Daniel Morrow: Aging and Communication > back to research programs My research investigates the role of communication and cognition in older adults' performance of complex daily tasks, and how to design task environments to promote successful performance. Current projects focus on aging and design in the aviation and health care domains. Aging and expertise in pilot performance Communication is essential to piloting because it integrates the components of the National Air System: Pilots continually talk with Air Traffic Control (ATC) and other pilots in order to coordinate tasks required for safe travel. It is important to understand the impact of age-related changes in cognition on these communication processes because of the aging aviation workforce, age-based retirement rules, and the possibility that designing for older workers will yield the broadest benefits for the workforce. My colleagues and I have investigated whether older expert pilots are more likely to maintain competence (and keep up with younger pilots) for domain-relevant tasks that enable them to maintain highly practiced skills or to develop new strategies that compensate age-related cognitive declines. Our lab studies suggest expertise is more likely to reduce age differences on communication that impose fewer demands on comprehension and integration abilities (Morrow, Menard et al., 2001; Morrow, Menard, Ridolfo et al., 2003). Notably, older pilots maintained high levels of performance even on demanding communication tasks when they could take advantage of external aids such as note-taking to reduce working memory demands (Morrow, Ridolfo, et al., 2003). They may be especially proficient at using these aids because the aids are part of their skill repertoire. These studies have led to more translational research investigating age-related costs and benefits of external aids during simulated flight. This project broadens our focus from communication to task management because pilots routinely coordinate communication with concurrent control and navigation tasks, and external aids may support communication at the expense of the efficiency of overall task management. Guided by multiple resource theories of attention, we are investigating aids varying in how integrated they are with concurrent tasks. We have developed an electronic notepad that is more integrated with primary flight displays compared to the pilot's traditional kneepad. This "e-pad" may support older pilots' ability to accurately communicate without reducing overall task management. Preliminary findings suggest that older pilots can use the "e-pad" as well as the kneepad to support accurate communication in a multi-task flying environment (Morrow et al., 2005). We are now using eye-tracking measures to explore attentional consequences of these aids for older and younger pilots. This project should lead to age-sensitive design recommendations for the flight deck. Health communication and older adults' self-care Communication is essential to health care. Older adults must be able to accurately describe symptoms and needs to their providers and to understand warnings, consent forms, instructions for taking medication or using medical devices, and other forms of communication. An aging population and a community-based health care system mean more chronically ill older adults must manage their own care. Older adults, unfortunately, may have trouble with these tasks because of age-related cognitive declines and poor health communication. Well-designed communication can help older adults maintain self-care despite cognitive declines. We are designing patient-centered communication to help older adults with diverse cognitive and literacy skills develop accurate and more complete plans for taking medication. In a series of laboratory studies, we developed recommendations for improving written instructions such as those patients receive at pharmacies along with their prescriptions. For example, we found that older and younger adults have similar preferences for organizing medication information, suggesting a shared schema for how to take medication. They also better remember instructions that follow this schema (Morrow & Leirer, 1999). Memory for medication information was further improved by adding a timeline to the instructions that explicitly depicted medication dose and schedule information (Morrow, Hier, et al., 1998). As with the aviation project, we are now conducting more translational research. Findings from our lab studies have been integrated into two clinical trials that test whether improved communication improves older adults' medication adherence. In collaboration with pharmacists and physicians, I am investigating whether a multi-faceted pharmacist-based patient education intervention, which include instructions designed according to our recommendations, improves electronically monitored medication adherence and health outcomes among older adults with chronic heart failure (Murray et al., 2004). Preliminary studies found that a diverse sample of CHF patients preferred (Morrow, Weiner, Deer et al., 2004) and better remembered (Morrow, Weiner, Young et al., 2005) our patient-centered instructions to those available at a chain pharmacy. These instructions are especially preferred by patients with lower levels of health literacy, which helps validate the instructions for this population. Adherence data from the clinical trials are now being analyzed. Preliminary findings suggest patient health literacy is associated with adherence (Murray et al., 2004), and we are currently investigating whether the association of literacy and adherence is mediated by differences in more basic cognitive mechanisms such as processing speed and working memory. The intervention also improved adherence to heart failure medications relative to a usual care control group. We plan to examine whether intervention effects are mediated by medication knowledge (improved by the educational intervention) and moderated by patients' cognitive and literacy skills. These studies also provide an opportunity to investigate spoken as well as written communication. The pharmacists in the studies use patient-centered strategies to teach patients about their medication, including structuring consultations in terms of the medication schema and working with patients to develop schedules that fit both patients' constraints and medication requirements. These strategies support the provider/patient collaboration needed to create a shared adherence plan (Morrow, 1997). I am now developing this approach to fit constraints of clinical practice by working with nurses as well as pharmacists. References Morrow, D. (1997). Improving consultations between health professionals and clients: Implications for pharmacists. International Journal of Aging and Human Development. 44, 47-72. Morrow, D.G., Chang, D., Wickens, C.D., Rantanen, E., & Raquel. L. (2005). External aids and age differences in pilot communication. Proceedings of the 12th International Symposium on Aviation Psychology (Oklahoma City, OK). Morrow, D., Hier, C., Menard, W., & Leirer, V. (1998). Icons improve older and younger adult comprehension of medication information. Journal of Gerontology: Psychological Sciences. 53B, 240-254. Morrow, D. & Leirer, V. Designing medication instructions for older adults. (1999). In D. Park, R. Morrell, & K. Shifren (Eds.), Aging patients and medical treatment: An information-processing perspective (pp 249-265). Mahwah, NJ: Erlbaum. Morrow, D.G., Menard, W.E., Ridolfo, H., Stine-Morrow, E.A.L., Teller, T. & Bryant, D. (2003). Expertise, cognitive ability, and age effects on pilot communication. International Journal of Aviation Psychology. 13, 345-371. Morrow, D.G., Menard, W.E., Stine-Morrow, E.A.L., Teller, T., & Bryant, D. (2001). The influence of task factors and expertise on age differences in pilot communication. Psychology and Aging. 16, 31-46. Morrow, D.G., Ridolfo, H.E., Menard, W.E., Sanborn, A., Stine-Morrow, E.A.L., Magnor, C., Herman, L., Teller, T. & Bryant, D. (2003). Environmental support promotes expertise-based mitigation of age differences in pilot communication tasks. Psychology and Aging. 18, 268-284. Morrow, D.G., Weiner, M., Young, J., Steinley, D., Deer, M., & Murray, M. (2005). Improving medication knowledge among older adults with heart failure: A patient-centered approach to instruction design. The Gerontologist. in press. Murray, M.D, Wu, J., Tu, W., Clark, D., Weiner, M., Morrow, D. & Brater, C. (2004). Health literacy predicts medication adherence. Clinical Pharmacology & Therapeutics, 75, P76. Paper presented at the 2004 Annual Meeting of the American Society for Clinical Pharmacology & Therapeutics, Miami Beach. Murray, M.D., Young, J., Morrow, D.G., Weiner, M., Tu, W., Hoke, S., Clark, D., Stroupe, K., Wu, J., Deer, M., Bruner-England, T., Sowinski, K., Smith, F.A., Oldridge, N., Gradus-Pizlo, Murray, L., Brater, C., & Weinberger, M. (2004). Methodology of an ongoing, randomized, controlled trial to improve drug use for elderly patients with chronic heart failure. The American Journal of Geriatric Pharmacotherapy. 2, 53-65.