{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T12:10:28Z","timestamp":1793275828807,"version":"4.5.0"},"reference-count":82,"publisher":"American Medical Association (AMA)","issue":"7","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Intern Med"],"published-print":{"date-parts":[[2026,7,1]]},"abstract":"<jats:sec id=\"ab-ioi260025-4\">\n                    <jats:title>Importance<\/jats:title>\n                    <jats:p>More than one-fourth of older individuals in the US with cognitive impairment live alone. These individuals often lack support for medication management and face a high risk of medication-related harm.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ioi260025-5\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To elucidate barriers and facilitators to medication management experienced by older adults living alone with cognitive impairment and their social contacts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ioi260025-6\">\n                    <jats:title>Design, Setting, and Participants<\/jats:title>\n                    <jats:p>This qualitative study was conducted between May 2016 and February 2024 among adults of diverse racial and ethnic backgrounds aged 55 years or older living alone with cognitive impairment in California, Louisiana, and Michigan (ie, participants), along with their social contacts, defined as family members or other familiar persons. Data were analyzed between February 2024 and March 2025.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ioi260025-7\">\n                    <jats:title>Main Outcomes and Measures<\/jats:title>\n                    <jats:p>As part of the Living Alone With Cognitive Impairment Project, participants\u2019 and social contacts\u2019 perspectives regarding barriers and facilitators were elicited via semistructured interviews conducted in English, Spanish, Cantonese, or Mandarin. Participants were interviewed a mean of 4 times (486 interviews total), mostly in their homes. Combined inductive and deductive thematic analysis was used to examine discussions specific to medication management.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ioi260025-8\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 116 older adults living alone with cognitive impairment (median [range] age, 74 [57-103] years; 86 females [74.1%]) and 54 social contacts (median [range] age, 59 [29-89] years; 44 females [81.5%]) were interviewed. At an individual level, barriers to medication management included a lack of reminders to take medications due to a lack of cohabitants, fear of experiencing adverse effects while alone, and stress related to managing complex medication regimens with inadequate support. At an interpersonal level, barriers included difficulty in verifying medication behaviors without cohabitants, distrust of health care professionals related to a desire to maintain independence, and communication barriers. At a system level, barriers included difficulty navigating health system logistics without advocates. Participants received crucial but intermittent support with medication management from noncohabiting social contacts. Both groups suggested potential solutions to barriers, but they nevertheless conveyed a sense of precarity related to medication management.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ioi260025-9\">\n                    <jats:title>Conclusions and Relevance<\/jats:title>\n                    <jats:p>This qualitative study involving racially and ethnically diverse participants from 3 states highlights the substantial barriers older adults living alone with cognitive impairment experience in managing their medications. Identification of cognitive impairment in older adults who live alone should spur targeted efforts to overcome medication-related challenges. In addition, more home- and community-based services are needed to provide medication management support to individuals living alone with cognitive impairment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1001\/jamainternmed.2026.1562","type":"journal-article","created":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T15:00:41Z","timestamp":1779807641000},"page":"838","source":"Crossref","is-referenced-by-count":3,"title":["Medication Management Among Older Adults Living Alone With Cognitive Impairment"],"prefix":"10.1001","volume":"186","author":[{"given":"Matthew