Understanding the challenges of medicine optimisation among older people (aged 60 years and above) from ethnic minority communities with polypharmacy in primary care: a realist review protocol

Nesrein Hamed; Clare Bates; Muhammed Umair Khan; Ian Maidment

doi:10.1186/s13643-025-02920-1

Understanding the challenges of medicine optimisation among older people (aged 60 years and above) from ethnic minority communities with polypharmacy in primary care: a realist review protocol

Nesrein Hamed, Clare Bates, Muhammed Umair Khan, Ian Maidment

Research output: Contribution to journal › Article › peer-review

1 Citation (SciVal)

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Abstract

Background
Across many countries, the number of older people from ethnic minority communities is growing due to ageing populations and migration trends. In England and Wales, the population of older people from ethnic minority communities, particularly those aged 60 and above, is also increasing. This demographic change, often accompanied by the prevalence of polypharmacy in these communities, 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).

Building on the MEMORABLE study exploring medication management in older people, this review aims to understand the complexities of medicine optimisation, exploring what works and does not work, when and under what circumstances for older people from ethnic minority communities. Key possible areas include cultural backgrounds, traditional beliefs, and systemic barriers that may influence medicine optimisation.

Methods
The review will follow the five-step realist approach that firstly establishes initial programme theories to highlight the expected context, mechanisms, and outcomes. Then a formal search for evidence will be conducted. The third step involves the selection and appraisal of studies screened by title, abstract/keywords and full text based on exclusion/inclusion criteria. Then data from these studies will be extracted, recorded, and coded. The final step will synthesise this information, to test, refine, and expand our initial programme theories and generate context-mechanism-outcome configurations to better understand medicine optimisation in these communities.

Discussion
This review will be conducted in line with the RAMESES reporting standards. By explaining what works, for whom, and in what contexts, the review will generate theory-informed insights into MO for older people from ethnic minority communities with polypharmacy in primary care. These findings can support the development of culturally responsive, person-centred interventions. Results will be shared through peer-reviewed publications and presentations at relevant national and international conferences.

Original language	English
Article number	166
Pages (from-to)	166
Number of pages	8
Journal	Systematic Reviews
Volume	14
Issue number	1
Early online date	15 Aug 2025
DOIs	https://doi.org/10.1186/s13643-025-02920-1 https://doi.org/10.1186/s13643-025-02920-1
Publication status	Published - 15 Aug 2025

Bibliographical note

Copyright © The Author(s) 2025. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/.

Keywords

Humans
Polypharmacy
Primary Health Care
Minority Groups
Aged
Ethnicity
Systematic Reviews as Topic
Middle Aged

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Understanding the challenges of medicine optimisation among older people
Copyright © The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/.
Final published version, 982 KBLicence: CC BY 4.0

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Hamed, N., Bates, C., Khan, M. U., & Maidment, I. (2025). Understanding the challenges of medicine optimisation among older people (aged 60 years and above) from ethnic minority communities with polypharmacy in primary care: a realist review protocol. Systematic Reviews, 14(1), 166. Article 166. https://doi.org/10.1186/s13643-025-02920-1, https://doi.org/10.1186/s13643-025-02920-1

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abstract = "BackgroundAcross many countries, the number of older people from ethnic minority communities is growing due to ageing populations and migration trends. In England and Wales, the population of older people from ethnic minority communities, particularly those aged 60 and above, is also increasing. This demographic change, often accompanied by the prevalence of polypharmacy in these communities, 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).Building on the MEMORABLE study exploring medication management in older people, this review aims to understand the complexities of medicine optimisation, exploring what works and does not work, when and under what circumstances for older people from ethnic minority communities. Key possible areas include cultural backgrounds, traditional beliefs, and systemic barriers that may influence medicine optimisation.MethodsThe review will follow the five-step realist approach that firstly establishes initial programme theories to highlight the expected context, mechanisms, and outcomes. Then a formal search for evidence will be conducted. The third step involves the selection and appraisal of studies screened by title, abstract/keywords and full text based on exclusion/inclusion criteria. Then data from these studies will be extracted, recorded, and coded. The final step will synthesise this information, to test, refine, and expand our initial programme theories and generate context-mechanism-outcome configurations to better understand medicine optimisation in these communities.DiscussionThis review will be conducted in line with the RAMESES reporting standards. By explaining what works, for whom, and in what contexts, the review will generate theory-informed insights into MO for older people from ethnic minority communities with polypharmacy in primary care. These findings can support the development of culturally responsive, person-centred interventions. Results will be shared through peer-reviewed publications and presentations at relevant national and international conferences.",

