It’s time to change how we talk about medicines
By Deborah swinglehurst
Deborah Swinglehurst reports on a story telling intervention that supports older adults who take many medicines to reflect on their medicine use, challenge unnecessary or unwanted prescribing and spark everyday conversations about medicines.
Polypharmacy – the use of multiple medicines by one person – continues to escalate. Overprescribing is a significant cause of harm to patients in the NHS and internationally. According to Age UK, over one-third of adults in England aged 80-89 are prescribed at least eight medicines. Many of these medicines are not wanted or needed. They are often not taken at all.
We know that medicines and prescribing raise issues for older people which are difficult to talk about, even within medication reviews designed for that very purpose. As it stands, interventions to address polypharmacy, including medication reviews do not appear to benefit patients as intended.
Implementing medication reviews across the NHS is resource intensive and costly. In our research we found that medication reviews with older people affected by polypharmacy were time consuming (often exceeding the allocated appointment slot), but changes to medication were rare and modest. Tackling polypharmacy is a delicate matter.
The Chief Medical Officer for England has said that improving quality of life for older people might mean they take less medicine. He calls for older adults ‘to have realistic discussions with their doctors’. But are older adults and health professionals talking about medicines in ways that enable meaningful change?
We set out to change the way we talk about medicines with our story-based intervention Let’s Talk Differently About Medicines (LTDAM). LTDAM consists of fictionalised stories rooted in research which explored the experiences of older people affected by polypharmacy. For example we explored the work that people do to organise their medicines and shed light on the struggle and precarity of navigating the ‘multimorbidity tightrope’. LTDAM supports older adults and the people caring for them to reflect on medicines, challenge unnecessary or unwanted prescribing and spark everyday conversations about medicines use. It was developed using a design-led storytelling methodology to reimagine medication reviews.
We recently collaborated with Care City, a community-focused innovation centre, to test the LTDAM resources in community settings. Care City delivered and evaluated 14 sessions of story-sharing using the LTDAM resources with 126 older adults. They found that older people are ready to question their medicines; they just need space to do it. Key impacts included participants initiating medication reviews, reducing or stopping medicines and disposing of unneeded stockpiles, often for the first time. Many described new confidence to question prescriptions, grounded in their personal values. The stories sparked preventative shifts: small lifestyle changes, rethinking routines, and a growing sense of agency in health decisions. Conversations about medicines moved into everyday life, among peers, families, and with friends. Some participants even began running their own LTDAM story-sharing sessions, expanding the reach of the intervention.
Care City’s impact evaluation report is available here. You can read or listen to the stories at www.medicinestalk.co.uk where you can also download a Facilitator Guide to support people who would like to facilitate the sharing of these stories with others in a group setting.