Helping older people manage their medications: the MEMORABLE study
As people get older, the likelihood of taking daily pills for a variety of health conditions increases. But dealing with lots of tablets makes managing them more difficult. Sometimes people forget or choose not to take them for a number of different reasons.
Poor medication management can limit the benefits from the pills. It can have cost implications for the NHS. For people with dementia and memory problems, taking the right pills at the right time can be particularly difficult.
A National Institute of Health Research (NIHR)-funded project is underway to look at how this can be improved. The MEMORABLE study aims to improve the way older people are able to manage their medications, particularly where this involves taking a lot of different pills. The project is led by Dr Ian Maidment and supported by a small team of clinicians, researchers and patients/carers, all expert in their own areas.
As part of the project, the team have looked at what has already been written about medication management. They have also talked to older people, carers, doctors, nurses and pharmacists to understand their day-to-day experiences and what they think would make managing medications better and easier.
By knowing more about their first-hand experience, the study team will then make suggestions about how medication management might be improved.
46 older people, their carers and doctors, nurses and pharmacists have been interviewed as part of the research. Seven were recruited through Join Dementia Research.
“Join Dementia Research was really useful in helping deliver MEMORABLE to time and target,” said Dr Maidment. “In addition to helping with recruitment, they raised the profile of the study. Registration was straight-forward. If you have a research project in dementia, I would strongly recommend using the service.”
The study is due to finish in December 2018, after which the team will publish their findings.
Dr Ian Maidment, Reader in Clinical Pharmacy, Aston University, wrote a blog, originally published in The Conversation, which explains why this area of research is so important. You can read the full blog below.
Medication nation: new research shows nearly half of all older people now taking at least five medicines
Dr Ian Maidment
Researcher in Clinical Pharmacy, Aston University
More and more people are relying on their daily dose of medication for long-term health conditions. Recent figures show that prescriptions for antidepressant medications are on the rise with treatments for diabetes among the most commonly prescribed. However, the greatest number of prescriptions dispensed in 2016 in England were to treat hypertension and heart failure.
Maybe this last one isn’t totally surprising given that more people are living longer – into their sixties and well beyond.
People over this age are more likely to be taking a number of medicines, and our recent research has found a large increase in the number of older people taking multiple medications.
These numbers have increased by over 400% in the past 20 years – with nearly half of all older people now taking at least five medicines. Compare this with the 12% of people over 65 on this number of medications between 1991 and 1994, and you can see this increase has been massive.
Worryingly though, previous findings show that between a third and a half of all medicines for long term illnesses are not taken correctly. And we found that the more medicines someone takes, the more difficult it is for them to take them as recommended by the doctors.
In reality this means that some older people may struggle to remember to take these complex regimens of medications – particularly if they suffer from any symptoms of dementia. And of course if they don’t take the medicines properly, their illnesses may get worse or they may suffer nasty side effects.
This is something of a growing problem – the NHS spends £300m every year on medicines that aren’t taken, while so-called “medication-related adverse events” – which includes side effects and errors – costs £750m annually. These side effects and medication errors are also believed to be responsible for around 5,700 deaths every year.
Difficult pill to swallow
Older people may also find taking lots of different medicines very stressful which then makes them anxious and fearful. This is particularly the case for people with dementia – when a person may struggle to remember to take their medication. In such cases a person’s husband or wife may have to take over the role of giving medication. And this can be particularly stressful and difficult, as they may also have their own medication to deal with.
This could easily mean that one person is handling ten or more different medications on a daily basis. And this is when mistakes can happen – for example giving a laxative to someone who has diarrhoea – which does happen.
Of course, older people – like everyone else – want medication to improve their quality of life. But due to side effects, errors and the stress associated with taking lots of different tablets, being prescribed many different medications may actually worsen a person’s quality of life. It is hardly surprising then that so many people don’t take the medicines as recommended by their doctor.
There is also evidence that all these medicines may not always be needed. This is because many long-term treatments take years to show any benefits. And the benefits of prescribing such long term preventative medicines in someone over eighty may be questionable.
Part of the problem is that guidelines for clinical staff tend to focus on a single disease and need to be applied flexibly to older people with many diseases. Then there is also the issue that clinical trials tend to be conducted in younger people with single diseases – not on older people with many diseases – who are also taking many medicines.
In this way clinical trials are a bit like a “best case scenario”. They are primarily designed to show whether or not the medication works in the rarefied clinical trial environment, not whether the benefits from the medication outweigh the risks in the “real world”.
Ultimately, what this all shows is that while modern pharmaceuticals bring many benefits and extend life, this comes at a cost. Taking lots of medicine increases the risk of side effects and mistakes, and can be very stressful for older people and any family.
It is clear then that going forward, with the ageing population continuing to grow, there must be more of a focus on quality of life. This is important because it would seem there is a serious issue with over-prescription, which at times can be counterproductive.