Living with polypharmacy: A narrative interview study with older Pakistanis in East London

Abstract

Background Polypharmacy is a growing and major public health issue. It can be burdensome and risky for patients and costly to healthcare systems. Older adults and those from ethnic minority backgrounds are disproportionately affected by polypharmacy. This study focuses on medication practices among Urdu-speaking Pakistani patients, a significant ethnic group in the UK. Most existing research on medication practices within South-Asian communities focuses on adherence, leaving the social and moral dimensions of polypharmacy practices unpacked. Understanding how British Pakistani patients understand and manage polypharmacy in the context of their daily lives is crucial to optimising medication practices and avoiding harmful polypharmacy.Methods We interviewed 15 first-generation Pakistani patients, prescribed ten or more regular medications (a pragmatic marker of ‘higher risk’ polypharmacy). Participants were aged over 50 and were recruited from GP practices in East London. They completed an in-depth interview at home, conducted with a bilingual researcher. Interviews were designed to elicit narratives of patients’ experiences of polypharmacy in the context of their biographies and daily lives.Results Polypharmacy is enacted through networks of interpersonal and socio-material relationships. The doctor-patient relationship and the family network held particular significance to study participants. In addition, participants described emotional bonds between themselves and their medicines, identifying them as ‘forces for good’ - substances which allowed them to maintain their health through the intercession of God. Meanings attributed to medicines and enacted through these social, emotional, and spiritual relationships contributed to emerging and sustaining polypharmacy.Conclusions Patients integrate treatments into their daily lives in culturally specific ways. For older Pakistani patients, medication becomes intricately connected with participants’ commitments to their faith and social networks. Clinicians must better understand the way medication functions as a tool for communication and a symbol of these wider commitments to be able to have meaningful and effective conversations with patients about their medicines. Engaging with the cultural and moral values that patients ascribe to their medicines is likely to be crucial to the success of programmes aimed at medicines optimisation. Our findings contribute to enabling the integration of culturally sensitive approaches to prescribing practices.