“No trouble at all” - medication work amongst nonagenarians : a qualitative study of the Newcastle 85+ cohort participants at 97

Background: People aged over 85 years are the fastest growing section of our population across most high-income countries. A majority live with multiple long-term conditions and frailty, but we have limited understanding of how the associated polypharmacy is experienced by this group. Aim: To explore the experiences of medication management among nonagenarians and the implications for primary care practice. Design and setting: Qualitative interviews with a purposive sample of survivors of the Newcastle 85+ study (a longitudinal cohort study). Methods: Semi-structured interviews (n=20) were conducted, transcribed verbatim and analysed using a thematic approach. Results: In most cases, although considerable work is associated with self-management of medication use, it is generally not experienced as problematic by the older people themselves. Taking medications is habitualised into everyday routines and practices and is experienced in much the same way as other activities of daily living. For some, the work associated with medications has been relinquished (either partially or wholly) to others – minimising the burden experienced by the individual. Exceptions to this were found when disruptions to these steady states occurred, for example, following a new medical diagnosis with associated medication changes or a major life event. Conclusion: We have shown a high level of acceptance of the work associated with medications amongst this group and trust in the prescribers to provide the most appropriate care. Medicines optimisation should build on this trust and be presented as personalised, evidence-based care.