E.","family":"Growdon","sequence":"first","affiliation":[{"name":"Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco"},{"name":"Geriatrics, Palliative, and Extended Care Service Line, San Francisco VA Medical Center, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krista L.","family":"Harrison","sequence":"additional","affiliation":[{"name":"Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco"},{"name":"Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael A.","family":"Steinman","sequence":"additional","affiliation":[{"name":"Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco"},{"name":"Geriatrics, Palliative, and Extended Care Service Line, San Francisco VA Medical Center, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren J.","family":"Hunt","sequence":"additional","affiliation":[{"name":"Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco"},{"name":"Department of Physiological Nursing, University of California, San Francisco, San Francisco"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robyn I.","family":"Stone","sequence":"additional","affiliation":[{"name":"Center for Applied Research, LeadingAge, Washington, DC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thi","family":"Tran","sequence":"additional","affiliation":[{"name":"Institute for Health & Aging, University of California, San Francisco, San Francisco"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julene K.","family":"Johnson","sequence":"additional","affiliation":[{"name":"Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Portacolone","sequence":"additional","affiliation":[{"name":"Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco"},{"name":"Institute for Health & Aging, University of California, San Francisco, San Francisco"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"12","key":"ioi260025r1","doi-asserted-by":"publisher","first-page":"1047","DOI":"10.1016\/j.jamda.2018.07.005","article-title":"Advancing research on care needs and supportive approaches for persons with dementia: recommendations and rationale.","volume":"19","author":"Kolanowski","year":"2018","journal-title":"J Am Med Dir Assoc"},{"issue":"2","key":"ioi260025r2","doi-asserted-by":"publisher","first-page":"271","DOI":"10.1093\/geront\/gnx193","article-title":"The precarity of older adults living alone with cognitive impairment.","volume":"59","author":"Portacolone","year":"2019","journal-title":"Gerontologist"},{"issue":"8","key":"ioi260025r3","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2023.29913","article-title":"Perceptions of the role of living alone in providing services to patients with cognitive impairment.","volume":"6","author":"Portacolone","year":"2023","journal-title":"JAMA Netw Open"},{"issue":"8","key":"ioi260025r4","doi-asserted-by":"publisher","first-page":"1125","DOI":"10.1002\/alz.12102","article-title":"Difficulty and help with activities of daily living among older adults living alone with cognitive impairment.","volume":"16","author":"Edwards","year":"2020","journal-title":"Alzheimers Dement"},{"issue":"12","key":"ioi260025r5","doi-asserted-by":"publisher","first-page":"3719","DOI":"10.1111\/jgs.19108","article-title":"High-risk medication use among older adults with cognitive impairment living alone in the United States.","volume":"72","author":"Growdon","year":"2024","journal-title":"J Am Geriatr Soc"},{"issue":"2","key":"ioi260025r6","doi-asserted-by":"publisher","first-page":"271","DOI":"10.1111\/j.1532-5415.2007.01047.x","article-title":"Adverse drug events resulting from patient errors in older adults.","volume":"55","author":"Field","year":"2007","journal-title":"J Am Geriatr Soc"},{"key":"ioi260025r7","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1080\/10810730.2013.825672","article-title":"Rethinking adherence: a health literacy-informed model of medication self-management.","volume":"18","author":"Bailey","year":"2013","journal-title":"J Health Commun"},{"issue":"1","key":"ioi260025r8","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1177\/1533317516673154","article-title":"Living alone with cognitive impairment.","volume":"32","author":"Gibson","year":"2017","journal-title":"Am J Alzheimers Dis Other Demen"},{"issue":"1","key":"ioi260025r9","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1517\/14740338.2013.827660","article-title":"Clinical consequences of polypharmacy in elderly.","volume":"13","author":"Maher","year":"2014","journal-title":"Expert Opin Drug