A Nurse-Led Metamemory-Based Intervention to Improve Medication Adherence in Older Adults With H-Type Hypertension

BACKGROUND: H-type hypertension substantially increases cardiovascular and cerebrovascular risk in older adults, yet long-term medication adherence remains suboptimal. Beyond regimen complexity, age-related cognitive vulnerability and limited self-monitoring capacity may undermine adherence. However, few nurse-led interventions explicitly target memory-related mechanisms underlying medication-taking behavior. OBJECTIVE: To evaluate the effectiveness of a nurse-led, metamemory-based intervention in improving medication adherence and related cognitive and psychosocial outcomes in older adults with H-type hypertension. METHODS: In this 12-week, randomized controlled trial, 76 older adults with H-type hypertension were randomly assigned (1:1) to a nurse-led metamemory-based intervention or usual care. The intervention combined face-to-face sessions and remote follow-up to enhance memory strategy use, self-monitoring, and medication adherence. Primary outcomes were metamemory and medication adherence. Secondary outcomes included cognitive function, anxiety, depression, quality of life, and self-management. RESULTS: Seventy-one participants completed the trial (intervention n = 35; control n = 36). Compared with usual care, the intervention group demonstrated significantly greater improvements in metamemory (mean change: 36.7 vs. 1.7; P < .001) and medication adherence (mean change: 2.1 vs. 0.5; P < .001). Significant between-group improvements were also observed in cognitive function, anxiety, quality of life, and self-management (all P < .05). Changes in depressive symptoms were modest and not statistically significant. CONCLUSIONS: A nurse-led metamemory-based intervention significantly improved medication adherence in older adults with H-type hypertension by strengthening memory self-monitoring and strategy use. These findings support metamemory as a clinically meaningful mechanism through which nursing interventions can enhance adherence in cognitively vulnerable cardiovascular populations.