Elderly patients who visualize themselves taking their medication may be more likely to do so regularly over the long term, according a study supported by the National Institutes of Health and published in the June issue of Psychology and Aging.

"This is an innovative study. It presents an unusual but apparently very effective way to use imagination as a memory tool to help older adults more successfully follow medical instructions," said Jeffrey Elias, Ph.D., of the National Institute of Aging. "The best medical care in the world isn't much good if a patient can't or won't follow through. Creative approaches such as this one need to be explored further if we are to solve difficult medication adherence problems. The genius of this method is that it requires less conscious effort than other memory methods. So, it can be easily learned and applied."

In the current study, researchers taught 31 non-diabetic volunteers to do home blood glucose testing. The participants, ages 60 to 81 years, 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. 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.

Participants in the implementation group, defined by the investigators as an "imagination" intervention, spent one three-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 with an average of 46 percent for 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, the authors noted that further studies will need to be conducted to replicate the findings more generally.

"Getting older people to remember to take their medications and conduct self-monitoring tests is a huge issue," said Denise Park, Ph.D., a coauthor of the study. "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.' "