School of Pharmacy and Medical Sciences, Faculty of Life Sciences, University of Bradford, Bradford, UK.
NIHR Yorkshire and Humber Patient Safety Research Collaboration, Bradford, UK.
Health Expect. 2024 Feb;27(1):e13952. doi: 10.1111/hex.13952.
Many older people live with both multiple long-term conditions and frailty; thus, they manage complex medicines regimens and are at heightened risk of the consequences of medicines errors. Research to enhance how people manage medicines has focused on adherence to regimens rather than on the wider skills necessary to safely manage medicines, and the older population living with frailty and managing multiple medicines at home has been under-explored. This study, therefore, examines in depth how older people with mild to moderate frailty manage their polypharmacy regimens at home.
Between June 2021 and February 2022, 32 patients aged 65 years or older with mild or moderate frailty and taking five or more medicines were recruited from 10 medical practices in the North of England, United Kingdom, and the CARE 75+ research cohort. Semi-structured interviews were conducted face to face, by telephone or online. The interviews were recorded, transcribed verbatim and analysed using reflexive thematic analysis.
Five themes were developed: (1) Managing many medicines is a skilled job I didn't apply for; (2) Medicines keep me going, but what happened to my life?; (3) Managing medicines in an unclear system; (4) Support with medicines that makes my work easier; and (5) My medicines are familiar to me-there is nothing else I need (or want) to know. While navigating fragmented care, patients were expected to fit new medicines routines into their lives and keep on top of their medicines supply. Sometimes, they felt let down by a system that created new obstacles instead of supporting their complex daily work.
Frail older patients, who are at heightened risk of the impact of medicines errors, are expected to perform complex work to safely self-manage multiple medicines at home. Such a workload needs to be acknowledged, and more needs to be done to prepare people in order to avoid harm from medicines.
An older person managing multiple medicines at home was a core member of the research team. An advisory group of older patients and family members advised the study and was involved in the first stages of data analysis. This influenced how data were coded and themes shaped.
许多老年人同时患有多种长期疾病和衰弱症；因此，他们需要管理复杂的药物治疗方案，并且面临药物错误后果的风险增加。旨在增强人们管理药物的研究侧重于药物治疗方案的依从性，而不是安全管理药物所需的更广泛技能，而且在家中患有衰弱症和管理多种药物的老年人群体尚未得到充分探索。因此，本研究深入探讨了轻度至中度衰弱的老年人如何在家中管理他们的多种药物治疗方案。
2021 年 6 月至 2022 年 2 月期间，从英国北部的 10 家医疗实践和 CARE 75+研究队列中招募了 32 名年龄在 65 岁或以上、有轻度或中度衰弱且服用五种或更多种药物的患者。通过面对面、电话或在线进行半结构化访谈。对访谈进行了记录、逐字转录，并使用反思性主题分析进行了分析。
确定了五个主题：（1）管理许多药物是一项我从未申请过的技能工作；（2）药物使我保持活力，但我的生活怎么了？；（3）在不明确的系统中管理药物；（4）药物支持使我的工作更轻松；（5）我的药物对我来说很熟悉-我不需要（或想要）了解其他任何信息。在零碎的护理中，患者需要将新的药物常规融入他们的生活，并保持药物供应。有时，他们对创建新障碍而不是支持他们复杂日常工作的系统感到失望。
处于药物错误影响风险增加的衰弱老年患者需要执行复杂的工作，以在家中安全地自行管理多种药物。需要承认这种工作量，并需要做更多的工作来准备人们，以避免药物造成的伤害。
在家中管理多种药物的老年人是研究团队的核心成员。一个由老年患者和家庭成员组成的咨询小组为该研究提供建议，并参与了数据分析的早期阶段。这影响了数据的编码和主题的形成。
