Establishing knowledge and confidence of hospital pharmacists to medicines optimisation for older people

Abstract

Background: Polypharmacy, commonly defined as taking five or more medicines, is prevalent in people aged 65 and over. It is strongly associated with adverse events, hospitalisation, and increased treatment burden, particularly among those living with frailty. Medicines optimisation (MO) for older adults is a key priority within the LTHT Frailty Strategy. Pharmacists play a central role within multidisciplinary teams to reduce inappropriate polypharmacy, yet little is known about hospital pharmacists’ knowledge and confidence in delivering MO for this population.

Aims: To assess the knowledge and confidence related to MO for older people among hospital pharmacists at LTHT.

Methods: A survey incorporating Likert-scale questions was developed to measure pharmacists’ confidence across multiple aspects of medicines optimisation in older adults. The survey, hosted on Microsoft Forms, was distributed to all LTHT clinical pharmacists via email and shared during face to face team meetings.

Results: Forty four responses were received, which included: 31 females and 13 males, representing a range of practice levels from trainee to advanced clinical pharmacists. Participants worked across diverse specialties including surgery, general medicine, and older people’s services. Forty three percent reported that at least half of their caseload comprised patients aged 65 or over. Confidence varied across domains of MO. High confidence (≥75% agreeing or strongly agreeing) was reported for identifying medicines requiring caution in older adults (77.3%) and adjusting doses appropriately (79%). Lower confidence (<50% agreement) was reported for deprescribing medicines that may still offer therapeutic benefit but are no longer appropriate due to prognosis, and for optimising or deprescribing medicines when conditions are over treated or targets are no longer clinically appropriate (e.g., hypertension, diabetes).

Conclusion: Hospital pharmacists demonstrate strong confidence in several core aspects of medicines optimisation for older adults but identify challenges in more complex MO decisions. These findings highlight opportunities for targeted training and support to enhance MO and deprescribing confidence within LTHT.