Understanding the Challenges of Medicine Optimisation among Older People from Ethnic Minority Communities (aged 60 years and above) with Polypharmacy in Primary Care: a Realist Review

Problem

The number of older adults from ethnic minority communities (EMCs) in England and Wales particularly those aged 60 and above is increasing. The 2021 Census report shows a 6.4% rise in the older adults from EMCs aged 60 years and above, an increase from the 4.5% recorded in the 2011 report. This demographic change, coupled with the prevalence of polypharmacy among these populations. which presents unique challenges in the context of medicine optimisation. Failure in this context can lead to exacerbated health disparities, non-adherence, and inappropriate prescribing (whether over or under).This review builds on MEMORABLE study. With aims to understand the complexities of medicine optimisation, does it work/does not work under what circumstances for older adults from EMCs. Acknowledging the diverse cultural backgrounds, traditional beliefs, and systemic barriers that may influence health-seeking behaviours and medication management.

Approach

This review follows the five-step approach that is recommended by RAMSES guidelines. Initially, we will establish initial program theories to highlight the expected context, mechanisms, and outcomes. Following this, a formal search for evidence will be conducted through academic databases and grey literature. The third step involves the selection and appraisal of studies, studies will be screened by title, abstract/keywords and full text against inclusion and exclusion criteria. In the fourth stage, data from these studies will be extracted, recorded, and coded. The final step will synthesis this information, refining our initial theories to understand how medicine optimisation work/ does not in these populations.

Findings

We anticipate formulating the context-mechanism-outcome (CMO) configurations that underpin how medicine optimisation works for older adults from EMCs with polypharmacy. We expect to identify key contextual factors (e.g., cultural beliefs, healthcare system barriers) and mechanisms (e.g., patient-provider communication, community support) that either facilitate or hinder medicine optimisation.

Consequences

This realist review will provide meaningful findings to understand how medicine optimisation work/ do not for older adults from EMCs with polypharmacy in primary care. This method will give deeper understanding of what work, for whom, and under which circumstances. Furthermore, the findings of this review will be refined, tested in the next stage “realist evaluation” focusing on the real-life applicability of MO strategies for older people from EMCs.