PROJECT SUMMARY/ABSTRACT This is an application for a Beeson K76 award for Dr. Matthew Growdon, a geriatrician-researcher at University of California, San Francisco (UCSF). One-third of older adults with Alzheimer's Disease and Related Dementias (ADRD) live alone. A critical but understudied challenge facing people with dementia (PWD) who live alone is the safe and effective use of medications. Due to cognitive impairment, PWD are more likely to misuse medications than those without dementia; compounding this risk, PWD who live alone are more likely to lack support for medication management than those who live with others. Balancing potential benefits and harms of therapy for PWD living alone is paramount. Yet, prior research on prescribing practices, supports, and medication-related experiences for this vulnerable population is scant, impeding targeted interventions. There is an urgent need for an evidence-informed framework for addressing medication management in PWD who live alone to guide clinicians in prescribing decisions, support PWD who live alone, and inform interventions to improve care. The objectives of this proposal are to characterize medication use and supports among PWD who live alone, to understand key perspectives on their use of medications, and to develop a stakeholder- informed clinical decision framework that will guide future interventions to optimize medication use in this group. Mentored by an extraordinary team led by Dr. Michael Steinman at UCSF, Dr. Growdon will: 1) Evaluate medication use and medication management supports among PWD who live alone using National Health and Aging Trends Survey data merged with Medicare claims; 2) Conduct qualitative interviews with PWD who live alone, their care partners, and multidisciplinary clinicians to understand medication-related experiences and needs; and 3) Develop and refine a clinical decision framework and set of prioritized interventions attuned to medication optimization for PWD who live alone by conducting focus groups with PWD who live alone, care partners, and clinicians as well as a transdisciplinary expert Delphi panel informed by findings from Aims 1 and 2. These Aims dovetail with career development activities focused on: 1) Advanced pharmacoepidemiology; 2) Rigorous qualitative research skills with socially vulnerable older adults; 3) Stakeholder engagement and intervention development in dementia care; and 4) Leadership skills. This Beeson K76 proposal will advance much-needed knowledge of the epidemiology and lived experiences of medication use and supports among PWD who live alone. This knowledge will directly inform an innovative stakeholder-informed clinical decision framework and intervention strategies to optimize medication use, forming the basis for a compelling R01 proposal to improve prescribing quality and outcomes for older adults with ADRD who live alone. It will also provide advanced research skills and valuable data to launch Dr. Growdon's career as a leading independent investigator improving prescribing quality for older adults with ADRD and social vulnerability.

PROJECT NARRATIVE Over 1 million older adults with Alzheimer's Disease and Related Dementias (ADRD) live alone in the US, and little is known about their use of medications, support for medication management, or how to intervene effectively to optimize their use of medications. The objectives of this Beeson K76 proposal are to characterize medication use and medication management supports among older people with ADRD who live alone, to understand in-depth multifaceted perspectives on their use of medications, and to develop a stakeholder- informed clinical decision framework to support clinicians and guide future interventions to optimize medication use in this group. Ultimately, the information learned from this proposal will lead to the development of clinical interventions to improve quality of life and reduce medication-related harms for older adults with ADRD who live alone.