Saf"},{"issue":"4","key":"ioi260025r10","doi-asserted-by":"publisher","first-page":"482","DOI":"10.1001\/jamainternmed.2015.8597","article-title":"Polypharmacy\u2014time to get beyond numbers.","volume":"176","author":"Steinman","year":"2016","journal-title":"JAMA Intern Med"},{"issue":"3","key":"ioi260025r11","doi-asserted-by":"publisher","first-page":"213","DOI":"10.2174\/1574884710666150812141525","article-title":"Ability of older people with dementia or cognitive impairment to manage medicine regimens: a narrative review.","volume":"10","author":"Elliott","year":"2015","journal-title":"Curr Clin Pharmacol"},{"issue":"12","key":"ioi260025r12","doi-asserted-by":"publisher","first-page":"1562","DOI":"10.1002\/gps.4985","article-title":"Medicines management issues in dementia and coping strategies used by people living with dementia and family carers: a systematic review.","volume":"33","author":"Lim","year":"2018","journal-title":"Int J Geriatr Psychiatry"},{"issue":"2","key":"ioi260025r13","doi-asserted-by":"publisher","DOI":"10.1002\/gps.5673","article-title":"How do people with dementia make sense of their medications? An interpretative phenomenological analysis study.","volume":"37","author":"Lim","year":"2022","journal-title":"Int J Geriatr Psychiatry"},{"issue":"1","key":"ioi260025r14","doi-asserted-by":"publisher","first-page":"44","DOI":"10.1111\/ijpp.12158","article-title":"Assisting people with dementia with their medicines: experiences of family carers.","volume":"23","author":"Smith","year":"2015","journal-title":"Int J Pharm Pract"},{"issue":"10","key":"ioi260025r15","doi-asserted-by":"publisher","first-page":"3011","DOI":"10.1111\/jgs.19065","article-title":"Managing medications among individuals with mild cognitive impairment and dementia: patient-caregiver perspectives.","volume":"72","author":"O\u2019Conor","year":"2024","journal-title":"J Am Geriatr Soc"},{"issue":"6","key":"ioi260025r16","doi-asserted-by":"publisher","first-page":"349","DOI":"10.1093\/intqhc\/mzm042","article-title":"Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups.","volume":"19","author":"Tong","year":"2007","journal-title":"Int J Qual Health Care"},{"issue":"10","key":"ioi260025r17","doi-asserted-by":"publisher","first-page":"6021","DOI":"10.3390\/ijerph19106021","article-title":"The Living Alone With Cognitive Impairment Project\u2019s Policy Advisory Group on Long-Term Services and Supports: setting a research equity agenda.","volume":"19","author":"Portacolone","year":"2022","journal-title":"Int J Environ Res Public Health"},{"issue":"4","key":"ioi260025r18","doi-asserted-by":"publisher","first-page":"351","DOI":"10.1177\/109019818801500401","article-title":"An ecological perspective on health promotion programs.","volume":"15","author":"McLeroy","year":"1988","journal-title":"Health Educ Q"},{"issue":"1","key":"ioi260025r19","doi-asserted-by":"publisher","first-page":"102","DOI":"10.1177\/10497315241256560","article-title":"Transferability and generalization in qualitative research.","volume":"35","author":"Drisko","year":"2025","journal-title":"Res Soc Work Pract"},{"issue":"9280","key":"ioi260025r20","doi-asserted-by":"publisher","first-page":"483","DOI":"10.1016\/S0140-6736(01)05627-6","article-title":"Qualitative research: standards, challenges, and guidelines.","volume":"358","author":"Malterud","year":"2001","journal-title":"Lancet"},{"issue":"1","key":"ioi260025r21","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1177\/0164027595171005","article-title":"Sampling in qualitative research: rationale, issues, and methods.","volume":"17","author":"Luborsky","year":"1995","journal-title":"Res Aging"},{"issue":"4","key":"ioi260025r22","doi-asserted-by":"publisher","first-page":"897","DOI":"10.1177\/14733250211024516","article-title":"Big enough? Sampling in qualitative inquiry.","volume":"20","author":"Staller","year":"2021","journal-title":"Qual Soc Work"},{"issue":"4","key":"ioi260025r23","doi-asserted-by":"publisher","first-page":"3000","DOI":"10.1002\/alz.13612","article-title":"Mapping racial and ethnic healthcare disparities for persons living with dementia: A scoping review.","volume":"20","author":"Hinton","year":"2024","journal-title":"Alzheimers Dement"},{"issue":"8","key":"ioi260025r24","doi-asserted-by":"publisher","first-page":"679","DOI":"10.1097\/MLR.0000000000001577","article-title":"Dementia diagnosis disparities by race and ethnicity.","volume":"59","author":"Lin","year":"2021","journal-title":"Med