.edu for more information. ISR is also home to the Inter-University Consortium for Political and Social Research (ICPSR), the world’s largest computerized social science data archive.

The NIA, a component of the National Institutes of Health, leads the federal effort in supporting and conducting basic and clinical research on aging and the special needs of older people. For information about the NIA, visit the website at http://www.nia.nih.gov/. For free brochures and booklets about aging and health topics of interest to older people, call the NIA Information Center at (800) 222-2225.

E-mail:swanbrow@umich.edu