Medication-related adverse events in older people with dementia; causes and possible solutions

General Pharmaceutical Council : Member

Royal Pharmaceutical Society : Founding Member

College of Mental Health Pharmacy : Member

Anticholinergic drugs and incident dementia, mild cognitive impairment and cognitive decline: a meta-analysis

Does the Formulation of Oral Solid Dosage Forms Affect Acceptance and Adherence in Older Patients? A Mixed Methods Systematic Review

How, why, for whom and in what context, do sexual health clinics provide an environment for safe and supported disclosure of sexual violence: protocol for a realist review

MEDREV (pharmacy-health psychology intervention in people living with dementia with behaviour that challenges): the feasibility of measuring clinical outcomes and costs of the intervention

Neuropathological Correlates of Cumulative Benzodiazepine and Anticholinergic Drug Use

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Aston University

Ian Maidment is a Professor in Clinical Pharmacy at Aston University. Prior to moving to academia in 2012, he spent 20+ years in practice including community pharmacy and acute pharmacy. The majority of his career was as a specialist clinical pharmacist in dementia care/mental health; he was also chief pharmacist in two NHS Trusts. 

He has strong links with the local NHS and the NIHR. Currently, he is joint West Midlands NIHR Community Trust Specialty Lead, member of the NIHR Dementia Portfolio Development Group and joint chair of the Society of Academic Primary Care Medication Optimisation Group.

Since 2014 he has obtained £1,111K in grant income (as chief investigator) including four NIHR grants (MEDREV, MEMORABLE, RESOLVE, MEDIATE); he has also been a co-investigator on a further £3,963K of grants and a NIHR fellowship for which he is the main supervisor [£71K].

His research is focused on medication management in vulnerable populations including mental health and dementia. He has published over 110 papers in peer-reviewed journals including BMJ and the British Journal of Psychiatry and presented at 50+ international conferences/workshops in USA, Australia and most countries in Europe.

Community Pharmacy

Dementia

Pharmacology

Mental Health

Medication Management for Older People

Aston Research Explorer Profile

Aston University Birmingham Faculty Profile

ResearchGate Citations

Essential Pharma drops plans to withdraw bipolar drug amid competition investigation

Aston Univeristy to research role of community pharmacy during pandemics

Research tackles hidden 'tablet overload' as COVID isolation fears grow

Patients told not to stop anticholinergic drugs after study links them to dementia

'Don't panic' over medicines' link to dementia, says expert

Dementia risk linked to some medicines

People with dementia need more support managing their medication

PERISCOPE: A rapid realist review of community pharmacy support for the public health agenda during the COVID-19 pandemic and future health emergencies

MEMORABLE

Research for Patient Benefit

Pharmacy Research UK

pharmacy-researchers-investigating-drug-optimisation-for-severe-mental-illness-hold-workshop-for-people-with-lived-experience-

Professor of Clinical Pharmacy

  Members of the Lived Experience Stakeholder Group meet at Aston University for the first time to give feedback on the project MEDIATE investigated how medication for severe mental illness can be optimised Research funded by the National Institute for Health Research (NIHR).  Researchers from Aston Pharmacy School welcomed people with lived experience involved in the MEDIATE research project to campus for a one-day workshop on 17 March to enable these members of the Lived Experience Stakeholder Group - who all live with and take medication for severe mental illness (SMI) - to meet in person to give feedback and discuss their participation in the project.

The group members have participated in the National Institute for Health Research (NIHR) funded project since January 2022 until its conclusion in March 2023.
The MEDIATE project investigated how medication can be best optimised (safely getting the right drug at the right dose to the individual at the right time) for people living with SMI.

The first part of the workshop allowed participants to discuss with the research team their involvement as people with lived experience of severe mental illness in the project. 

Dr Jo Howe, MEDIATE project researcher at Aston University, said:
“Although this group was formed to help us as researchers, we became aware that involvement in the group has also helped group members. They enjoyed linking with their peers, despite having had different lives and journeys, they discovered shared experiences, which helped them feel less isolated.   “Importantly some members said that their involvement in our research improved their self-confidence and helped them to speak about their medication concerns with their healthcare team.”  The second part of the workshop bought the group together to gauge opinions on three separate research projects currently being planned by the MEDIATE research team. The group were able to give useful insights to help shape the research teams future project proposals. 