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Hamed, N, Bates, C, Khan, MU & Maidment, I 2025, 'Understanding the challenges of medicine optimisation among older people (aged 60 years and above) from ethnic minority communities with polypharmacy in primary care: a realist review protocol', Systematic Reviews, vol. 14, no. 1, 166, pp. 166. https://doi.org/10.1186/s13643-025-02920-1, https://doi.org/10.1186/s13643-025-02920-1

Understanding the challenges of medicine optimisation among older people (aged 60 years and above) from ethnic minority communities with polypharmacy in primary care: a realist review protocol. / Hamed, Nesrein; Bates, Clare; Khan, Muhammed Umair et al.
In: Systematic Reviews, Vol. 14, No. 1, 166, 15.08.2025, p. 166.

Research output: Contribution to journal › Article › peer-review

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AU - Hamed, Nesrein

AU - Bates, Clare

AU - Khan, Muhammed Umair

AU - Maidment, Ian

N1 - Copyright © The Author(s) 2025. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/.

PY - 2025/8/15

Y1 - 2025/8/15

N2 - BackgroundAcross many countries, the number of older people from ethnic minority communities is growing due to ageing populations and migration trends. In England and Wales, the population of older people from ethnic minority communities, particularly those aged 60 and above, is also increasing. This demographic change, often accompanied by the prevalence of polypharmacy in these communities, 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).Building on the MEMORABLE study exploring medication management in older people, this review aims to understand the complexities of medicine optimisation, exploring what works and does not work, when and under what circumstances for older people from ethnic minority communities. Key possible areas include cultural backgrounds, traditional beliefs, and systemic barriers that may influence medicine optimisation.MethodsThe review will follow the five-step realist approach that firstly establishes initial programme theories to highlight the expected context, mechanisms, and outcomes. Then a formal search for evidence will be conducted. The third step involves the selection and appraisal of studies screened by title, abstract/keywords and full text based on exclusion/inclusion criteria. Then data from these studies will be extracted, recorded, and coded. The final step will synthesise this information, to test, refine, and expand our initial programme theories and generate context-mechanism-outcome configurations to better understand medicine optimisation in these communities.DiscussionThis review will be conducted in line with the RAMESES reporting standards. By explaining what works, for whom, and in what contexts, the review will generate theory-informed insights into MO for older people from ethnic minority communities with polypharmacy in primary care. These findings can support the development of culturally responsive, person-centred interventions. Results will be shared through peer-reviewed publications and presentations at relevant national and international conferences.

AB - BackgroundAcross many countries, the number of older people from ethnic minority communities is growing due to ageing populations and migration trends. In England and Wales, the population of older people from ethnic minority communities, particularly those aged 60 and above, is also increasing. This demographic change, often accompanied by the prevalence of polypharmacy in these communities, 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).Building on the MEMORABLE study exploring medication management in older people, this review aims to understand the complexities of medicine optimisation, exploring what works and does not work, when and under what circumstances for older people from ethnic minority communities. Key possible areas include cultural backgrounds, traditional beliefs, and systemic barriers that may influence medicine optimisation.MethodsThe review will follow the five-step realist approach that firstly establishes initial programme theories to highlight the expected context, mechanisms, and outcomes. Then a formal search for evidence will be conducted. The third step involves the selection and appraisal of studies screened by title, abstract/keywords and full text based on exclusion/inclusion criteria. Then data from these studies will be extracted, recorded, and coded. The final step will synthesise this information, to test, refine, and expand our initial programme theories and generate context-mechanism-outcome configurations to better understand medicine optimisation in these communities.DiscussionThis review will be conducted in line with the RAMESES reporting standards. By explaining what works, for whom, and in what contexts, the review will generate theory-informed insights into MO for older people from ethnic minority communities with polypharmacy in primary care. These findings can support the development of culturally responsive, person-centred interventions. Results will be shared through peer-reviewed publications and presentations at relevant national and international conferences.

KW - Humans

KW - Polypharmacy

KW - Primary Health Care

KW - Minority Groups

KW - Aged

KW - Ethnicity

KW - Systematic Reviews as Topic

KW - Middle Aged

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SN - 2046-4053

VL - 14

SP - 166

JO - Systematic Reviews

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Understanding the challenges of medicine optimisation among older people (aged 60 years and above) from ethnic minority communities with polypharmacy in primary care: a realist review protocol

Abstract

Bibliographical note

Keywords

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Realist review: understanding the challenges of medicine optimisation among older people from ethnic minority communities with polypharmacy in primary care

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 Protocol

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