Medication risks and challenges among people with dementia who live alone

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PROJECT SUMMARY/ABSTRACT One-third of older adults with dementia live alone. A crucial challenge facing this vulnerable, growing, and understudied population is the safe and effective use of medications. Due to cognitive impairment, people with dementia (PWD) are more likely to misuse medications and face a threefold increased risk of medication- related hospital admissions compared to those without dementia. For older adults with dementia who live alone, the situation is even more dire. PWD living alone are more likely to lack support with medication management than those living with others. They are therefore potentially at higher risk of adverse drug events, particularly when exposed to certain high-risk medications. Despite recognition of the vulnerability of PWD who live alone, we lack reliable national data regarding medication use in this population. The objective of this study is to characterize high-risk medication use (defined as medications with adverse cognitive effects and medications with a low tolerance of misuse, including anticoagulants, hypoglycemics such as insulin, and opioid medications) and medication management supports and challenges among PWD who live alone. Using a nationally representative US cohort derived from merged National Health and Aging Trends Study (NHATS) data and Medicare claims, we will investigate two specific aims: (1) To determine the prevalence of and risk factors for high-risk medication use among PWD living alone and to compare this to PWD living with others and (2) To characterize medication management supports and challenges among PWD who live alone compared to those who live with others. We will determine medication use from Medicare Part D claims and will elucidate medication management supports and challenges from NHATS self and proxy reports. Significance & Innovation: Results from the proposed research project will directly inform clinical and policy interventions to support community-dwelling PWD, including a sizeable fraction who are living alone. This aligns with the National Institute on Aging's mission of promoting better quality of life for older Americans, including those with Alzheimer's Disease and Related Dementias, and improving the safe use of medications by older adults. This project is innovative because it will be the first to provide reliable national data regarding what high-risk medications are prescribed in this vulnerable group and to identify health system, patient/clinical, and social factors associated with these prescribing patterns. Describing medication management supports and challenges will identify populations in greatest need of supportive interventions. Future directions of this work include designing targeted interventions to improve the quality and safety of medication prescribing and provision of supportive services for community-dwelling PWD who live alone.