Medication risks and challenges among people with dementia who live alone

项目总结/摘要 三分之一的老年痴呆症患者独自生活。这一脆弱的、不断增长的、 研究不足的人群是安全和有效地使用药物。由于认知障碍， 痴呆症（PWD）更有可能滥用药物，并面临三倍的药物风险- 与非痴呆患者相比，对于老年痴呆症患者， 单是这一点，情况就更加严峻。独居的残疾人更有可能缺乏药物支持 管理比那些与他人生活。因此，他们可能面临更高的药物不良事件风险， 尤其是接触某些高危药物的时候尽管认识到残疾人的脆弱性， 由于我们独自生活，我们缺乏关于这一人群药物使用情况的可靠国家数据。本研究的目的 是描述高风险药物使用（定义为具有不良认知影响的药物， 滥用耐受性低的药物，包括抗凝剂、降糖药（如胰岛素）， 阿片类药物）和药物管理的支持和挑战的残疾人谁独居。使用 一个具有全国代表性的美国队列，来自合并的国家健康和老龄化趋势研究（NHATS） 数据和医疗保险索赔，我们将调查两个具体目标：（1）确定患病率和风险 单独生活的PWD中使用高风险药物的因素，并将其与与其他PWD一起生活进行比较 及（2）探讨独居残疾人士的药物管理支援与挑战 与那些和别人住在一起的人相比。我们将根据Medicare Part D索赔确定药物使用， 将阐明药物管理的支持和挑战，从NHATS自我和代理报告。 意义和创新：拟议研究项目的结果将直接为临床和政策提供信息 采取干预措施，支持社区居住的残疾人，包括相当大一部分独居者。这 与国家老龄问题研究所促进美国老年人更好生活质量的使命相一致， 包括阿尔茨海默病和相关痴呆症患者，并改善药物的安全使用 被老年人。该项目具有创新性，因为它将首次提供可靠的国家数据， 为这一弱势群体开什么样的高风险药物，并确定卫生系统， 患者/临床和与这些处方模式相关的社会因素。描述药物 管理支助和挑战将确定最需要支助性干预的人群。 这项工作的未来方向包括设计有针对性的干预措施，以提高 为独居的社区残疾人士开药及提供支援服务。

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.