Comprehension and Memory for Medical Information

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In an initial study, Morrell, Park, and Poon (1989) studied comprehension and memory for a fictitious medical regimen in old and young adults. They reported that older adults showed poorer memory than young adults for the adherence instructions associated with the medications. The deficits persisted even when the older adults were able to have these written instructions available to them while they planned their medication schedules, as well as when the older adults had unlimited time to encode the information. These data are suggestive of comprehension, working memory, and long-term (retrospective) memory difficulties in planning and remembering a medical regimen. The working memory difficulties were manifested by older adults' difficulty in integrating an accurate adherence schedule across the multiple medications, even when the medications were available to them. The increased deficits observed when older adults were required to remember, rather than merely comprehend, the regimen points to retrospective memory problems as well.

In an effort to relieve the working memory and retrospective memory burden associated with prescription labels, Morrell, Park, and Poon (1990) hypothesized that pictorial labels may improve older adults' knowledge about prescriptions when compared to labels that only include text because older adults maintain stable memory for pictures (Park, Puglisi, & Smith, 1986; Park, Royal, Dudley, & Morrell, 1988). Surprisingly, the presence of the pictures on some of the labels increased younger adults' performance on tasks related to the information these labels contained, but this pictorial label type did not help older adults, and in fact for this group the picture labels were associated with lower levels of performance than were the text-based labels.

The advantage of word-based mediums to communicate information also extends to other domains; older adults are also better at remembering instructions about time of day when they are shown the relevant information in words as opposed to by pictures of clocks (Morrow, Leirer, & Andrassy, 1996). Because presentation of medical information via pictures is a relatively novel way to communicate such information, Morrell et al. (1990) suggested that encoding information shown in this modality may require higher levels of effortful processing, and they ideated that any novel methods used should be introduced slowly to increase familiarity before they are implemented as tools used to increase understanding of medical material. Within the domain of text, presentation style can also affect ease of comprehension and remembrance. For example, presenting information in list format as opposed to paragraph format can increase comprehension and memory for medical information by older adults (Morrow, Leirer, & Altieri, 1995; Morrow, Leirer, Andrassy, Hier, & Menard, 1998). Overall, these data suggest that older adults have comprehension difficulties as well as working memory and long-term (retrospective) memory difficulties.

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