Identifying and minimising problematic polypharmacy in older patients admitted to critical care

This PhD will identify the effects of admission to critical care on medication-related risks in older patients (≥65 years of age), leading to the development of an in-hospital intervention suitable for routine implementation in clinical practice and future evaluation.

This PhD will build on an understanding of the relationship between polypharmacy, multimorbidity and clinical frailty on adverse outcomes in older people (e.g. cognitive impairment, cardiotoxicity, falls and prolonged hospital stay), applied to the context of a critical care admission.

Firstly, this PhD will systematically identify the contemporary literature describing problematic polypharmacy and adverse outcomes in older people admitted to a critical care unit and measurement tools used. This PhD will then identify the in-hospital effects of a critical care episode on potentially and actual inappropriate medication in older patients using the most appropriate criteria identified (e.g., Beers, STOPP). Using electronic health records within multiple hospital settings, capturing the dynamic medication changes from the pre-admission, critical care (admission to and transfer from) and then hospital discharge risk periods.

This PhD will then develop a critical care specific portfolio of medicines to try to minimise exposure in older patients and identify alternatives, potentially suitable for routine use in clinical practice.

Working with healthcare professionals from appropriate clinical specialties (e.g. intensive care, geriatrics) and professions (e.g. medical, nursing, pharmacy), this PhD will confirm the acceptability of the medication portfolio and develop an intervention that supports safe medication use and review in older patients admitted to a critical care unit. The intervention will be co-produced, engaging with patients and family members with a lived experience of critical care. The intervention will include several aspects including medicine selection, use, monitoring and review during the critical care episode. It will also consider who will deliver the intervention and when, anticipating the tools and technologies required to support the intervention implementation and continuity of care post-critical care.   

Entry Criteria

Candidates are expected to hold (or be about to obtain) a minimum 2:1 or higher honours degree in Pharmacy (MPharm).

1.  For information on how to apply for this project, please visit the Faculty of Biology, Medicine and Health Doctoral Academy website (https://www.bmh.manchester.ac.uk/study/research/apply/).   Interested candidates must first make contact with the Primary Supervisor prior to submitting a formal application, to discuss their interest and suitability for the project. On the online application form select PhD Pharmacy

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