Metamemory and Emotional Contributions to the Relationship Between Cognitive Function and Medication Adherence in...

H-type hypertension substantially increases cardiovascular and cerebrovascular risk. In older adults, medication adherence is often challenged by cognitive decline, symptom burden, and emotional distress. This study examined the relationship between cognitive function and medication adherence in older adults with H-type hypertension and tested whether metamemory and emotional states mediate this relationship.

This cross-sectional study recruited 380 older adults with H-type hypertension. Cognitive function, metamemory, anxiety, depression, and medication adherence were assessed using validated instruments. Pearson correlations and a parallel mediation model were performed. Indirect effects were tested using bias-corrected bootstrapping (5,000 resamples), reporting standardized coefficients (β) and 95% confidence intervals (CIs).

Cognitive function was positively associated with medication adherence (r = 0.196, p < 0.01). The total indirect effect was significant (β = 0.151, 95% CI 0.087-0.227), whereas the direct effect of cognitive function on adherence was not significant after including mediators (β = 0.028, p = 0.636). Metamemory showed a significant mediating effect (β = 0.164, 95% CI 0.109-0.225), and depressive symptoms demonstrated a smaller but significant mediating role (β = -0.031, 95% CI -0.078 to -0.002); anxiety was not a significant mediator. Higher serum homocysteine level and greater daily medication frequency were also associated with poorer adherence.

In older adults with H-type hypertension, the link between cognitive function and medication adherence appears to operate mainly through modifiable psychological mechanisms, particularly metamemory and depressive symptoms, rather than cognitive function alone. Routine chronic care may benefit from brief screening for metamemory difficulties and depressive symptoms, followed by patient centered adherence support and appropriate referral for mood management. Prospective studies are needed to confirm directionality and inform targeted interventions.