Helping frail elderly people manage multiple medicines safely is the focus of a new research project led by Dr Beth Fylan, Senior Lecturer in Patient Safety in the Faculty of Life Sciences at the University of Bradford.
The potential impact is considerable: nearly 12 million people in the UK are over 65 and of those, around half suffer from more than one chronic condition, usually requiring them to take multiple medicines over a long period of time. Older people are also more likely to experience avoidable adverse drug events.
The £156,000 project will run for two years and is funded by the National Institute for Health Research (NIHR). It is being run through the NIHR Patient Safety Translational Research Centre and the Wolfson Centre for Applied Health Research, which are collaborations between the University of Bradford, Bradford Teaching Hospitals NHS Trust and the University of Leeds.
Dr Fylan explains: “Frail older people’s medicines regimens are often extremely complicated and it requires significant work to manage them safely. When older people aren’t supported to do this, they may be more likely to be admitted into hospital or suffer a fall from which they can find it hard to recover, leading to a downward spiral. Our aim is to help them manage things better, so they never enter that cycle.”
Rather than unpicking the causes of poor medicines management after something has gone wrong, the project aims to take a different approach, using a resilient healthcare framework.
This means the team will identify the safe and successful strategies older people and their carers can use to manage their medicines, including how they respond to changes in their own health and anticipate problems such as mistakes in repeat prescriptions. The researchers will then build on these insights to design an intervention with patients and healthcare staff to help others achieve similar success.
The project will focus on people over 65 who are taking multiple medicines and are categorised as mildly or moderately ‘frail’. This means they have a range of symptoms, such as hearing loss and tremors, and health conditions, such as heart disease or arthritis, all of which make them more vulnerable.
The team – involving academics, clinicians and patients at the University of Bradford, Bradford Teaching Hospitals NHS Trust, the University of Leeds and Doncaster Clinical Commissioning Group – will work with eight GP practices across Yorkshire and Humber.
They will interview patients and carers to understand the strategies they use and how the healthcare system supports or hinders these. Extracts from these interviews will be made into a short film that will be shown at workshops with healthcare staff, patients and carers to trigger thoughts, ideas and discussion about the issues raised.
Participants in the workshops will help identify the most important ideas to take forward, based on all the evidence presented and develop prototype interventions.
“It’s important that solutions are designed jointly by staff, carers and patients as each group has an important perspective on the challenges faced,” said Dr Fylan. “It’s a fascinating process to be part of – you can never predict what might come out of it. It could be as varied as a toolkit for patients to use at home or a ‘buddy scheme’ providing peer support to give patients and carers more confidence to talk to healthcare staff about any problems.”
The interventions identified through the workshops will then be tested in focus groups – again comprising healthcare staff, patients and carers – to see how easily they would be accepted by patients and their feasibility. The final outcome should be a system that is ready to be evaluated in a trial, alongside guidance for putting it into practice