The average person aged over 70-years lives with at least three long term conditions and is likely to take multiple medications. Our outlook on life can change as we get older. Older people often express what matters most to them in terms of relationships and autonomy. How might what’s important to them impact on the treatment they choose? Might they want more time at home or with family, or to maintain their independence? In areas of deprivation, many people are living with multiple morbidities at a younger age, so they should also be prioritised for conversations about the benefits and risks of treatments.
We need to be honest about the limitations of many of our best treatments. While medicines can bring great benefit, they can also bring great harm. Older people tend to experience worse side effects or consequences of treatment. As people take more medicines, they are less likely to take them as prescribed. 3 Fifty percent of people taking four or more medicines don’t take them as prescribed. By finding out what matters to people, we can ensure they receive the treatment which suits their individual needs and reduces risk of harm. Awareness and education about polypharmacy should be embedded in inter-professional training for all practitioners who care for people with multimorbidity or frailty.
iSIMPATHY, (implementing Stimulating Innovation in the Management of Polypharmacy and Adherence Through the Years) is a three year EU funded project in Northern Ireland, Scotland and the Republic of Ireland. Launched in November 2020, it strives to tackle the harms associated with polypharmacy. By 2023, iSIMPATHY aims to ensure optimal and sustainable use of medicines in people living with multiple morbidity by sharing learning across the three jurisdictions and providing training for GPs, hospital doctors and pharmacists to deliver Polypharmacy Medicine reviews for 15,000 people. These Polypharmacy Medicine reviews will ensure that people receive a personalised assessment of their medication and are able to participate in shared prescribing decisions.
They also allow assessment of side effects of treatment, drug interactions and adherence, which helps reduce harm and waste and supports achieving the Third WHO Global Patient Safety Challenge: Medication without Harm.
iSIMPATHY will make a considerable contribution towards embedding a shared approach to polypharmacy and adherence management and tackling unwarranted variation in treatment and practice, both within and across participating jurisdictions. More information can be found at www.iSimpathy.eu.
Alpana Mair FFRPS, IP, MRPharmS
Head of Effective Prescribing and Therapeutics Division,
Scottish Quality, Safety & Improvement Fellow