Understanding the extent of, and variation in, polypharmacy in people living with dementia and the impact of care home admission

PI Title: Khadijah Noor Daud / Dr Michelle Marshall

Lead Member: Keele University

Almost a million people in the UK live with dementia. Studies in Europe and the USA have found that over half of people living with dementia have polypharmacy (take more than five medications) and one in five have excessive polypharmacy
(take more than ten medications). It is unclear whether there are also high rates of polypharmacy in the UK and this research aims to investigate this.

Managing lots of medications is difficult for the person living with dementia and their caregivers, making it more likely a medication is forgotten or the wrong dose is taken. Polypharmacy increases the risk of side effects, and the effectiveness of
some medicines could be reduced. It has also been associated with worsening dementia symptoms, falls, poorer quality of life, caregiver burden, going to A&E, being admitted to hospital and early death. Research has indicated that people living with dementia are willing to reduce their medications, and clinicians are encouraged to assess if this is possible.

This research aims to find out about polypharmacy in people living with dementia and identify whether there are particular people (e.g., by age, sex, ethnicity, deprivation, and care home residence) who are prescribed a higher number of medications. This could indicate inequalities and groups of people where polypharmacy is a problem.

The impact of this research would mean that we can identify particular groups of people that can be assessed to see if there are medications that can be reduced or stopped. This will be of benefit to those people living with dementia, their families and caregivers, and also reduce the costs and burden on healthcare systems.

This research will be undertaken within a database of medical records called the Secure Anonymised Information Linkage (SAIL) Databank. This contains anonymised healthcare data from around 80% of general practices in Wales. This dataset, unlike others, includes information on care home residence and the population is comparable to the rest of the UK. We will explore how many people living with dementia have polypharmacy or excessive polypharmacy, and how this differs by age, sex, ethnicity, and deprivation. We will also find out if polypharmacy increases just before or after moving into a care home.

Our patient and public involvement and engagement (PPIE) group have shared the journey of our dementia research and will continue to be involved and advise on this project. We aim to recruit new PPIE members, including people living with
dementia, and make sure we have diversity in our group. Our findings will be shared widely in different formats for different audiences. This study will then act as the basis for a further study proposal to understand how best to reduce polypharmacy in people living with dementia.