Max Carlish, MEDIATE group member, said: “Our participation throughout this project has really made us feel that we have been influencing the direction of the research. With our unique service user perspectives helping to make the research findings practicable and applicable to the vitally important - and often overlooked - area of medication optimisation.”  Mustak Mirza, MEDIATE group member, added: “People will trust their leaders when the leaders do the thing that make them feel psychologically safe. And I believe and feel you (the MEDIATE Team) have done that. Many thanks for being so kind.”  Dr Jo Howe added: “Input from the group has been invaluable for this project. Their involvement has shaped the trajectory of our research and they have been instrumental in identifying gaps in the research evidence.  “It really was fantastic to meet everyone in person, I felt like we connected at a deeper level and I’m really looking forward to working with everyone again on future research.”  Professor Ian Maidment, MEDIATE project lead at Aston University, said: 
“It is vital that the people who this research affects are actively involved in the process. We aimed to do this in MEDIATE and working with this group has really helped inform the research. For example, any guidance or outputs we produce will be centred on real world experience and are therefore much more likely to have an impact.”   

Pharmacy researchers investigating drug optimisation for severe mental illness hold workshop for people with lived experience 

new-research-to-help-manage-excessive-weight-gain-in-patients-being-treated-with-antipsychotics

  New research led by Dr Gurkiran Birdi and Dr Ian Maidment in the College of Health and Life Sciences at Aston University will explore ways of managing excessive weight gain in patients being treated with antipsychotics for mental health illnesses such as schizophrenia. 

The project, known as RESOLVE and funded by the National Institute for Health Research (NIHR), will study non-pharmacological interventions for antipsychotic-induced weight gain in people living with severe mental illness (SMI) by working directly with patients to understand and explain how, why, for whom, and in what contexts non-pharmacological interventions could help service users to manage antipsychotic-induced weight gain.

Antipsychotics are widely used in the treatment of schizophrenia and other severe mental illnesses (SMI). Over the last 20 years, the first generation of antipsychotics has been replaced by the newer second generation of antipsychotics. There are over 220,000 people being treated for schizophrenia in the UK at any one point in time. 

Up to 80% of people with schizophrenia or bipolar disorder are overweight or obese. 
Weight gains of up to 33kg have been reported with antipsychotics. This weight gain has devastating consequences: life expectancy is reduced by 20 years in people with schizophrenia, partly related to the consequences of this weight gain. Diabetes has been reported to be a major issue with second-generation antipsychotics. 

In RESOLVE - which includes partners from University of East Anglia, Oxford, Cambridge, Birmingham Universities, the NHS and the McPin Foundation - the researchers will combine literature what has been written about the subject. The team will also interview volunteers, both people who have suffered from the weight and healthcare staff involved to understand their lived experience of weight gain. We also want to find out what works to help manage weight. 

At the end of the project, the team plans to develop guidance for service users and practitioners on the best ways to treat and manage weight gain.

Dr Ian Maidment, reader in clinical pharmacy and lead researcher, said: “Prior to moving to academia, I spent 20 years working in mental health services. This is a really important issue, I have seen patients literally “balloon” weight with their weight increasing from 80 to 120kg. We need to find better ways to help them.”  One member of the RESOLVE Lived Experience Advisory Group said: “The RESOLVE study could provide a tailored solution to my antipsychotic weight gain, that could benefit my unique needs as an individual. I have found that weight gain from taking anti-psychotics has been a real health problem. I find that this is often ignored or stigmatized by friends, family and healthcare professionals. Added to which there seems to be no currently available solution that works”.  

New research to help manage excessive weight gain in patients being treated with antipsychotics

community-pharmacy-can-play-a-key-clinical-role-in-delivery-of-covid19-vaccinations-new-research

  New research published in BMJ Open shows that community pharmacy could play a ‘key clinical role’ in the future role of COVID-19 vaccination programmes, according to a study led by Aston University in Birmingham, UK, in collaboration with UK and international researchers.     

The team found that community pharmacists, as a ‘skilled clinical workforce’, could positively contribute, supporting the community in which they serve - by playing a critical role in ongoing COVID-19 vaccination campaigns. 

