Deprescribing for Post-Acute Care Older Patients with Dementia in Home Health Care

PROJECT SUMMARY/ABSTRACT Older persons with Alzheimer’s disease and related dementias (ADRD) often use potentially inappropriate medications (PIMs) - medications with a risk of harm or that are unlikely to be beneficial. The use of PIMs leads to accelerated functional decline, hospitalization, institutionalization, and death, yet it is difficult to

appropriately deprescribe (discontinue/reduce) these medications, especially during the post-acute care transitions when PIM use is common and has substantial consequences. Current research in deprescribing for persons with ADRD has focused on long-term care, with a critical gap in our understanding of deprescribing in

routine clinical practice for community-dwelling older adults with ADRD during care transitions. In this study, we focus on home health care (HHC) - a logical setting to address PIM use and deprescribing in persons with ADRD during post-acute care transitions due to its existing care processes, clinician workforce, and resources

that can serve as a foundation to deprescribing of PIMs. This 5-year project includes two aims. Aim 1 is to identify the factors associated with, and novel barriers/facilitators in, routine practice PIM deprescribing among persons with ADRD in HHC. We will use a sequential mixed methods approach, including analysis of existing

data in national administrative service datasets and qualitative stakeholder engagement through group concept mapping. Then, we will integrate and synthesize the results from quantitative data analysis and qualitative stakeholder engagement to further develop a deprescribing intervention in HHC for older adults with ADRD

and caregivers. Aim 2 is to test the feasibility, acceptability, and preliminary effects of the intervention in a one- group pre-post clinical trial. This proposal is aligned with NIA’s strategic priorities to develop innovative interventions to target multimorbidity and its associated geriatric syndromes (e.g., polypharmacy), and to

support older persons with ADRD through care and services provided at home and in the community. Findings will form the basis for a subsequent R01 that will examine the effects of the developed deprescribing intervention on medication and clinical outcomes of older HHC patients with ADRD. The candidate, Dr. Jinjiao

Wang, Ph.D., RN, is a registered nurse with experience in HHC and an assistant professor at the University of Rochester (UR) School of Nursing. The long-term goal of Dr. Wang is to become a leading geriatrics health services researcher in home-based geriatric care with a focus on medication safety and optimization. Under a

multidisciplinary team of exemplary mentors from medicine, psychiatry, psychology, nursing, and gerontology, and clinical pharmacy, Dr. Wang will build on her preliminary work on polypharmacy management in HHC to accomplish training goals in ADRD care, mixed methods approach, design and conduct of clinical trials,

particularly with persons with ADRD and their caregivers, and leadership development. UR provides an exceptional environment for the completion of the proposed research and for Dr. Wang, who has already begun to emerge as a leading researcher in the field of home-based geriatric care and deprescribing.