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Translation of these interventions into population-level improvements in adherence and clinical outcomes among older adults remains suboptimal. From the Cohort Study of Medication Adherence among Older adults (CoSMO), we evaluated traditional barriers to antihypertensive medication adherence among older adults with established hypertension (N = 1,544; mean age = 76.2 years, 59.5% women, 27.9% Black, 24.1% and 38.9% low adherence by proportion of days covered (i.e., PDC &amp;lt;0.80) and the 4-item Krousel-Wood Medication Adherence Scale (i.e., K-Wood-MAS-4 \u22651), respectively), finding that they explained 6.4% and 14.8% of variance in pharmacy refill and self-reported adherence, respectively. Persistent low adherence rates, coupled with low explanatory power of traditional barriers, suggest that other factors warrant attention. Prior research has investigated explicit attitudes toward medications as a driver of adherence; the roles of implicit attitudes and time preferences (e.g., immediate vs. delayed gratification) as mechanisms underlying adherence behavior are emerging. Similarly, while associations of individual-level social determinants of health (SDOH) and medication adherence are well reported, there is growing evidence about structural SDOH and specific pathways of effect. Building on published conceptual models and recent evidence, we propose an expanded conceptual framework that incorporates implicit attitudes, time preferences, and structural SDOH, as emerging determinants that may explain additional variation in objectively and subjectively measured adherence. This model provides guidance for design, implementation, and assessment of interventions targeting sustained improvement in implementation medication adherence and clinical outcomes among older women and men with hypertension.<\/jats:p>","DOI":"10.1093\/ajh\/hpab046","type":"journal-article","created":{"date-parts":[[2021,3,5]],"date-time":"2021-03-05T20:12:57Z","timestamp":1614975177000},"page":"895-909","source":"Crossref","is-referenced-by-count":28,"title":["Medication Adherence: Expanding the Conceptual Framework"],"prefix":"10.1093","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9662-3947","authenticated-orcid":false,"given":"Marie","family":"Krousel-Wood","sequence":"first","affiliation":[{"name":"Department of Medicine, Tulane University School of Medicine , New Orleans, Louisiana , USA"},{"name":"Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine , New Orleans, Louisiana , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leslie S","family":"Craig","sequence":"additional","affiliation":[{"name":"Department of Medicine, Tulane University School of Medicine , New Orleans, Louisiana , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erin","family":"Peacock","sequence":"additional","affiliation":[{"name":"Department of Medicine, Tulane University School of Medicine , New Orleans, Louisiana , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily","family":"Zlotnick","sequence":"additional","affiliation":[{"name":"Department of Medicine, Tulane University School of Medicine , New Orleans, Louisiana , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samantha","family":"O\u2019Connell","sequence":"additional","affiliation":[{"name":"Office of Academic Affairs, Tulane University , New Orleans, Louisiana , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Bradford","sequence":"additional","affiliation":[{"name":"Department of Public Administration and Policy, University of Georgia , Athens, Georgia , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lizheng","family":"Shi","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Management, Tulane University School of Public Health and Tropical Medicine , New Orleans, Louisiana , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Petty","sequence":"additional","affiliation":[{"name":"Department of Psychology, The Ohio State University , Columbus, Ohio , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,3,7]]},"reference":[{"key":"2022100812240322700_CIT0001","volume-title":"Health, United States, 2016: With Chartbook on Long-Term Trends in 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