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

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.