New research aims to help GPs and pharmacists with a more structured way of managing their patients who are on multiple medications during the pandemic.

Older people and family carers often find medication management challenging and burdensome particularly for complex regimens and researchers say the new approach rooted in real-world experience is needed to tackle the “unrivalled complexity” many older people and family carers face.

They identified five ‘key burdens’ faced by older people and their family carers. These included ‘ambiguity’, where the purpose of medicines was not explained clearly, through to ‘fragmentation’ from having to deal with lots of different health and care practitioners and ‘exclusion’ when older people and family carers were not involved in care decisions.

Around half of the UK’s 12 million people aged 65 or over regularly take five or more separate medicines for long-term health conditions. And even before the coronavirus crisis, it was estimated that errors such as taking the wrong medication cause or contribute to over 2,400 deaths per year.  

Regular reviews of medications are still needed

The study published in the journal BMC Geriatrics was conducted by researchers from Aston University between 2017 and 2019 in collaboration with the universities of Oxford, Sheffield, Bradford and Wollongong and the NHS. 

The team led by Dr Ian Maidment was behind the MEMORABLE (MEdication Management in Older people: Realist Approaches Based on Literature and Evaluation) study, funded by the National Institute for Health Research (NIHR). In the MEMORABLE study, the researchers reviewed existing academic literature and carried out 50 in-depth interviews with older people, their family carers and health and care practitioners.

The five-stage framework for clinicians to help older people and family carers manage medication more effectively places greater emphasis on the need for regular reviews of the medications older people are taking involving patients and their carers – something that isn’t always done routinely at present.

Polypharmacy is a huge burden in lockdown

Dr Ian Maidment, from Aston University’s School of Life and Health Sciences, said: “The reality is that many older people are taking what amounts to a ‘shopping list’ of different medicines. They may all be necessary, but older people and their family carers have told us what a huge burden it can be to remember how and when to take them all. And that was in ordinary times without the added pressures of lockdown.

“Many older people may struggle to access their GP and pharmacy right now and with such bad news every day, may even be avoiding asking for help because they don’t want to be putting further strain on the NHS. We urgently need further research on the impact of Covid and I am planning future research in this area.

“What we’re hoping to show with this study is that practitioners need to be aware that the burden and risk with medication is often hidden. There needs to be a simpler way of identifying people who are struggling and more emphasis on fitting managing medication into older people’s day-to-day lives. When prescribing new drugs, GPs will often consider things like side effects, but they equally need to think about how someone will actually manage taking them. That human side needs to be front and centre.”