Assessment of Medication Optimization in Rural Kentucky Appalachian patients with mild cognitive impairment or dementia: The AMOR Kentucky Study

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3 R24 AG065025-02S1, Steinman, Michael A. Medication-related problems are often the cause of emergency room visits, hospitalizations, and transition to higher levels of care in older adults experiencing mild cognitive impairment (MCI) and Alzheimer’s Disease or Related Dementias (ADRD). Medication complexity adds to the caregiver burden and often results in negative health outcomes and diminished quality of life for both, the patient and the caregiver. Nowhere is this problem more real and impactful than in older adults with MCI and ADRD in the underserved, lower socioeconomic, and health disparity populations in rural Appalachian Kentucky. Outreach into such areas to improve healthcare through interventions such as multidisciplinary deprescribing and medication optimization has been further impacted by the current COVID-19 pandemic. Developing novel, remotely delivered, deprescribing and medication optimization strategies to ADRD populations in Appalachia is a primary goal of our efforts. Utilizing our vast and well-established (16 years of operation) rural telemedicine clinic focused on age-related cognitive decline, MCI, and ADRD, we propose to develop and assess the efficacy of remote strategies for medication optimization and healthcare assessment. We will evaluate remote delivery of optimal deprescribing strategies that will serve as a translational bridge between our prior work at the University of Kentucky and service delivery to underserved populations. Such efforts will serve as a model to be further investigated in other health disparate and underserved populations with ADRD nationwide. These efforts are bolstered by our previous experience implementing deprescribing regimens to improve cognitive reserve in participants seen in a tertiary care setting through our NIA funded study (R01AG054130), our adaptation to remote medication therapy management during the time of COVID, our well-established network of engaged rural healthcare practices, as well as our ability to deliver such interventions directly into the homes of those with ADRD living remotely in underserved, health disparate, regions of rural Kentucky Appalachia. Mobilizing our resources to optimize an immediately implementable strategy for remote outreach in rural ADRD populations using HIPAA-compliant videoconferencing technology, allows for both an immediate direct impact on such interventions in the time of COVID, and will greatly expand the translational reach to health disparity populations that may be geographically distanced from the core centers of the parent grant. Our well-established experience in providing medication optimization interventions to the aging population with cognitive decline of ADRD type has allowed us to develop routine practices of assessment of medication appropriateness, as well as implementation of a multidisciplinary physician-pharmacist team targeting improvement in cognitive outcomes in the aging population. This approach will be carried forward through a telemedicine practice comprised of approximately 500 ADRD patient-caregiver dyads throughout rural areas of Appalachian Kentucky.