Understanding the challenges of medicine optimisation among older people (aged 60 years and above) from ethnic minority communities with polypharmacy in primary care: a realist review protocol.

Background: Across many countries, the number of older people from ethnic minority communities is growing due to ageing populations and migration trends. In England and Wales, the population of older people from ethnic minority communities, particularly those aged 60 and above, is also increasing. This demographic change, often accompanied by the prevalence of polypharmacy in these communities, presents unique challenges in the context of medicine optimisation. Failure in this context can lead to exacerbated health disparities, non-adherence, and inappropriate prescribing (whether over or under). Building on the MEMORABLE study exploring medication management in older people, this review aims to understand the complexities of medicine optimisation, exploring what works and does not work, when and under what circumstances for older people from ethnic minority communities. Key possible areas include cultural backgrounds, traditional beliefs, and systemic barriers that may influence medicine optimisation.

Methods: The review will follow the five-step realist approach that firstly establishes initial programme theories to highlight the expected context, mechanisms, and outcomes. Then a formal search for evidence will be conducted. The third step involves the selection and appraisal of studies screened by title, abstract/keywords and full text based on exclusion/inclusion criteria. Then data from these studies will be extracted, recorded, and coded. The final step will synthesise this information, to test, refine, and expand our initial programme theories and generate context-mechanism-outcome configurations to better understand medicine optimisation in these communities.

Discussion: This review will be conducted in line with the RAMESES reporting standards. By explaining what works, for whom, and in what contexts, the review will generate theory-informed insights into MO for older people from ethnic minority communities with polypharmacy in primary care. These findings can support the development of culturally responsive, person-centred interventions. Results will be shared through peer-reviewed publications and presentations at relevant national and international conferences. TRIAL REGISTRATION: Systematic review registration: PROSPERO CRD42023432204.