Care"},{"issue":"12","key":"ioi260025r25","doi-asserted-by":"publisher","first-page":"2954","DOI":"10.1111\/jan.13031","article-title":"Systematic methodological review: developing a framework for a qualitative semi-structured interview guide.","volume":"72","author":"Kallio","year":"2016","journal-title":"J Adv Nurs"},{"issue":"2","key":"ioi260025r26","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1177\/1471301204042332","article-title":"Make it easy on yourself!: advice to researchers from someone with dementia on being interviewed.","volume":"3","author":"McKillop","year":"2004","journal-title":"Dementia (London)"},{"issue":"9","key":"ioi260025r27","doi-asserted-by":"publisher","first-page":"1277","DOI":"10.1177\/1049732305276687","article-title":"Three approaches to qualitative content analysis.","volume":"15","author":"Hsieh","year":"2005","journal-title":"Qual Health Res"},{"issue":"2","key":"ioi260025r28","doi-asserted-by":"publisher","first-page":"237","DOI":"10.1177\/1098214005283748","article-title":"A general inductive approach for analyzing qualitative evaluation data.","volume":"27","author":"Thomas","year":"2006","journal-title":"Am J Eval"},{"issue":"1","key":"ioi260025r30","doi-asserted-by":"publisher","first-page":"91","DOI":"10.5014\/ajot.2013.005033","article-title":"Using daily routines to promote medication adherence in older adults.","volume":"67","author":"Sanders","year":"2013","journal-title":"Am J Occup Ther"},{"issue":"1","key":"ioi260025r31","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/afab207","article-title":"In-home medication management by older adults: a modified ethnography study using digital photography walkabouts.","volume":"51","author":"Faisal","year":"2022","journal-title":"Age Ageing"},{"issue":"12","key":"ioi260025r33","doi-asserted-by":"publisher","first-page":"1033","DOI":"10.2165\/0002512-200825120-00005","article-title":"Adherence to medication in patients with dementia: predictors and strategies for improvement.","volume":"25","author":"Arlt","year":"2008","journal-title":"Drugs Aging"},{"issue":"23","key":"ioi260025r34","doi-asserted-by":"publisher","first-page":"2461","DOI":"10.1001\/jama.2018.19271","article-title":"Interventions to improve medication adherence: a review.","volume":"320","author":"Kini","year":"2018","journal-title":"JAMA"},{"issue":"2","key":"ioi260025r35","doi-asserted-by":"publisher","first-page":"244","DOI":"10.1007\/s41666-024-00161-w","article-title":"A systematic review on pill and medication dispensers from a human-centered perspective.","volume":"8","author":"Gargioni","year":"2024","journal-title":"J Healthc Inform Res"},{"key":"ioi260025r36","doi-asserted-by":"publisher","DOI":"10.3389\/fdgth.2025.1523070","article-title":"Artificial intelligence-based tools for patient support to enhance medication adherence: a focused review.","volume":"7","author":"Reis","year":"2025","journal-title":"Front Digit Health"},{"issue":"3","key":"ioi260025r37","doi-asserted-by":"publisher","first-page":"399","DOI":"10.18553\/jmcp.2021.27.3.399","article-title":"Is it time to replace the star ratings adherence measures?","volume":"27","author":"Farley","year":"2021","journal-title":"J Manag Care Spec Pharm"},{"key":"ioi260025r40","first-page":"1284","article-title":"Enhancing patient medication safety at home: a patient-facing technology architecture integrating REDCap, visualization dashboards, and an AI-driven chatbot.","volume":"2024","author":"Yu","year":"2025","journal-title":"AMIA Annu Symp Proc"},{"issue":"5","key":"ioi260025r41","doi-asserted-by":"publisher","first-page":"827","DOI":"10.1001\/jamainternmed.2015.0324","article-title":"Reducing inappropriate polypharmacy: the process of deprescribing.","volume":"175","author":"Scott","year":"2015","journal-title":"JAMA Intern Med"},{"issue":"3","key":"ioi260025r42","doi-asserted-by":"publisher","first-page":"284","DOI":"10.1001\/jama.2010.2015","article-title":"Finding the right level of posthospital care: \u201cwe didn\u2019t realize there was any other option for him\u201d.","volume":"305","author":"Kane","year":"2011","journal-title":"JAMA"},{"issue":"5","key":"ioi260025r44","doi-asserted-by":"publisher","first-page":"367","DOI":"10.1089\/pop.2014.0096","article-title":"Application of PACE principles for population health management of frail older adults.","volume":"18","author":"Stefanacci","year":"2015","journal-title":"Popul Health Manag"},{"issue":"3","key":"ioi260025r45","doi-asserted-by":"publisher","DOI":"10.2196\/35157","article-title":"Technologies