Over time as people get older, some medicines are no longer beneficial or have harmful side effects on cognitive function (thinking, memory and decision-making) and balance, increasing the risk of falling.
People living in care homes with multiple health problems are often taking lots of different medicines. Evidence shows that it can be better to take less or stop some, known as ‘deprescribing’. Previous research has found that deprescribing is generally safe, but more understanding and guidance is needed to make it work in real-life settings like care homes.
Krystal Warmoth, ARC East of England researcher, Senior Research Fellow at the University of Hertfordshire, and former PenARC PhD student, led an ageing and multi-morbidity research project to review current approaches and challenges for stopping medicines and create guidance for best practice. This work was supported by the National Institute for Health and Care Research (NIHR) Applied Research Collaborations for the East of England and South West Peninsula (PenARC).
The STOPPING study involved participants from 15 care homes, researchers at the Universities of Exeter and Hertfordshire, care home managers, geriatricians, pharmacists, and family carers. Discussions with health professionals, family members and residents throughout the project informed the funding application, methods and findings and ensured all views were heard.
Krystal Warmoth
Krystal Warmoth, ARC East of England researcher and project lead said:
“Deprescribing within care homes is a complex and collaborative process, which involves many individuals with unique skills, knowledge, and beliefs. To ensure it is successful, these different people need to be involved and contribute their specific knowledge and views. Information sharing and integrated working can improve communication and collaboration between care homes and healthcare professionals like GPs, nurses, and pharmacists, which is essential to support safe deprescribing.
“We found that current deprescribing tools and approaches were not suitable for care homes and would need to be modified for use. Further work is needed to develop these tools and approaches, which must involve care home staff and residents for their input.”
As a result of taking part, people living in care homes reported greater awareness and engagement with them around medicines and deprescribing. Care home staff and residents have had more conversations with health professionals about medicines and whether they could be reduced or stopped, and audits of the residents’ medicines have been undertaken.
Some staff also reported sharing the deprescribing approaches and tools with other care home staff and managers as a resource to use in their care home. Participating care homes also received certificates of their involvement in the study, which they presented as part of their Care Quality Commission (CQC) inspections.
Most participants, especially care home staff, reported having mostly positive views and experiences of deprescribing. Care home staff reported the various potential benefits to residents’ health, quality of life, costs, time and safety. All participants thought that a deprescribing process should be individualised to the resident.
One care home resident said:
“Well, yeah, we’re all slightly different. We think we’re the same, but we’re not and our bodies react differently. But what works – if I come back to this, all these tablets, to my knowledge, work for me.”
A Care Home Assistant shared:
“I think there’d be a bit of a process involved. I think probably the family members and staff, the people that know the individuals well, or better than anybody else, they’d have to have an input for their opinion. And then the person that prescribes the medicines, would have to review it and decide what they think for the best.”
The research team presented their findings at a national PrescQIPP Care Home Virtual Professional Group meeting, attended by 50 pharmacists and pharmacy technicians who discussed the methods and the findings of the study.
Krystal added:
“This research has given us a better understanding of how to support deprescribing in care homes. We are currently using the findings to guide future work which could ensure that deprescribing becomes routine practice to enhance residents’ wellbeing, support carers and balance the benefits and harm of taking multiple medicines to manage long-term conditions.”
Findings and learnings from the STOPPING study were presented on 23 June 2023 at a joint ARC event exploring how deprescribing in care homes can support best practice and resident care. The findings have also been published in scientific journals and are freely accessible online:
- Determinants of implementing deprescribing for older adults in English care homes
- Assessing deprescribing tools for implementation in care homes
If you have any questions about this study or would like to know more about further work being done in this area, please email Krystal Warmoth.
- Find out more about the cross-ARC care home network here
- If you are interested in joining the cross-ARC care home mailing list or need more information, please email: ARCoffice@cpft.nhs.uk