Provider Perspectives On Managing Medications At Home: Evaluating Adherence And Home Care Settings For Older Adults With Cognitive Impairment

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Medication nonadherence is a pervasive and complex issue among community-dwelling older adults with mild, moderate, or advanced cognitive impairment (CI). Successful management requires patient-specific solutions, strong collaboration between providers and caregivers, and well-implemented and scalable policies and practices. Although nonadherence is an issue for 70% of older adults with CI, state-level assessments of medication management barriers, challenges, and problems are missing. Currently absent are carefully tailored, evidence-based solutions driven by the working relationships and practices of home healthcare providers who serve older adults with CI across New York State. Knowledge of the effectiveness of current solutions used by professionals in practice needs to be improved, and improvements must involve assessment and feedback from professionals regarding shortcomings spurred by noticed risk factors and barriers to current solutions. This thesis showcases the craft of a needs assessment survey tool directed at home healthcare professionals within New York State. It examines the critical criteria surrounding nonadherence among older adults with CI living at home. As part of a larger study funded by the National Institute of Aging and Cornell University’s Center for Health Equity, a state-specific survey to gather home healthcare professional perspectives on medication management was developed in close collaboration with providers, university partners, and state-level advocacy organizations. Survey participants are healthcare professionals from Certified Home Health Agencies (CHHAs) or Licensed Home Care Services Agencies (LHCSAs) in New York State. This thesis shares study methods, including review and adaptation of prior assessment tools to create a state-specific survey, preliminary pilot findings from the dissemination of the adapted survey to local partners in Tompkins County, NY, and recommendations for survey and sampling revisions for a state-wide survey.

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78 pages


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Sagha Zadeh, Rana

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Safi, Amelia

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Design and Environmental Analysis

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M.S., Design and Environmental Analysis

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Master of Science

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dissertation or thesis

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