BackgroundDementia is an important health and social care problem and is one of the main causes of disability in later life. The number of families affected by dementia will dramatically increase over the next five decades. Despite the implications for health and social care services in the future, the overwhelming majority of care for people with dementia takes place away from health care settings. Providing informal care for someone with dementia can be psychologically, physically and financially expensive and a range of health service interventions aimed at supporting and providing information to these carers has developed to help carers meet these demands. This review examines whether information and support interventions improve the quality of life of people caring for someone with dementia.MethodsA systematic review examining evidence from randomised controlled trials in which technology, individualised or group-based interventions built around the provision of support and/or information were evaluated.ResultsForty-four studies were included in the review. Controlling for the quality of the evidence, we found statistically significant evidence that group-based supportive interventions impact positively on psychological morbidity. However, whilst the improvement was unlikely to be due to chance, the clinical significance of this finding should be interpreted tentatively, due to the difficulties in interpreting the standardised mean difference as a measure of effect and the complex aetiology of depression. No evidence was found for the effectiveness of any other form of intervention on a range of physical and psychological health outcomes.ConclusionThere is little evidence that interventions aimed at supporting and/or providing information to carers of people with dementia are uniformly effective. There is a pressing need to ensure that supportive interventions at the development stage are accompanied by good quality randomised evaluations in which outcomes that are important to clinicians and carers are measured.

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Feasibility studies are increasingly undertaken in preparation for randomised controlled trials in order to explore uncertainties and enable trialists to optimise the intervention or the conduct of the trial. Qualitative research can be used to examine and address key uncertainties prior to a full trial. We present guidance that researchers, research funders and reviewers may wish to consider when assessing or undertaking qualitative research within feasibility studies for randomised controlled trials. The guidance consists of 16 items within five domains: research questions, data collection, analysis, teamwork and reporting. Appropriate and well conducted qualitative research can make an important contribution to feasibility studies for randomised controlled trials. This guidance may help researchers to consider the full range of contributions that qualitative research can make in relation to their particular trial. The guidance may also help researchers and others to reflect on the utility of such qualitative research in practice, so that trial teams can decide when and how best to use these approaches in future studies.

Objective: Polypharmacy is widespread among older people, but the adverse outcomes associated with it are unclear. We aim to synthesize current evidence on the adverse health, social, medicines management, and health care utilization outcomes of polypharmacy in older people. Design: A systematic review, of systematic reviews and meta-analyses of observational studies, was conducted. Eleven bibliographic databases were searched from 1990 to February 2018. Quality was assessed using AMSTAR (A Measurement Tool to Assess Systematic Reviews). Setting and participants: Older people in any health care setting, residential setting, or country. Results: Twenty-six reviews reporting on 230 unique studies were included. Almost all reviews operationalized polypharmacy as medication count, and few examined medication classes or disease states within this. Evidence for an association between polypharmacy and many adverse outcomes, including adverse drug events and disability, was conflicting. The most consistent evidence was found for hospitalization and inappropriate prescribing. No research had explored polypharmacy in the very old (aged 85 years), or examined the potential social consequences associated with medication use, such as loneliness and isolation. Conclusions and implications: The literature examining the adverse outcomes of polypharmacy in older people is complex, extensive, and conflicting. Until polypharmacy is operationalized in a more clinically relevant manner, the adverse outcomes associated with it will not be fully understood. Future studies should work toward this approach in the face of rising multimorbidity and population aging. Ó 2019 AMDA e The Society for Post-Acute and Long-Term Care Medicine. Polypharmacy describes the situation where multiple medications are prescribed for an individual, and it is most commonly defined as the concomitant use of 5 or more medicines. 1,2 Polypharmacy among older people has become more common in recent years 3,4 because of disease-specific prescribing guidelines, 5e7 rising levels of multimorbidity due to population ageing, 7,8 and a lack of evidence to support deprescribing approaches. 9 Indeed, the proportion of older people taking 10 or more medicinesdso-called hyperpolypharmacydmore than tripled between 1995 (4.9%) and 2010 (17.2%). 3 Polypharmacy in older people may be appropriate 7 but it also has potential negative effects including reduced adherence, adverse drug events, increased health care utilization, falls, cognitive impairment, and mortality. 10,11 The literature relating to polypharmacy has expanded over the past 2 decades, with many groups exploring its adverse outcomes through systematic review. 12e14 Despite this progress and the growing literature base, the data relating to the spectrum of polypharmacy-related adverse effects is conflicting in people aged 65 years, and even less clearly defined in the very old (aged 85 years), or across a range of health care and residential settings. This is problematic as the very old are the fastest-growing sec...

This project was funded by the NIHR Health Technology Assessment programme and the Wellcome Trust and will be published in full in Health Technology Assessment; Vol. 18, No. 43. See the NIHR Journals Library website for further project information.