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Addressing the Polypharmacy Challenge in Older People

Related projects

On this page you will find information and links to other research projects taking place within the Centre for Primary Care and Public Health which attend to similar concerns to those of APOLLO-MM: polypharmacy, multi-morbidity, medicines use and practices, medicines optimisation, patient experiences.

Experiences of Medicine Use amongst Urdu-speaking Londoners of Pakistani origin

Najia Sultan is an NIHR In-Practice Fellow. She is undertaking a qualitative research project using in-depth interviews to explore the experience of polypharmacy and multi-morbidity in Urdu-speaking patients of Pakistani origin. Najia is interested to discover how these patients make sense of their medicines and how they incorporate their medicines into their daily lives.
South Asian patients in London experience higher levels of multimorbidity compared to white and black ethnic groups. Previous research has shown that South Asian patients are also at the receiving end of higher levels of prescribing than the general population, and less likely to take medicines prescribed in the context of polypharmacy.
According to census data, Urdu is the third most commonly spoken immigrant language in England and Wales. Patients who speak languages other than English are often excluded from research studies. As a bilingual English-Urdu speaker, Najia is well placed to extend the interests of the APOLLO-MM project to include this group.
The findings of Najia’s research will inform the delivery of culturally sensitive medicines optimisation in primary care.
Najia gained her medical degree from Imperial College London and completed her GP training in East London. Najia splits her time between academic work and working as a GP in Tower Hamlets. Previously she has been involved in several research projects: post-operative pain outcomes in abdominal surgery; gestational vitamin D levels and their link to diabetes; a historical study of nutritional guidance for pregnant women.

Medicine practices of people living with dementia

Lucie Hogger is a NIHR Clinical Doctoral Research Fellow. Her PhD explores the experiences of taking multiple medicines on people living with dementia (PLWD) and their carers. 

The risk of developing dementia increases with age, as does the likelihood of needing to take multiple medications for chronic health problems. One common effect of dementia is difficulty with communicating, including finding a particular word and remembering what has already been said in a conversation. This may impact on the way in which medicines and their side effects are discussed. Lucie is interested in how people living with dementia and their carers talk about medicines and how these interactions influence their medicines practices. 

The outcomes of the study will contribute to our understanding of how PLWD take their medicines and produce guidance on how best to support PLWD and their carers in their interactions around medicines.

Lucie is a Specialist Speech and Language Therapist and has over ten years of experience working with adults with acquired communication and swallowing disorders. She completed an MSc in Neuroscience and Communication at UCL in 2017 where her research project investigated interactions between people with acquired brain injury and their conversation partners. She has an interest in global healthcare development and has worked in Uganda to provide continuing professional development for East African Speech and Language Therapists.

Informal carers' experiences of polypharmacy

Sarah Spencer is an Academic Clinical Fellow in Primary Care. Using in-depth interviews, her study explores the experience of informal carers supporting people prescribed multiple medications. She is interested in how these carers develop and navigate their responsibilities when supporting individuals taking these medicines.

Polypharmacy is complex. It involves professional decisions to prescribe, organisational systems of repeat prescribing and dispensing, and patient perspectives and practices of medicine taking. For some patients, the responsibility for decisions about medicines and medicine practices will have been delegated, either explicitly by the patient or because the patient lacks capacity to organise their own medicines.

Existing research has indicated that carer involvement in and understanding of the proposed treatment can affect carer trust and self-esteem. This study will contribute to our understanding of how notions such as treatment burden and trust impacts carers in their home environment.

Sarah is currently studying for her Masters in clinical research at Queen Mary University London. Sarah completed her medical studies at Warwick University, where she was awarded the Pigeon Gold Medal for research. Following this, she completed her foundation years at The John Radcliffe Hospital, Oxford. Subsequently she entered medical training and became a Member of the Royal College of Physician’s. Sarah currently splits her working week between academic work and General Practice, where she is a GP registrar in Tower Hamlets. Her previous research has included a systematic review and qualitative studies into identity formation of the general practitioner and perceptions of general practice amongst medical students.

Navigating complex systems of care: working-age adults living with multimorbidity

Esca van Blarikom is a PhD student funded by NIHR ARC North Thames. Using ethnographic and visual methods, her project will explore the patient experience of physical and mental co-existing health conditions in working-age adults.

It was commonly thought that multimorbidity was related to ageing. However, a recent study showed that in absolute numbers more working-age people live with multiple health conditions, specifically with the combination of physical and mental illness. The occurrence of this type of multimorbidity is the highest in areas that are considered socially disadvantaged.

Esca will investigate the experiences of adults of working age who have multiple physical and mental health conditions. Through in-depth interviews, observations, and visual methods, the study aims to explore the burden of treatment for adults who are juggling self-care responsibilities with work, social, and/or family life. The focus on mental and physical co-existing health conditions may inform what ‘good practice’ for integrating mental and physical health care look like and how care can be better organised according to complex care needs of patients.

Esca completed her Master’s in Medical Anthropology and Sociology at the University of Amsterdam. She is currently studying for a PhD at Queen Mary University London. Her previous research has looked at care for pregnant women with psychosocial vulnerabilities and community building and social exclusion of ‘urban nomads’ in Amsterdam.

Najia Sultan
Najia Sultan
NIHR In-Practice Fellow
Lucie Hogger - CLAHRC North Thames Research Fellow
Lucie Hogger
NIHR Doctoral Research Fellow
Sarah Spencer - Academic Clinical Fellow in Primary Care
Sarah Spencer
Academic Clinical Fellow in Primary Care
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Esca van Blarikom
NIHR ARC North Thames PhD Candidate
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Barts and The London School of Medicine and Dentistry Queen Mary University of London logo