Medicines use review is the broad term used to describe interventions to review a patient’s medicines with the aim of rationalising and improving the quality, safety and appropriate use of medicines. In frail older patients with polypharmacy, it also considers whether any ‘deprescribing’ – the safe and effective cessation (withdrawal) of inappropriate medicines – should take place.

A step-by-step approach to optimising medicines use in older people was proposed by Barnett et al. (see Figure 1). Each step provides practical support for embedding medicines optimisation into everyday practice. It suggests points to consider, actions to take and questions to ask, allowing issues to be prioritised based on the importance to the patient, associated risks, benefits and current evidence.

Reflective exercises

• Use your PMR to identify two patients who are over 80 years of age and take eight or more medicines
• List any drug, patient, health, functional or psychosocial factors that may increase their risk of ADEs
• Can you identify any potential prescribing cascades from the medicines list?
• Think about your last face-to-face consultation with a patient about their medicine(s).
• For what percentage of the conversation were you giving information, advising or telling?
• Did you find out how they felt about taking the medicine(s)?
• What three questions might you ask next time to get this information?