Polypharmacy, the use of five medicines or more,  is increasingly common in older adults and is linked to higher risks of adverse events, hospitalisation, and reduced quality of life. Managing multiple medicines at home can be complex and stressful. Few practical tools exist to support older people with polypharmacy, and there is limited understanding of how acceptable these solutions are, particularly across different cultural groups. If older adults cannot manage their medicines effectively, it can lead to harm, poor adherence, and greater pressure on health services. Understanding whether tools like “I manage my meds” are acceptable to patients is important, as acceptability influences whether people will use them in real life. It is also important to test whether culturally adapted versions are effective for minority groups, who may face additional barriers in managing medicines. Sixty participants (aged 65–94, each taking at least five medicines) tested the “I manage my meds” toolkit in Bradford. Half were from South Asian backgrounds, and the toolkit was available in English and Urdu. Overall acceptability of the toolkit was high and participants found it clear and easy to understand, but confidence in applying it to manage medicines was lower. The participants from a South Asian background rated the toolkit significantly more acceptable than non-South Asian participants, especially in terms of perceived usefulness and reduced barriers to use. The study shows that “I manage my meds” is a practical and well-received resource for older people managing multiple medicines at home. Cultural adaptation made it especially acceptable to South Asian participants, demonstrating the importance of tailoring healthcare toolkits to diverse communities. For patients and carers, this means more accessible support for medication management. For healthcare services, it highlights the value of culturally relevant tools in reducing inequalities, improving adherence, and supporting safer care at home.

Cognitive difficulties can make it difficult for community-dwelling people with dementia and their family carers to self-manage medicines. Community-based support for people with dementia and family carers with their medicines is limited. Interventions have lacked appreciation for risks to patients inherent in the system, and more often focused on improving adherence as opposed to a more holistic, person-centred view of medicines self-management which could involve checking for errors, seeking support, adherence, knowledge, supply management and monitoring effects. We identified that a resilient healthcare (Safety II) approach, which shows how safe outcomes can be reached depending on the flexibility and adaptability of healthcare systems, could be a critical underpinning theory. People with dementia and family carers need support to organise medicines in the way that best works for them. Self-management interventions have been shown to take a person-centred approach enhancing quality of life, self-efficacy, knowledge and skills to manage illness and stress reduction for people with dementia. Applying a self-management approach to medicines may potentially support people, reducing adverse drug events and related costs to the NHS.

A co-designed psychosocial intervention to support medicines self-management for community-based people living with mild-moderate dementia and family carers was created. We continue to analyse findings, such as evidence as to the feasibility and acceptability of the co-design intervention. The experience-based co-design process applied had an immediate positive social impact for public, patient, health and social care stakeholders. We anticipate benefits to patient safety as part of this study, and following a randomised controlled trial (RCT) should this be conducted.

Older people often face difficulties managing their medications after leaving the hospital, due to complex regimens, changes during hospitalisation, and limited support. Ensuring safe medication management is important for patients’ health and independence, reducing preventable medication-related harm and hospital readmissions. Research identified medication self-management behaviours enacted by older people across the hospital-to-home transition, patterns in the behaviours leading to a patient typology, and the contextual and systemic factors that help or hinder safe medication self-management. Building on these findings, we co-designed a practical toolkit to support patients in managing their medications with confidence and safety, using a person-centred approach that incorporates patient typologies. For older patients and their families, the toolkit offers more personalised and practical support across the risky hospital-to-home transition. For health and care services, it provides a resource to improve care transitions, reduce medication-related harm, and potentially enhance outcomes.

Parents and caregivers are responsible for safely administering prescribed medicines to their children at home. This complex process relies on caregivers to be adaptive to any disruptions during medicines administration that could cause harm to their children. Learning about what disruptions caregivers experience, alongside how caregivers create and maintain adaptions to these disruptions, will inform improvements to healthcare systems to make life easier for parents and medicines safer for children. We have reviewed all the research which looked at the experiences of parents and caregivers who give medicines to children at home. We found that the use of adaptions by caregivers was well described and often involved significant effort from caregivers. The adaptive capability and capacity of caregivers was influenced by several factors such as family characteristics, access to resources and healthcare systems design. Future improvements to healthcare systems should reduce disruptions to avoid the need for adaptions entirely, alongside strengthening the ability of caregivers, professionals and healthcare systems to be adaptive to novel and unpredictable disruptions. We have started a study to learn from families using NHS services about what, where and when these improvements should be made to make ensure safer care.

Many older people have changes made to their medicines while they are in hospital. When they return home, this can cause confusion and worry about which medicines to take and when. This can sometimes lead to mistakes with medicines, causing harm, hospital readmissions and a poorer quality of life. As people get older and take more medicines, managing them safely becomes harder. Around one in three older people experience some kind of problem with their medicines within two months of leaving hospital. Supporting people to understand and manage their medicines well can prevent harm, reduce waste and improve confidence and independence. Together with older adults, family carers and healthcare staff, we have designed My Medicines Journey, a practical toolkit to help people with their medicines management when they move between hospital and home. Hospital pharmacy teams introduce the toolkit, and community pharmacists continue the support after discharge. We have created and pilot-tested a short questionnaire to understand patients’ experiences and are now running a feasibility study across eight NHS hospital sites (4 using the toolkit and 4 who are delivering their standard care). We are working with staff to test how well the toolkit works in real settings aiming to recruit 168 participants, and we are learning what helps or hinders its use. My Medicines Journey aims to make taking medicines safer and less stressful for older people. By improving communication between patients, hospital, and community pharmacy teams, it supports safer care, helps people feel more confident about their medicines, and could reduce avoidable harm and hospital readmissions in the future.