for medication adherence monitoring and technology assessment criteria: narrative review.","volume":"10","author":"Mason","year":"2022","journal-title":"JMIR Mhealth Uhealth"},{"issue":"10","key":"ioi260025r46","first-page":"E1","article-title":"Guiding principles for the care of older adults with multimorbidity: an approach for clinicians: American Geriatrics Society Expert Panel on the Care of Older Adults With Multimorbidity.","volume":"60","year":"2012","journal-title":"J Am Geriatr Soc"},{"key":"ioi260025r48","first-page":"1783","article-title":"Residence, living situation, and living conditions information documentation in clinical practice.","volume":"2017","author":"Winden","year":"2018","journal-title":"AMIA Annu Symp Proc"},{"issue":"12","key":"ioi260025r49","doi-asserted-by":"publisher","first-page":"2716","DOI":"10.1093\/jamia\/ocab170","article-title":"Extracting social determinants of health from electronic health records using natural language processing: a systematic review.","volume":"28","author":"Patra","year":"2021","journal-title":"J Am Med Inform Assoc"},{"issue":"1","key":"ioi260025r50","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1186\/s13326-019-0198-0","article-title":"Moonstone: a novel natural language processing system for inferring social risk from clinical narratives.","volume":"10","author":"Conway","year":"2019","journal-title":"J Biomed Semantics"},{"issue":"9","key":"ioi260025r51","doi-asserted-by":"publisher","first-page":"2958","DOI":"10.1111\/jgs.19540","article-title":"Older adults without family caregivers need better access to Medicaid support services.","volume":"73","author":"Dickman","year":"2025","journal-title":"J Am Geriatr Soc"},{"issue":"3","key":"ioi260025r52","doi-asserted-by":"publisher","first-page":"571","DOI":"10.1111\/jgs.13315","article-title":"Pharmacist calls to older adults with cognitive difficulties after discharge in a tertiary Veterans Administration medical center: a quality improvement program.","volume":"63","author":"Paquin","year":"2015","journal-title":"J Am Geriatr Soc"},{"issue":"1","key":"ioi260025r53","doi-asserted-by":"publisher","first-page":"83","DOI":"10.3233\/JAD-190162","article-title":"The impact of pharmacist interventions on quality use of medicines, quality of life, and health outcomes in people with dementia and\/or cognitive impairment: a systematic review.","volume":"71","author":"Nguyen","year":"2019","journal-title":"J Alzheimers Dis"},{"issue":"2","key":"ioi260025r54","doi-asserted-by":"publisher","first-page":"366","DOI":"10.1177\/14713012251332350","article-title":"Living alone with dementia: supportive care for dementia, a replicable model for support and lessons learned.","volume":"25","author":"Hamilton","year":"2026","journal-title":"Dementia (London)"},{"issue":"3","key":"ioi260025r55","doi-asserted-by":"publisher","first-page":"76","DOI":"10.1093\/ppar\/praf010","article-title":"Bridging the care gap for people living alone with dementia.","volume":"35","author":"Menne","year":"2025","journal-title":"Public Policy Aging Rep"},{"issue":"11","key":"ioi260025r56","doi-asserted-by":"publisher","first-page":"1322","DOI":"10.1016\/j.jagp.2024.07.006","article-title":"Living alone with dementia: a reality check.","volume":"32","author":"Portacolone","year":"2024","journal-title":"Am J Geriatr Psychiatry"},{"issue":"1","key":"ioi260025r57","doi-asserted-by":"publisher","DOI":"10.1093\/geroni\/igab004","article-title":"Use of services by people living alone with cognitive impairment: a systematic review.","volume":"5","author":"Rosenwohl-Mack","year":"2021","journal-title":"Innov Aging"},{"issue":"4","key":"ioi260025r58","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2025.3316","article-title":"Perspectives on AI and novel technologies among older adults, clinicians, payers, investors, and developers.","volume":"8","author":"Schoenborn","year":"2025","journal-title":"JAMA Netw Open"},{"issue":"8","key":"ioi260025r59","doi-asserted-by":"publisher","first-page":"580","DOI":"10.7326\/0003-4819-157-8-201210160-00013","article-title":"Rethinking adherence.","volume":"157","author":"Steiner","year":"2012","journal-title":"Ann Intern Med"},{"issue":"6","key":"ioi260025r60","doi-asserted-by":"publisher","first-page":"1223","DOI":"10.1111\/jgs.14164","article-title":"Potentially unsafe activities and living conditions of older adults with dementia.","volume":"64","author":"Amjad","year":"2016","journal-title":"J