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Pilot program helps older adults with dementia manage meds

For a woman in her late 70s, difficulty navigating more than two-dozen medications resulted in repeated trips to the emergency room. For an older man, misunderstanding a prescribed medicine’s directions led to an overdose.

A Cornell-led collaboration seeks to support older adults like these – living alone and diagnosed with mild dementia – to take critical medications safely, helping them to continue living independently and avoid unnecessary hospital visits.

“Medication mistakes occur commonly and can be dangerous and costly, especially for serious medication like opioids,” said Rana Zadeh, associate professor in the Department of Design and Environmental Analysis in the College of Human Ecology and co-director of the Health Design Innovations Lab. “This is a huge issue to be addressed nationally, and we have to provide better design solutions for older people and others who experience a decline of cognitive functioning to accommodate all their needs.”

With support from a $250,000 National Institutes of Health (NIH) grant, Zadeh and partners this spring are launching a program piloting one potentially innovative design solution in a pair of upstate New York counties near Cornell’s Ithaca campus.

The Home Opioid Prescription Education and Smart Storage (HOPES) program will provide 40 diverse residents of Tompkins and Cortland counties with assistive medication organizers and training to help them plan, organize and take medications as prescribed.

Assistive medication organizers and support for medication management are not currently covered by health insurance for all populations that critically need it, Zadeh said, and would be prohibitively expensive for many of the older adults living at home, including low-income residents from urban and rural communities. HOPES will help integrate the pill organizers into participants’ daily lives and train users and their caregivers, including family members, on how to operate them and on medication safety.

A key partner is the Visiting Nurse Service of Ithaca and Tompkins County (VNS), which helped develop the pilot program from its inception and will monitor participants and evaluate benefits and challenges experienced over the four-week study period.

“If we can utilize this integrative program to help people manage their medication schedules better, they will be able to remain at home longer, and unnecessary hospitalizations may be prevented,” said Deb Parker Traunstein, palliative care specialist with VNS’ Advanced Care Management program.

Achieving those outcomes could result in significant health benefits and cost savings, Zadeh and Traunstein said.

HOPES builds upon another pilot program in which one of Zadeh’s partners, the Johns Hopkins Center for Injury Research and Policy, has been working closely with the Indian Health Service to provide older adults in Native American communities with locked medication boxes for their homes.

“This project is a great opportunity to bring injury prevention and human-centered design together to address a known hazard for older adults,” said Wendy Shields, the collaborating partner from Johns Hopkins.

Funding for this project was awarded through the Translational Research Institute on Pain in Later Life (TRIPLL), a National Institute on Aging-funded Edward R. Roybal Center for Translational Research on Aging. Additional partners include Weill Cornell Medicine’s Division of Geriatrics and Palliative Medicine; Cornell Cooperative Extension; and Hunter College’s Hunter-Bellevue School of Nursing.

Among older Americans with cognitive decline who live at home, Zadeh said, loss of cognitive function can impair their ability to execute medication regimens, placing them at high risk for errors, research has shown. Often those challenges are compounded by high numbers of prescribed medications and the involvement of multiple visitors and caregivers at home.

“It takes a lot of mental load to know when to take a given medication, in what order and how many medications to take overall,” Zadeh said. “Without the right support and system in place, it can be really burdensome for the individuals receiving care, but also for their family members as well. The consequences of taking medications in error can negatively affect patients, their loves ones and their community as well.”

Based on lessons learned from the pilot program, Zadeh hopes to design a comprehensive and improved medication management home solution that can be extended to residents with cognitive impairment living in rural and urban communities.

“We want to make sure the solution is helpful for people from various backgrounds, whether they live close to or far from a health center,” Zadeh said. “Hopefully, this will be a steppingstone to a more refined version that works on a larger scale. If we have a working solution nationally, we can help older people live at their home longer with better quality of life, and prevent health issues, accidents and even deaths.”

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Abby Butler