A public consultation from the European Medicines Agency (EMA), which could lead to more medications tailored to suit older people, has been welcomed by a consultant pharmacist specialising in their care.
But Lelly Oboh, who works in the adult community health services run by Guys and St Thomas’ Foundation Trust in London, warned that the very elderly could require bespoke solutions to help them take medicines they need — and that pharmacists needed a “pick and choose” menu to help them do this rather than a single solution.
An EMA reflection paper, which was put out to public consultation on 1 August 2017, on the pharmaceutical development of medicines for use in the older population, emphasises the importance of taking into account the needs of older people who are ”the majority users of many medicines and at highest risk of encountering practical medication [usability] problems”.
Many of the problems it identifies are practical ones around taking medications — such as the route of administration, the ease of opening and measuring medicines, and the need for assistance in taking them.
Some medications may need modification to make them easier to take or to allow for lower doses — for example, if a tablet needs to be broken in half. Older patients with sight difficulties taking multiple medications may also be at risk of mixing them up.
The paper suggests that pharmaceutical companies need to consider all of these aspects when developing medicines and to take a ”patient-centric approach”.
Doing this could lead to, for example, looking at whether medications aimed at older people are stable at room temperature and can be kept in a multi-dose dispenser, or that alternative methods of administration are considered during development, if that will help patients to take them.
Oboh welcomed the paper but stressed the need for flexibility in dealing with this patient group.
”We all need to work together with the patient and among ourselves to come up with the best solution for the patient,” she said, adding that carers and nurses who visited housebound patients often knew of precise problems which could be fed back to GPs and pharmacists.
She said cognitive issues other than forgetfulness also needed to be considered — older people could find it harder to learn new things or to concentrate which might, for example, impact on learning inhaler techniques.
Comments on the paper are invited by 31 January 2018 and could lead to some of the points in the paper being incorporated into scientific guidance.