Side Effects and Aging 2

Remembering information often requires remembering associations such as names and faces, times and dates, or allergies to medications. Although some aspects of memory such as memory for facts and general knowledge is preserved with age, episodic memory and particularly paired-associate learning is one area in which older adults (65+ years old) show memory decrements (Naveh-Benjamin, 2000). One context in which remembering associations may be particularly important is learning drug interactions. For example, a patient may be prescribed atenolol for high blood pressure and need to remember not to take it in combination with amiodarone (a heart rhythm drug) because doing so could cause a slowed heart rate. Given that over 50% of older adults experience polypharmacy by taking five or more prescription medications regularly (Qato et al., 2008), and 10-30% of older adults’ hospital admission results from adverse drug effects (Parameswaran Nair et al., 2016), it is essential for this population to effectively learn and remember drug interactions for prescribed medications to prevent adverse health outcomes from occurring. One way that older adults can compensate for their memory decrements is by prioritizing learning more important over less important information (e.g., Castel, McGillivray, & Friedman, 2012; McGillivray & Castel, 2017). For example, when asked to remember items to take to a picnic, older adults are as good as younger adults (18-25 years old) at remembering the items rated as most important to bring (e.g., a blanket; McGillivray & Castel, 2017). As well, when learning a foreign language such as Swahili (e.g., money : pesa), older adults can selectively focus on remembering more important over less important concepts (Murphy, Hargis, & Castel, 2023). In addition to the described scenarios, strategically remembering some information over other information can extend to medication interactions. For instance, it would be perhaps more important for one to remember that taking prednisone with ibuprofen can cause stomach bleeding and a physician should be contacted immediately if this occurs relative to remembering that taking prednisone on an empty stomach can cause mild stomach aches. One study suggests that with task experience, older adults can be as effective as younger adults when remembering medication interactions that cause severe side effects. However, this evidence is only preliminary, and older adults’ memory for mild and moderate interactions was often poorer than younger adults’ (Friedman et al., 2015). A critical open question is how much task experience is necessary for young and older adults to optimize their learning and moreover, how much practice is needed to master medication interaction information. The answers to these questions may differ for younger and older adults. Younger and older adults face different challenges when learning essential medical information. Older adults can draw on prior health knowledge that younger adults lack but also experience difficulties remembering complicated side effects and drug interactions due to associative memory deficits that occur in older age. Additionally, tasks that allow older adults to bring their schemas to mind can enhance memory for subjectively important item information (Murphy et al., 2023); in the context of medications, older adults may have a schema for some potential side effects and may have even previously experienced them. However, according to the processing deficit hypothesis, older adults experience associative memory deficits because effortful learning strategies tax their limited attentional resources, which leads to suboptimal implementation of these strategies (Naveh-Benjamin et al., 2007; Naveh-Benjamin et. 2005; Shaw & Craik, 1989). This may result in differences in effective usage of symptom severity between the age groups across trials. Thus, considering age-related changes in cognitive ability – especially changes in the efficiency of processing information – is necessary to establish the optimal learning regimen for side effects and drug interactions. To explore optimal learning regiments for health information and determine how much practice is necessary to master such important information, we will present younger and older adults with multiple lists of medication names with medication interactions that cause negative health outcomes that vary in severity. Specifically, both younger and older adults will study medications paired with outcomes to drug interactions that vary from mild events (bothersome experiences that are not medically detrimental), moderate events (concerning experiences that may lead to additional care or hospitalization), to severe events (alarming experiences that may be life-threatening or cause permanent damage). Participants will then take a test on which they are given a medication name and must recall the interacting medication or food along with the health outcome that occurs when combined. They will also be tested by being given the medication name and must recall the interacting medication or food and health outcome that occurs when combined. There will be 5 total study-test cycles on the same information.