The researchers working on the PERISCOPE study found that community pharmacy is uniquely placed to support individuals, because it is seen by the public as a credible, trustworthy service, which could be key to any future clinical role it might play, especially where addressing vaccine hesitancy in ‘seldom heard’ communities. They are therefore calling on decision-makers to endorse and provide their support for a public health role for community pharmacy.  

Across the UK, community pharmacy is a critical part of primary care. According to the Kings Fund, as of the end of March 2019, there were more than 11,500 community pharmacies in England alone. It is viewed as one of the four pillars of the primary care system, along with general practice, optical services and dentistry. It has also, in areas of the UK, helped to deliver COVID-19 vaccinations. 

The study included partners from the Universities of Sheffield, Oxford, Hull and Bradford in the UK, as well as internationally, the University of British Columbia and University of Tasmania. The group reviewed more than a hundred documents including peer reviewed articles, blogs and websites on the role of community pharmacy during COVID-19 and other previous pandemics. 

Their findings were discussed with more than 30 health professionals and members of the public, to ensure that the findings made sense in the real world. Health professionals included pharmacists, pharmacy technicians, dispensers, counter assistants, and GPs, together with members of the public from a range of diverse ethnic backgrounds.

Several recommendations were made by the researchers from the findings of the study. Most significantly the group found it was imperative that policy and practice should focus on the clinical role of community pharmacy.  

Dr Ian Maidment, reader in clinical pharmacy at Aston University and former community pharmacist leading PERSICOPE, said: 

“We need to use community pharmacy to a much greater extent for COVID-19 vaccination, particularly for boosters against new variants such as the Delta (Indian) variant. The current model (for example, the large hubs) may not be sustainable in the longer term, particularly if annual COVID-19 vaccination is required. “Our work found some key ways to make this happen. The easy access and local convenience of high street pharmacies makes them an ideal location for vaccinating at-risk populations.”   The study includes guidance for policy makers:
•	Have a clear role for community pharmacy in response to the public health agenda, with that role championed by decision-makers
•	Involve frontline community pharmacists in the development of policy and service specification in relation to vaccination
•	Provide prompt, clear, consistent guidelines with adequate detail and enough flexibility to allow community pharmacies to adapt the guidelines to meet the needs of their local population
•	Provide adequate funding and reimbursement for the delivery and necessary adaptations of any new services community pharmacies are asked to deliver 
•	Provide pharmacy teams with adequate systems to deliver this new role and then trust them to deliver.  

Hadar Zaman, head of pharmacy and medical sciences at University of Bradford and a community pharmacist, said:

“Our research has highlighted the important role community pharmacy has played in overcoming vaccine hesitancy, particularly in ethnic minority communities who have been disproportionately affected by COVID and subsequent mortality.  “What comes out very strongly, especially in areas of high social deprivation, is that community pharmacists have worked very closely with their local communities addressing concerns around vaccine safety.  “It is through these strongly rooted relationships in local communities that we will ensure vaccine uptake rates in ethnic minority and the wider population can be further improved. Therefore, community pharmacy needs to be seen as an essential delivery partner if the Government is to achieve its national vaccination coverage in the short and long term”.  PERISCOPE searched for the best evidence across the world and the team included international collaborators. The findings therefore have international relevance. 

Maura MacPhee, professor of nursing, University of British Columbia and member of the research team, said: 

“Our review findings and recommendations for decision-makers, community pharmacists and pharmacy users are adaptable and relevant internationally, including my country, Canada, where community pharmacy has a major role to play in COVID-19 vaccination programmes.”  Juanita Breen, also a member of the PERISCOPE team and associate professor of dementia studies at Wicking Dementia Centre, School of Health and Medicine, University of Tasmania, added: 

"This study demonstrates how pharmacists can contribute towards this important public health initiative and enhance the uptake of the vaccine.  “It provides important learnings for other countries on how best to utilise the skills of our most accessible health professional - the community pharmacist."  Professor Claire Anderson, chair of the Royal Pharmaceutical Society’s English Board said:

“This research clearly demonstrates the vital role community pharmacy has played during the pandemic, providing essential advice to communities and tackling health inequalities in areas of high social deprivation.  “Policy makers and commissioners need to take forward the recommendations of this research and ensure the strengths of the community pharmacy network are maximised for the benefits of patients.”  Alastair Buxton, director of NHS Services at the Pharmaceutical Services Negotiating Committee, said:

