Faculty Showcase The Effect of Chronic Disease and Cognitive Aging on Self-Management	Jessica Shearer, Dr. Kathie Insel, Cynthia Jentgen,Chao-pin Hsiao (from left to right)
Kathie Insel , PhD, RN insel@nursing.arizona.edu

	This program of research is focused on the effect of chronic illness and age on cognitive function and then the influence of cognitive function on self-management. We examine the association of cognitive ability to: Self-care capacity, Self-management, Self-assessment in relationship to health care needs. We are also investigating nursing interventions that enhance self-care capacity with the goal of promoting independence for as long as possible. Cognitive function is conceptualized as the processes involved with thinking and remembering and builds from the foundation provided through both cognitive psychology and neuroscience. Cognitive function influences self-care capacity and therefore is an important but frequently underestimated component in assessing individual strengths and needs.
	The overall goal of this research program is to enhance the capacity for continued independence of our aging population. Attention is focused on individuals with hypertension and those with chronic obstructive pulmonary disease. Prior and current research seeks first to extablish the indicators of risk for self-management failures for middle aged and older adults. Self-management is often indexed by examining adherence to prescribed medications. It is estimated that 40 to 50% of individuals over 65 years of age have hypertension and yet control of blood pressure among older adults is often inadequate. Inadequate control is linked to medication nonadherence (or more likely to inconsistent adherence). Older adults are specifically at risk for inconsistent medication taking since aging is associated with decline in prefrontal function (prefrontal function refers to congintive processes that include monitoring task goals and adjusting strategies and the cognitive resources required by these processes). We have found that prefrontal function is associated with medication adherence. Additionally, individuals with a history of hypertension are at greater risk for cognitive decline. An application currently under review at the National Institute of Health examines the effect of an intervention tailored to the unique needs of the hypertensive older adult in relationship to the specific cognitive changes they experience with the goal of improving medication adherence and blood pressure levels. The intervention is based on the premise that structuring the environment to compensate for both declining function and increasing need enhances individual capacity. Magnetic resonance imaging (MRI) is used in a current investigation funded through the Center on Injury Mechanisms and Related Respsonses. This investigation examines the relationship between behavioral assessments of thinking and remembering and structural MRI. Finally with my colleague Dr. Paula Meek from the University of New Mexico and principal investigator of "Cognitive Function and Symptom Self-Management in COPD" we are examining the relationship of executive function and verbal memory to symptom self-management in individuals with COPD.
	Please join us in this important endeavor either as an interested student, research assistant or research participant. I believe our research participants are also our partners in research because you enable us to understand the issues involved with self-care and the potential role of nursing to promote self-management and thereby to plan and provide care for our communities. I can be reached at insel@nursing.arizona.edu