Executive functioning interacts with complexity of daily life in predicting daily medication management among older adults

Objective: Executive functioning (EF) is critical for performance of instrumental activities of daily living, including medication management. Under complex conditions, daily activities require greater EF resources. This study examined if older adults who exhibit weaknesses in EF are at an increased risk for mismanaging their medications under complex contexts.Method: Participants were 50 non-Hispanic white community-dwelling older adults, ages 60–85. At a baseline visit, EF was assessed using the Push-Turn-Taptap task, and daily life complexity and medication regimen complexity were assessed using a structured interview. Medication management across the subsequent 8 weeks was assessed by weekly pill counts.Results: A general linear regression using at-home medication management as the dependent variable showed that EF and the interaction between EF and life complexity were significant predictors (both p values < .001). Specifically, life complexity had a deleterious impact on medication management, but only for older adults whose EF performance was in the bottom 22% of the sample. There was no association between medication regimen complexity and accuracy of medication management.Conclusions: These findings demonstrate that older adults who have even mild EF weaknesses are at an increased risk for mismanaging their medication when leading complex daily lives. These findings add support for the Contextually Valid Executive Assessment (ConVExA) model, which asserts that EF interacts with contextual factors as a predictor of functional outcomes.