Nikesh Parekh1,2, Beatrice Gahagan3, Lizzie Ward4, Khalid Ali1,2. 1. Academic department of Geriatrics, Brighton and Sussex Medical School, Brighton, Sussex, UK. 2. Department of Elderly Medicine, Brighton and Sussex University Hospitals NHS Trust, Sussex, UK. 3. Age UK Brighton and Hove, Brighton, Sussex, UK. 4. School of Applied Social Science, University of Brighton, Brighton, Sussex, UK.
Abstract
Objective: medication-related problems (MRP) are common for older adults and can lead to harm. The older person's perspective on MRP has been seldom reported in published literature. This study explored the lived experience of MRP in older adults with varying functional levels, focussing on the hospital discharge period. Design, setting, participants: this qualitative study was conducted in Brighton and Hove, UK. A purposive sample of 20 older people with experience of MRP, involving carers, took part in focus groups and semi-structured interviews. Data were thematically analysed using a 'framework' approach. Results: four major themes associated with MRP were identified; (1) experience of the healthcare system, (2) practicalities of using medicines, (3) management of medication problems and (4) participant beliefs. Participants encountered problems in communication with healthcare professionals such as passive listening and paternalistic consultations. A conflict was acknowledged between participants' implicit trust in the healthcare system and their negative experience of MRP. Participants felt vulnerable around hospital discharge, describing reduced capacity to comprehend information, pressured discharge circumstances and lack of integrated care in the community. Drug formulations, packaging and information leaflets were felt to be poorly tailored to the needs of older people. Conclusions: the lived experience of older people with MRP in this study was multifaceted and complex. Participants felt communication was poor around hospital discharge, and insufficient support with medicines was offered in the community when problems arose. Harm due to MRP might be reduced if the contributory factors described by patients inform clinical and policy-level intervention.
Objective: medication-related problems (MRP) are common for older adults and can lead to harm. The older person's perspective on MRP has been seldom reported in published literature. This study explored the lived experience of MRP in older adults with varying functional levels, focussing on the hospital discharge period. Design, setting, participants: this qualitative study was conducted in Brighton and Hove, UK. A purposive sample of 20 older people with experience of MRP, involving carers, took part in focus groups and semi-structured interviews. Data were thematically analysed using a 'framework' approach. Results: four major themes associated with MRP were identified; (1) experience of the healthcare system, (2) practicalities of using medicines, (3) management of medication problems and (4) participant beliefs. Participants encountered problems in communication with healthcare professionals such as passive listening and paternalistic consultations. A conflict was acknowledged between participants' implicit trust in the healthcare system and their negative experience of MRP. Participants felt vulnerable around hospital discharge, describing reduced capacity to comprehend information, pressured discharge circumstances and lack of integrated care in the community. Drug formulations, packaging and information leaflets were felt to be poorly tailored to the needs of older people. Conclusions: the lived experience of older people with MRP in this study was multifaceted and complex. Participants felt communication was poor around hospital discharge, and insufficient support with medicines was offered in the community when problems arose. Harm due to MRP might be reduced if the contributory factors described by patients inform clinical and policy-level intervention.
Authors: Manuel Montero-Odasso; Nathalie van der Velde; Finbarr C Martin; Mirko Petrovic; Maw Pin Tan; Jesper Ryg; Sara Aguilar-Navarro; Neil B Alexander; Clemens Becker; Hubert Blain; Robbie Bourke; Ian D Cameron; Richard Camicioli; Lindy Clemson; Jacqueline Close; Kim Delbaere; Leilei Duan; Gustavo Duque; Suzanne M Dyer; Ellen Freiberger; David A Ganz; Fernando Gómez; Jeffrey M Hausdorff; David B Hogan; Susan M W Hunter; Jose R Jauregui; Nellie Kamkar; Rose-Anne Kenny; Sarah E Lamb; Nancy K Latham; Lewis A Lipsitz; Teresa Liu-Ambrose; Pip Logan; Stephen R Lord; Louise Mallet; David Marsh; Koen Milisen; Rogelio Moctezuma-Gallegos; Meg E Morris; Alice Nieuwboer; Monica R Perracini; Frederico Pieruccini-Faria; Alison Pighills; Catherine Said; Ervin Sejdic; Catherine Sherrington; Dawn A Skelton; Sabestina Dsouza; Mark Speechley; Susan Stark; Chris Todd; Bruce R Troen; Tischa van der Cammen; Joe Verghese; Ellen Vlaeyen; Jennifer A Watt; Tahir Masud Journal: Age Ageing Date: 2022-09-02 Impact factor: 12.782
Authors: Nikesh Parekh; Khalid Ali; John Graham Davies; Jennifer M Stevenson; Winston Banya; Stephen Nyangoma; Rebekah Schiff; Tischa van der Cammen; Jatinder Harchowal; Chakravarthi Rajkumar Journal: BMJ Qual Saf Date: 2019-09-16 Impact factor: 7.035