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Identify a patient over the age of 65 who would benefit from a review of their medication and an evaluation of their risk of harm from medicines.


Module 7BBPP005: Medicines and older people

Guidance: Critical reflection of a risk framework for an older patient

Course participants are required to apply a risk framework, designed to identify and manage drug-related risk in older people, to an older patient (see criteria below) who they have encountered in their local practice. Practitioners are expected to assess the likelihood and consequence of each drug-related event occurring and discuss how risk can be minimised or eliminated. The following stages should be worked through:

  1. Identify a patient over the age of 65 who would benefit from a review of their medication and an evaluation of their risk of harm from medicines. The patient should ideally be taking at least eight different medicines via at least two different routes of administration.
  2. Undertake an MUR or other patient consultation/medication review for this patient and ensure that as part of this review you gather all of the information necessary to support you in identifying any adherence or social issues and any medical history that is relevant to their risk review.
    1. Consider which medicines may exhibit altered pharmacokinetics and/or pharmacodynamics as a result of the patient`s age.
  1. Apply the PREVENT risk framework to this patient to identify all of the factors that may contribute to their overall risk from medicine-related harm [see example below]. Consider the overall likelihood and consequence of your patient experiencing a medicine-related event. Throughout this process you are advised to consider the following:
    1. Medication adherence (What are the actual or potential barriers to adherence? How will adherence be monitored?)
    2. Medication safety (Which medicines are more likely to cause harm due to altered handling/toxicity?)
    3. Medicines rationalisation (Do you think any medicines are unnecessary? Are there any medicines that you would recommend adding or changing? Should you consider deprescribing?)
    4. Integration of medicines management services (What other healthcare professionals should this patient engage with? Are there any services that you would like to refer the patient to?)

Example of PREVENT framework and risk stratification:



Actual or likely consequence

Physical impairment

Patient has arthritis, which affects dexterity in hands and wrists. She experiences difficulty using her salbutamol MDI inhaler as she struggles

to press down on the canister to activate a dose.

Unable to self-manage exacerbations of COPD.




Risk factor


and justification of choice


and justification of choice





Patient reports that she is often unable to press down on canister.


Uncontrolled exacerbation of COPD could lead to acute deterioration and need for hospitalisation.






  1. Identify what strategies you can put in place to prevent medication-related harm and prioritise the actions that you recommend. Justify the reasons for your recommendations and your prioritisation.
  2. Critically appraise the risk framework and reflect on its usability, applicability, effectiveness and accuracy, and identify what you would do to develop and adapt the tool to allow you to use it in your everyday practice.

Assessment criteria

Use the template provided (boxes can be enlarged as required). The total word count should not exceed 2500 words. This does not include references or the section headings or other pre-printed text. Work that exceeds the word limit will not be marked beyond the first 2500 words. Work that exceeds the word limit will not be marked beyond the first 2500 words. Consult markscheme for weighting of each section (i.e. how marks are allocated). Ensure that references are reputable and are cited appropriately.

Module 7BBPP005: Medicines and older people

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