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 阿尔茨海默氏病和相关痴呆症（ADRD）是渐进疾病，其特征是它们的衰弱 对认知功能的影响。 65岁及以上的成年人代表大多数案件，并且正在管理 不仅是ADRD，而且多种慢性病（MCC），它们与年龄相同。坚持 处方药方案对于优化认知和身体健康至关重要，但尤其困难 在多药方案的背景下。关于老年人与Adrd自我管理的了解知之甚少 药物，这些责任如何随着疾病的进展过渡到护理人员，如何有能力 护理人员应履行这些责任，以及门诊医疗实践如何支持患者和护理人员 确保使用安全的药物使用和依从性。该K01申请旨在为Rachel博士提供培训 O'Conor推出独立的研究议程，重点是理解认知和社会心理 老年人及其慢性疾病自我管理行为和健康结果的决定因素及 护理人员在管理复杂的慢性病时，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，获得暴露于 老年人和专业记忆诊所的ADRD老年人的临床管理，获得经验 与认知受损的个人及其护理人员进行研究，并获得正式培训 纵向数据分析和高级统计技术。拟议研究的目的是 研究ADRD + MCC老年人的潜水员样本中的药物自我管理行为 和他们的照顾者。 O'Conor博士将与西北阿尔茨海默氏病中心合作，并正在进行 NIA资助的认知老化队列研究进行了完整的混合方法研究。研究 目的是1）检查ADRD及其护理人员对自我的老年人采用的不断发展的策略 随着疾病的发展，管理多药方案； 2）特征障碍初级保健临床医生 面对老年人和看护人参与ADRD和MCC的管理； 3）调查关联 在认知能力下降和药物治疗自我管理行为之间 多药方案； 4）探索因素影响认知能力下降与药物自我自我的关联 管理行为。拟议的调查将为主要的开发和评估提供信息 基于护理的干预措施，以支持ADRD + MCC及其护理人员在药物中支持老年人 管理，并作为一项独特的队列研究的基础，以前瞻性研究老年人 具有早期ADRD + MCC及其护理人员过渡药物对疾病的自我管理角色 课程及其对健康结果的影响。