Am Geriatr Soc"},{"issue":"6","key":"ioi260025r61","doi-asserted-by":"publisher","first-page":"901","DOI":"10.1093\/geront\/gnv130","article-title":"Lifespan and healthspan: past, present, and promise.","volume":"55","author":"Crimmins","year":"2015","journal-title":"Gerontologist"},{"issue":"7","key":"ioi260025r62","doi-asserted-by":"publisher","first-page":"1131","DOI":"10.1007\/s11606-018-4377-y","article-title":"Underdiagnosis of dementia: an observational study of patterns in diagnosis and awareness in US older adults.","volume":"33","author":"Amjad","year":"2018","journal-title":"J Gen Intern Med"},{"issue":"9","key":"ioi260025r63","doi-asserted-by":"publisher","first-page":"1710","DOI":"10.1093\/geronb\/gbac057","article-title":"The graying of divorce: a half century of change.","volume":"77","author":"Brown","year":"2022","journal-title":"J Gerontol B Psychol Sci Soc Sci"},{"issue":"4","key":"ioi260025r64","doi-asserted-by":"publisher","first-page":"661","DOI":"10.1007\/s11113-020-09604-9","article-title":"Trends in intentions to remain childless in the United States.","volume":"40","author":"Rybinska","year":"2021","journal-title":"Popul Res Policy Rev"},{"issue":"1","key":"ioi260025r65","doi-asserted-by":"publisher","first-page":"62","DOI":"10.7812\/TPP\/07-057","article-title":"The B-SMART appropriate medication-use process: a guide for clinicians to help patients\u2014part 1: barriers, solutions, and motivation.","volume":"13","author":"Oyekan","year":"2009","journal-title":"Perm J"},{"key":"ioi260025r66","doi-asserted-by":"publisher","first-page":"175","DOI":"10.2147\/PPA.S151263","article-title":"Medication adherence and beliefs about medication in elderly patients living alone with chronic diseases.","volume":"12","author":"Park","year":"2018","journal-title":"Patient Prefer Adherence"},{"issue":"6","key":"ioi260025r67","doi-asserted-by":"publisher","first-page":"555","DOI":"10.1016\/S0022-3999(99)00057-4","article-title":"Patients\u2019 beliefs about prescribed medicines and their role in adherence to treatment in chronic physical illness.","volume":"47","author":"Horne","year":"1999","journal-title":"J Psychosom Res"},{"issue":"3","key":"ioi260025r68","doi-asserted-by":"publisher","first-page":"724","DOI":"10.1007\/s11606-019-05463-z","article-title":"What is a medication-related problem? A qualitative study of older adults and primary care clinicians.","volume":"35","author":"Nicosia","year":"2020","journal-title":"J Gen Intern Med"},{"issue":"1","key":"ioi260025r69","doi-asserted-by":"publisher","first-page":"46","DOI":"10.1186\/1471-2318-12-46","article-title":"Frail elderly patients\u2019 experiences of information on medication. A qualitative study.","volume":"12","author":"Modig","year":"2012","journal-title":"BMC Geriatr"},{"issue":"4","key":"ioi260025r70","doi-asserted-by":"publisher","first-page":"863","DOI":"10.1007\/s11606-020-06279-y","article-title":"Difficulty with taking medications is associated with future diagnosis of Alzheimer\u2019s disease and related dementias.","volume":"36","author":"Barthold","year":"2021","journal-title":"J Gen Intern Med"},{"issue":"2","key":"ioi260025r71","doi-asserted-by":"publisher","first-page":"132","DOI":"10.1177\/1533317515598859","article-title":"Adherence to medication regimens is an effective indicator of cognitive dysfunction in elderly individuals.","volume":"31","author":"Mizokami","year":"2016","journal-title":"Am J Alzheimers Dis Other Demen"},{"key":"ioi260025r72","doi-asserted-by":"publisher","DOI":"10.1007\/s41999-025-01376-9","article-title":"Association of impaired medication adherence with subsequent clinical recognition of dementia or cognitive impairment in older veterans.","author":"Buteyn","journal-title":"Eur Geriatr Med"},{"issue":"11","key":"ioi260025r73","doi-asserted-by":"publisher","first-page":"1764","DOI":"10.1093\/jamia\/ocaa143","article-title":"Social determinants of health in electronic health records and their impact on analysis and risk prediction: a systematic review.","volume":"27","author":"Chen","year":"2020","journal-title":"J Am Med Inform Assoc"},{"issue":"17-18","key":"ioi260025r74","doi-asserted-by":"publisher","first-page":"E474","DOI":"10.1503\/cmaj.160177","article-title":"Taking action on the social determinants of health in clinical practice: a framework for health professionals.","volume":"188","author":"Andermann","year":"2016","journal-title":"CMAJ"},{"issue":"11","key":"ioi260025r75","doi-asserted-by":"publisher","first-page":"1429","DOI":"10.1007\/s11606-014-2977-8","article-title":"Living