HEALTH APPS TO IMPROVE SELF-CARE FOR OLDER ADULTS ON WARFARIN THERAPY: A PILOT STUDY

Friday, April 24, 2015
Jung-Ah Lee, PhD, RN , Nursing Science, University of California Irvine, Irvine, CA
Lorraine Evangelista, PhD, RN , Nursing Science, University of California Irvine, Irvine, CA
Alison A Moore, MD, MPH, FACP , Departments of Medicine and Psychiatry, UCLA, Los Angeles, CA
Alpesh N. Amin, MD, MBA , Department of Medicine, University of California Irvine, Irvine, CA
Mark Bachman, PhD , Electrical Engineering and Computer Science, University of California Irvine, Irvine, CA
Javier Garcia-Rivas, MA , Public Health, University of California Irvine, Irvine, CA
Ryan Smith, MS , eHealth @ Calit2, University of California Irvine, Irvine, CA
Laura Narvaez , Nursing Science, University of California Irvine, Irvine, CA
Background: Mobile health applications (apps) have been found to improve self-management in patients with chronic conditions, particularly children and adults. Older adults are a group that can potentially benefit from mobile health interventions.

Objectives: The goal of the pilot study was to design and test the feasibility and acceptability of Mobile Applications for Seniors to enhance Safe anticoagulation therapy (MASS). The MASS is a mobile-based health technology intervention, composed of several culturally appropriate and age-sensitive tools and components to promote independence and self-care in older adults (including Hispanic elders) on oral anticoagulant (i.e., warfarin) treatment. The specific aims are to 1) assess changes from baseline (pre-test) to 3-months (post-test) of three primary outcomes: a) cognitive function (knowledge, attitudes); b) emotional well-being (quality of life, depression, anxiety); and c) adherence to medications. Additionally, changes in secondary outcomes from baseline to 3-months a) adverse outcomes (e.g., bleeding, thromboembolic events) and b) treatment efficacy (keeping therapeutic INR) were evaluated.

Methods: The pilot study used a single-arm, experimental, pre-post design to assess the feasibility of a 12-week intervention using the MASS in 20 older adults (>=55 years) taking warfarin by examining changes in primary and secondary outcomes.

Preliminary results: The MASS app development (English and Spanish) was completed. The components of the MASS app include 1) education about anticoagulation therapies and safety tips, 2) medication self-monitoring and reminders, 3) vitamin K content of foods including common Hispanic foods, 4) monitoring of signs and symptoms of bleeding, 5) monitoring INR, 6) connecting with people whom older adults trust (e.g., family caregivers, friends), and 7) resources. Currently 7 participants are enrolled and the recruitment has progressed. The preliminary results of this feasibility study including three month follow-ups will be presented at the conference.

Conclusion: These preliminary results will be used to modify the health app to make the design more elder-friendly and to identify challenges and benefits in using the health app for chronic disease self-management. In light of the increasing incidence and prevalence of conditions requiring anticoagulation therapy, the results of the study may offer important information in the use of information technology alternatives to meet the rising need for self-management in increasing numbers of patients and patient care-givers.

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