Enhancing understanding of polypharmacy and its complexities in elderly patients through the use of gamification

Introduction

Polypharmacy is commonly defined as the prescription of five or more medications [1,2]. It is effective in managing long-term conditions but poses numerous risks [3]. Several commonly used drugs have anticholinergic effects and in combination can cause delirium and falls, both resulting in hospitalisation [4,5,6]. These complications are encountered more frequently in an ageing population with increasing multimorbidity [2,3].

Method

The aim was to increase awareness of polypharmacy using an educational game named ‘Monopolypharmacy’, based on Monopoly. The ‘properties’ were long-term conditions for which participants prescribed medications. Players used the British National Formulary (BNF) to check interactions/contraindications [7,8].

Teaching was delivered to medical students (third- and fifth years) and foundation doctors, and the format aligned with their learning outcomes [9,10]. Third years should recognise common drug interactions and culprit medications for delirium/falls [9]. Fifth years are assessed on prescribing and drug monitoring in the Prescribing Safety Assessment (PSA) [11]. Foundation years must display competency in safe prescribing, including holding, stopping and adjusting medications appropriately [11,12,13].

Pre- and post-session data was collected anonymously. Questions were asked on a Likert scale, ranging from ‘(still) unsure’ to ‘very confident’.

Results

Each group became notably more confident in the area closely related to their individual learning outcomes. All groups felt more prepared for the PSA after the session, but the largest increase was seen in fifth years (4.33/10 to 6.76/10).

Most found the session applicable to their studies/work (94%). 95% of participants stated the game was effective in teaching polypharmacy, with several participants mentioning specific drug interactions/contraindications as their ‘take-home’ messages.

Conclusion

Gamification can effectively increase understanding of polypharmacy at many stages of one’s medical career. Although polypharmacy is often necessary to manage multimorbidity, raising awareness of the adverse effects results in earlier intervention and therefore fewer complications among a growing elderly population.