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

项目总结 阿尔茨海默病和相关痴呆(ADRD)是以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，并正在处理 不仅是ADRD，而且随着年龄的增长而常见的多种慢性病(MCC)。坚持 处方药物疗法对优化认知和身体健康至关重要，但尤其困难。 在多种药物疗法的背景下。关于患有ADRD的老年人如何自我管理，我们知之甚少 药物治疗，随着疾病的进展，这些责任如何转移到照顾者身上，如何能够 护理者要履行这些责任，以及门诊护理实践如何支持患者和护理者 以确保安全用药和依从性。此K01申请表旨在为雷切尔博士提供培训 O‘Conor将启动一项独立研究议程，专注于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局的决定因素及其影响因素 护理人员管理复杂的慢性疾病，包括ADRD。为了实现这一目标，她的短期 获取ADRD病理生理学和护理方面的科学知识，接触 老年和专科记忆诊所老年ADRD的临床治疗 与认知受损个人及其照顾者进行研究，并在以下方面获得正式培训 纵向数据分析和先进的统计技术。拟议研究的目的 培训目标是： 是为了 不同样本ADRD+MCC老年人的用药自我管理行为研究 和他们的照顾者。奥康纳博士将与西北阿尔茨海默氏症中心合作， NIA资助的认知老化队列研究采用互补的混合方法进行调查。这项研究 目的是1)研究患有ADRD的老年人及其照顾者使用的不断演变的策略，以自我保护 随着疾病的进展，管理多种药物方案；2)确定初级保健临床医生的障碍 面对让老年人和照顾者参与ADRD和MCC的管理；3)调查关联 老年管理情结患者认知功能减退与药物自我管理行为的关系 4)探讨认知功能减退与用药自我相关的影响因素 管理行为。拟议的调查将为制定和评估小学 以护理为基础的干预措施支持患有ADRD+MCC的老年人及其照顾者的药物治疗 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及其照料者过渡药物自我管理对疾病的作用 当然，以及它对健康结果的影响。

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 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 training goals are to: 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.