PROJECT SUMMARY Dr. Ariel Green is an Assistant Professor in the Department of Medicine, Division of Geriatric Medicine and Gerontology at the Johns Hopkins University School of Medicine. She seeks a K23 mentored career development award to obtain critical knowledge, skills and research experience to accelerate her development into a leader in patient-oriented geriatrics research. The training proposal details a four-year plan of formal and informal instruction in (1) epidemiology, particularly analytic skills using longitudinal, nationally-representative data linked to Medicare claims; (2) qualitative methods; (3) decision aid development and evaluation; and (4) interventional research in persons with Alzheimer's disease and related dementias. Short-term career goals include completing coursework in the above-mentioned areas, disseminating high-quality mentored research through publications and presentations, engaging in career development activities, and applying for independent R01 funding beginning in the third year of the award period. Long-term career goals are to be an independent geriatrics investigator who is a leader in shared decision making and medication safety in vulnerable older adults. Informing patients and families about potential outcomes and involving them in decision making could lead to a reduction in the use of potentially inappropriate medicines in patients with Alzheimer's disease and related dementias. The use of bladder antimuscarinics for treatment of urinary incontinence (UI) in older adults with dementia is an ideal model to learn how to improve decision making and develop an approach that could be applied to other potentially inappropriate medicines in people with dementia. The broad objective of this proposal is to address deficiencies in decision-making relating to antimuscarinic therapy in patients with dementia and UI. This will be accomplished through the following specific aims: (1) Among older adults (>65) with dementia and UI, to determine associations between antimuscarinic therapy and subsequent hospitalization, admission to NHs and death. (2a) To understand how patients, caregivers and clinicians communicate about antimuscarinic therapy in patients with dementia and UI. (2b) To determine how barriers to informed decision making about the use of antimuscarinic drugs in patients with dementia can be addressed. (3) To pilot an antimuscarinic decision aid for patients with dementia and UI and their caregivers. Completion of these aims will lay the groundwork for a future randomized trial to test an antimuscarinic decision aid for patients with dementia and UI and their caregivers.

PROJECT NARRATIVE Obtaining information and advice about medicines is a major source of strain for caregivers of patients with Alzheimer's disease and related disorders. Antimuscarinic drugs are commonly prescribed to patients with dementia for treatment of incontinence, despite concerns about the safety of these medicines in people with dementia. The overall goal of this proposal is to improve how older adults with dementia, their caregivers and clinicians make decisions about using antimuscarinic medicines to treat incontinence.