alone, socially isolated or lonely\u2014what are we measuring?","volume":"29","author":"Perissinotto","year":"2014","journal-title":"J Gen Intern Med"},{"issue":"4","key":"ioi260025r76","doi-asserted-by":"publisher","first-page":"293","DOI":"10.1007\/s12126-010-9062-3","article-title":"Long distance caregiving: an evaluative review of the literature.","volume":"35","author":"Bledsoe","year":"2010","journal-title":"Ageing Int"},{"key":"ioi260025r77","doi-asserted-by":"publisher","DOI":"10.1016\/j.ssmph.2021.100905","article-title":"Community-engaged healthcare model for currently under-served individuals involved in the healthcare system.","volume":"15","author":"Barker","year":"2021","journal-title":"SSM Popul Health"},{"issue":"1","key":"ioi260025r78","doi-asserted-by":"publisher","DOI":"10.1093\/haschl\/qxae180","article-title":"Paying for home care out-of-pocket is common and costly across the income spectrum among older adults.","volume":"3","author":"Shen","year":"2025","journal-title":"Health Aff Sch"},{"issue":"2","key":"ioi260025r81","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1177\/08445621211060935","article-title":"Recruitment of community-based samples: experiences and recommendations for optimizing success.","volume":"54","author":"Garnett","year":"2022","journal-title":"Can J Nurs Res"},{"issue":"2","key":"ioi260025r82","first-page":"86","article-title":"Approaches to recruiting \u2018hard-to-reach\u2019 populations into re-search: a review of the literature.","volume":"1","author":"Shaghaghi","year":"2011","journal-title":"Health Promot Perspect"},{"key":"ioi260025r29","volume-title":"Qualitative Data Analysis: A Methods Sourcebook","author":"Miles","year":"2019","edition":"4th ed"},{"key":"ioi260025r32","doi-asserted-by":"crossref","unstructured":"Maidment? ID, Lawson? S, Wong? G, . Medication Management in Older People: The MEMORABLE Realist Synthesis. NIHR Journals Library; 2020. Accessed February 20, 2026. https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK558337\/","DOI":"10.1186\/s12877-020-01568-x"},{"key":"ioi260025r38","unstructured":"US Food and Drug Administration. Where and how to dispose of unused medicines. April 16, 2025. Accessed November 1, 2025. https:\/\/www.fda.gov\/consumers\/consumer-updates\/where-and-how-dispose-unused-medicines"},{"key":"ioi260025r39","unstructured":"Best Practice Advocacy Centre New Zealand. Upfront: waste not want not. Reducing wastage. September 2009. Accessed February 1, 2026. https:\/\/bpac.org.nz\/bpj\/2009\/september\/upfront.aspx"},{"key":"ioi260025r43","unstructured":"Most older adults with cognitive impairment who live alone cannot access public home care aides. Living Alone With Cognitive Impairment policy brief 3. Winter 2024. Accessed February 18, 2026. https:\/\/livingalone.ucsf.edu\/policy-briefs"},{"key":"ioi260025r47","unstructured":"Diagnosis of cognitive impairment: challenges and opportunities for older adults living alone. Living Alone With Cognitive Impairment policy brief 2. Fall 2023. Accessed February 18, 2026. https:\/\/livingalone.ucsf.edu\/policy-briefs"},{"key":"ioi260025r79","unstructured":"Spetz? J. Home health aides and personal care assistants: scope of practice regulations and their impact on care. Healthforce Center at UCSF. July 2019. Accessed February 1, 2026. https:\/\/collections.nlm.nih.gov\/catalog\/nlm:nlmuid-101764269-pdf"},{"key":"ioi260025r80","unstructured":"CMS Innovation Center. Guiding an Improved Dementia Experience (GUIDE) Model. Centers for Medicare and Medicaid Services. July 1, 2024. Accessed February 1, 2026. https:\/\/innovation.cms.gov\/innovation-models\/guide"}],"container-title":["JAMA Internal Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamainternalmedicine\/articlepdf\/2849086\/jamainternal_growdon_2026_oi_260025_1781812054.51599.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T15:02:55Z","timestamp":1783350175000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamainternalmedicine\/fullarticle\/2849086"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,1]]},"references-count":82,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2026,7,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamainternmed.2026.1562","relation":{},"ISSN":["2168-6106"],"issn-type":[{"value":"2168-6106","type":"print"}],"subject":[],"published":{"date-parts":[[2026,7,1]]}}}