Medicines in an ageing society – an interdisciplinary research programme: MED-AGE

Medicines use in older people has been described as the ‘single most important health care intervention in the industrialised world’ (13).

Medicines have contributed enormously to management of medical conditions, improvements in quality of life and life expectancy.

However, medicines are not without risk in older people, who are more susceptible to adverse effects, the ‘prescribing cascade’ (a medicine is prescribed to counteract the side-effects of another medicine), inappropriate prescribing in care homes and polypharmacy (14).

In the United Kingdom (UK), approximately two million older individuals are reported to take at least seven prescribed medications (15). Detailed organisation is required by older people to manage multiple medicines. They develop strategies to ‘fit’ medicines into their routines to align with personal values and priorities (16).

Older people make decisions on which are the most important medicines to take, but also express anxiety about the consequences of not taking medicines (17).

Medicines have been employed as ‘chemical restraints’, particularly in care homes, and deliberately misused to sedate and subdue older residents (18).

How older people access health care, and by extension, medicines, has changed, resulting from a hugely pressurised National Health Service (NHS) and the continuing legacy of the COVID-19 pandemic.

Primary care is experiencing profound workforce pressures and general practitioners (GPs) and their patients experience lengthy delays in accessing secondary care services (19).

In parallel, community pharmacy is also experiencing workforce shortages, and its ability to continue to provide services to older people and those who may be living in disadvantaged areas is uncertain (20).

The projects listed below (encompassing cross-disciplinary supervision) will bring a unique research lens to this doctoral training programme.

These projects focus on the use and access to medicines by older people and reflect the challenges highlighted above, including appropriateness, empowerment, the healthcare environment and improving quality of life (see Figure 1).

Ultimately, the research will seek to contribute to a delay or reduce future health and social care requirements and improve quality of life, key elements of DMT’s priority areas.

Polypharmacy within the NICOLA cohort and impact on quality of life: Many older people take more than five medications (polypharmacy); some take more than 10 (hyperpolypharmacy).

Using the NICOLA cohort (n=8500 people >50-years old), data linkage will be used to ascertain the impact of polypharmacy on quality of life, frailty, hospital admissions, predicting admission to care homes.

This will be supplemented with case studies (n=20 participants) to explore the impact of polypharmacy on participants’ lives.

Non-prescription medication use amongst older adults: Most research on medication burden in older adults focuses on prescribed medications.

This project will use a mixed methods approach to establish the extent of non-prescription medication use amongst older adults, explore motivations for and consequences of using these medications, and develop strategies to improve data sources on non-prescription medication use for healthcare professionals.

Evidence and access to a novel treatment in the management of knee osteoarthritis: acceptability and feasibility in a primary care setting: Following the pandemic, there has been a marked increase in waiting times for a knee replacement in older people (approximately five years in Northern Ireland).

This project will evaluate evidence and accessibility to platelet-rich plasma (PRP) injections for symptom management, through a systematic review of the evidence and a feasibility study (mixed methods) to assess acceptability to older patients and practitioners.

Age-friendly accessibility strategies for community pharmacies: Community pharmacies are essential health hubs for older people receiving multiple medicines.

This project will use geospatial data to assess accessibility and quality of the built environment surrounding community pharmacies in Northern Ireland (n= c.530) for easy access by older adults.

Thereafter, a sample of c.30 case study pharmacies will be sampled, and using qualitative interviews with older people, potential environmental barriers to community pharmacies will be explored, leading to recommendations to support age-friendly city strategies.

Improving oral health for older adults in care homes: Prevention and management of malnutrition in care homes is a significant clinical challenge.

Residents are often provided with diets rich in complex carbohydrates, including sugars, plus additional sugared medications and oral nutritional supplements to increase caloric intake, leading to oral health problems.

This project will develop and pilot test (through co-production with residents and staff) nutritional interventions for older adults which better consider oral health in terms of medicines and supplements.

Using participatory action research to empower and inform older people about their medication use: Although many older people take multiple medicines daily, they may have limited knowledge of benefits, side effects and interactions associated with their medicines.

This project will investigate how an empowerment approach to education on medicines may help older people to be more critical and informed about medicines, and how health and social work professionals can support older people and their families in medicines management activities.

Developing a human rights approach to medication management in residential care for older people: There is increasing awareness that abuse in institutional settings for older people is high and underreported.

Promoting a human rights approach to residential living encourages older people’s involvement in when and how medication/treatment is provided and identifying and preventing abuse associated with medications.

Co-production methods will be used to explore patterns of medication abuse and elicit perceptions of older people, care home staff and family members of how medications may be managed in this setting.

Examining the potential of using linked, administrative data to evaluate the impact of general practice pharmacists on the health and wellbeing of older people in NI: In 2015, a pilot scheme was introduced to integrate general practice-based pharmacists (PBPs) into primary care to relieve GP pressure and provide many services focusing on medicines which could benefit the older population.

The scheme was rolled out in NI in geographic phases providing the perfect environment for a natural experiment.

This project will use population-wide linked administrative data to examine a range of health outcomes before and after PBP integration, e.g. mortality, hospitalisation (focusing on medicines) to evaluate the impact of PBPs in improving quality of life for older people.