# Medication Management During Hospital-to-Home Transitions of Older Adults with Alzheimer's Disease and Related Dementias (ADRD)

> **NIH NIH R03** · JOHNS HOPKINS UNIVERSITY · 2020 · $163,750

## Abstract

Care transitions are the movement of a person from one healthcare setting to another. The hospital-to-home
transition is a high-risk period, especially for medication errors and adverse events and for persons with
Alzheimer's disease and related dementias (ADRD). There is relatively little research to guide care transition
improvement efforts for the ADRD population. An area of particular risk for older adults with ADRD during the
hospital-to-home transition is role ambiguity regarding medication management (MM). Role ambiguity in MM
occurs when the roles of older adults with ADRD, informal caregivers, and healthcare providers remain without
a clear definition of who is responsible for completion of MM-related tasks, such as medication reconciliation.
The goal of the current proposal is to (1) identify issues related to role ambiguity regarding medication
management that threaten the safety of older adults with ADRD during hospital-to-home transitions, and (2)
engage stakeholders to develop a set of strategies specific to ADRD to decrease role ambiguity and support
MM during this high-risk transition.
Specific Aim 1: Identify critical tasks regarding medication management and categorize factors shaping
expectations for task distribution during hospital-to-home transitions of older adults with ADRD. We will
develop process-flow diagrams of critical MM tasks and categorize factors shaping older adult and informal
caregiver expectations for MM task distribution through (1) direct observations and interviews during initial home
health visits of recently hospitalized older adults with ADRD and their informal caregivers; (2) photographs of
objects used to support MM in the home; and (3) solicited participant diaries followed by post-diary semi-
structured interviews with informal caregivers.
Specific Aim 2: Identify and prioritize stakeholder strategies to manage expectations and distribute tasks
to decrease role ambiguity and support successful medication management during hospital-to-home
transitions. Guided by a participatory ergonomics approach from the field of human factors engineering, we will
form an intervention refinement team (IRT) comprised of older adults with ADRD, informal caregivers, and
healthcare providers involved in hospital-to-home transitions. The IRT will meet to use findings from the hospital-
to-home process-flow diagram (Aim 1) to develop strategies and rate each strategy according to (1) importance
to reducing role ambiguity, (2) likelihood of effectiveness in supporting MM, and (3) level of actionability.
The long-term goal of our research is to develop, evaluate, and disseminate best practices to deliver optimal
health care to older adults with ADRD in all stages of disease as they transition across healthcare settings.
Completion of these aims will result in a stakeholder-informed set of strategies to support MM. Study findings
will build a foundation for future work to develop and test a behavioral or technological soluti...

## Key facts

- **NIH application ID:** 9914197
- **Project number:** 5R03AG063083-02
- **Recipient organization:** JOHNS HOPKINS UNIVERSITY
- **Principal Investigator:** Alicia Ines Arbaje
- **Activity code:** R03 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $163,750
- **Award type:** 5
- **Project period:** 2019-04-15 → 2022-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9914197

## Citation

> US National Institutes of Health, RePORTER application 9914197, Medication Management During Hospital-to-Home Transitions of Older Adults with Alzheimer's Disease and Related Dementias (ADRD) (5R03AG063083-02). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/9914197. Licensed CC0.

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