Management of Complex Medication Regimens among Older Adults with Alzheimer's Disease and Related Dementias and their Caregivers

患有阿尔茨海默病和相关痴呆症的老年人及其照顾者的复杂药物治疗方案的管理

• 批准号: 10544550
• 负责人: Rachel O'Conor
• 金额: $ 12.2万
• 依托单位: NORTHWESTERN UNIVERSITY AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-01-15 至 2025-12-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10544550
• 关键词: Adherence; Adult; Affect; Age; Alzheimer' s Disease; Alzheimer' s disease related dementia; Ambulatory Care; Attention; Behavior; Behavior assessment; Caregivers; Caring; Chronic Disease; Clinic; Clinical Management; Cognitive; Cognitive aging; Cohort Studies; Complex; Data Analyses; Dementia; Development; Disease; Disease Progression; Dose; Drug Prescriptions; Elderly; Elements; Ensure; Ethnic Origin; Evaluation; Exclusion; Exposure to; Face; Foundations; Functional disorder; Funding; Goals; Health; Health behavior and outcomes; Impaired cognition; Individual; Intervention; Interview; Investigation; Knowledge; Measures; Medication Management; Memory; Mentored Research Scientist Development Award; Methods; Outcome; Patient Care; Patients; Pharmaceutical Preparations; Primary Care; Progressive Disease; Quality of life; Race; Regimen; Research; Research Methodology; Role; Sampling; Schedule; Self Management; Self Medication; Severities; Structure; Symptoms; Techniques; Time; Training; Work; aged; cognitive change; cognitive function; cognitive task; cognitive testing; cohort; comorbidity; complex chronic conditions; dosage; experience; follow-up; health assessment; medical specialties; medication compliance; member; mild cognitive impairment; multiple chronic conditions; patient oriented; physical conditioning; primary care clinician; primary care practice; prospective; provider factors; psychosocial; treatment planning

PROJECT SUMMARY Alzheimer’s disease and related dementias (ADRD) are progressive diseases characterized by their debilitating impact on cognitive function. Adults ages 65 years and older represent the majority of cases, and are managing not only ADRD, but multiple chronic conditions (MCC) that are common with advancing age. Adherence to prescribed medication regimens is critical to optimize both cognitive and physical health, but is especially difficult in the context of multidrug regimens. Little is known about how older adults with ADRD self-manage their medications, how these responsibilities transition to caregivers as the disease progresses, how capable caregivers are to fulfill these responsibilities, and how ambulatory care practices support patients and caregivers to ensure safe medication use and adherence. This K01 application seeks to provide training for Dr. Rachel O’Conor to launch an independent research agenda focused on understanding the cognitive and psychosocial determinants of chronic disease self-management behaviors and health outcomes for older adults and their caregivers as they manage complex chronic conditions, including ADRD. To achieve this goal, her short-term training goals are to: acquire scientific knowledge in ADRD pathophysiology and care, gain exposure to the clinical management of older adults with ADRD in geriatric and specialty memory clinics, gain experience conducting research with cognitively impaired individuals and their caregivers, and obtain formal training in longitudinal data analysis and advanced statistical techniques. The objective of the proposed research is to examine medication self-management behaviors among a diverse sample of older adults with ADRD + MCC and their caregivers. Dr. O’Conor will partner with the Northwestern Alzheimer’s Disease Center and an ongoing, NIA-funded cognitive aging cohort study to conduct complementary mixed methods investigations. The research aims are to 1) Examine the evolving strategies employed by older adults with ADRD and their caregivers to self- manage multidrug regimens as the disease progresses over time; 2) Characterize barriers primary care clinicians face engaging older adults and caregivers in the management of ADRD and MCC; 3) Investigate associations between cognitive decline and medication self-management behaviors among older adults managing complex multidrug regimens; 4) Explore factors influencing associations between cognitive decline and medication self- management behaviors. The proposed investigations will inform the development and evaluation of a primary care based intervention to support older adults with ADRD + MCC and their caregivers in their medication management, and serve as the foundation for a unique cohort study to prospectively investigate how older adults with early stage ADRD + MCC and their caregivers transition medication self-management roles over the disease course, and its impact on health outcomes.

项目摘要 阿尔茨海默病和相关痴呆（ADRD）是以其使人衰弱为特征的进行性疾病。 对认知功能的影响65岁及以上的成年人占大多数病例， 不仅是ADRD，还有随着年龄增长而常见的多种慢性疾病（MCC）。遵守 处方药物治疗方案对于优化认知和身体健康至关重要，但特别困难 在多药疗法的背景下。关于老年ADRD患者如何自我管理他们的行为， 药物，随着疾病的进展，这些责任如何过渡到护理人员， 护理人员履行这些责任，以及门诊护理实践如何支持患者和护理人员 以确保安全用药和依从性。此K 01应用程序旨在为Rachel博士提供培训 奥康纳将启动一项独立的研究议程，重点是了解认知和心理社会 老年人慢性病自我管理行为和健康结果的决定因素及其 护理人员，因为他们管理复杂的慢性疾病，包括ADRD。为了实现这一目标，她的短期 培训目标是：获得ADRD病理生理学和护理方面的科学知识， 在老年病和专业记忆诊所对患有ADRD的老年人进行临床管理，获得经验 与认知障碍者及其照顾者进行研究，并获得以下方面的正式培训： 纵向数据分析和先进的统计技术。拟议研究的目的是 在ADRD + MCC老年人的不同样本中检查药物自我管理行为 和他们的照顾者。奥康纳博士将与西北阿尔茨海默病中心合作， NIA资助的认知老化队列研究，以进行互补的混合方法调查。研究 目的是1）检查ADRD老年人及其照顾者采用的不断发展的策略， 随着疾病的进展，管理多种药物方案; 2）描述初级保健临床医生的障碍 面对参与老年人和照顾者在ADRD和MCC的管理; 3）调查协会 老年人的认知能力下降和药物自我管理行为之间的关系 多药治疗方案; 4）探索影响认知能力下降和自我用药之间关联的因素。 管理行为。拟议的调查将为制定和评价一个主要的 以护理为基础的干预，以支持ADRD + MCC老年人及其护理人员的药物治疗 管理，并作为一个独特的队列研究的基础，前瞻性地调查老年人如何 早期ADRD + MCC患者及其护理人员在疾病中过渡药物自我管理角色 以及它对健康结果的影响。