 
“This research provides a timely examination of the role community pharmacy teams have played in supporting their communities to fight back against COVID-19.  “By keeping their doors open throughout, pharmacies have maintained day-to-day activities, and managed increased demand for many services - including advice on the management of minor illness. They have also substantially increased the number of flu vaccinations administered and played a key part in the COVID-19 vaccination programme. “These findings will help guide policy in the later stages of the pandemic and guide practice in any future pandemics.”  Tony Kelly, a diabetes ambassador, Diabetes Strategic Patient Partner - NHS Birmingham and Solihull Clinical Commissioning Group and member of PERISCOPE, said: 

"Community pharmacists are ideally placed at the forefront of the vaccination agenda as they are the nucleus of ethnically diverse communities and are often the first point of contact for most people."    PERISCOPE was jointly funded by UK Research and Innovation (UKRI) and the National Institute for Health Research (NIHR).




Community pharmacy can play a ‘key clinical role’ in delivery of COVID-19 vaccinations – new research

Ian Maidment, PhD, sat with NeurologyLive at the Alzheimer’s Association International Conference on Alzheimer’s Disease (ICAD) in Chicago, Illinois, to talk about the findings of the ZED study, which looked into the use of hypnotic z-drugs—such as zolpidem, zopiclone, and zaleplon—in elderly patients with dementia.

The senior lecturer in Clinical Pharmacy at Ashton University spoke about how these patients, who are already at a risk for falls and fractures, have an added risk when administered these therapies, which themselves hav not been completely evaluated for safety and efficacy. Ultimately, trial found an increase in risk for both fractures in general and hip fractures. 

Maidment detailed how his work could lead to improved care outcomes and quality of life, reduced hospital admissions, mortality, and institutionalization for people who have dementia with sleep disturbance and their caregivers, as the findings provide better understanding of the consequences of Z-drugs.

Ian Maidment, PhD: The ZED Study

Ian Maidment, PhD, sat with NeurologyLive at the Alzheimer’s Association International Conference on Alzheimer’s Disease in Chicago, Illinois, to talk about the issues facing the medical community when it comes to treating the elderly and those with dementia who have cognitive impairment or sleep problems. 

The senior lecturer in Clinical Pharmacy at Aston University discussed the impact that hip fractures, which can often be caused by the adverse effects of hypnotic Z-drugs, on those who are elderly with dementia. This, he said, includes the appropriate prescribing of sedatives, antipsychotics, and all drugs that can lead to falls for these patients.

Specifically, Maidment spoke this issue of proper prescribing with those who have cognitive impairment, and his desire to help people with dementia who are on medications get the best out of them. He noted the struggles these patients face in identifying errors or changes in the medications, and how the medical community needs to provide support to these patients.

He also acknowledged a need for more and newer therapeutic options for these conditions, mentioning that, for the last 17  years, the area has been relatively stagnant in terms of options.

Maidment said that when physicians began switching from benzodiazepines, or benzos, to z-drugs, there was a belief that there would improvement, but new research, such as a study he helped conduct into the use of z-drugs, have shown that may not be the case. Overall, he said, the key focus for sleep issues with the elderly and those with dementia should be addressing them with non-pharmaceutical methods, such as proper diet and exercise, better regulation of the sleep-wake schedule, and having more person-centered care for these patients.

Ian Maidment, PhD: Treating Sleep Problems in Those with Dementia

BBC Breakfast covers the launch of the MEMORABLE project led by Dr Ian Maidment, Senior Lecturer in Clinical Pharmacy at Aston University's School of Life and Health Sciences. The 20-month study, funded by the NIHR, will develop practical, real-world solutions to the problem of medication management which is estimated to cause 5,700 deaths per year in the UK and cost over £1bn in over-prescribed and wasted medicines. The project will see Aston researchers work closely with NHS and social care professionals as well as patients and their carers.

Aston University medication project on BBC Breakfast

As the pandemic strained health care systems to their limit, pharmacies took on greater responsibilities and became more involved in direct patient care on the front lines. New research shows that community pharmacy could play a 'key clinical role' in ongoing vaccination programs and future health emergencies. Dr. Ian Maidment, reader in clinical pharmacy at Aston University and chief investigator of the PERISCOPE study shares the findings with NewsPoint360 and the recommendations made by the team of researchers to guide policy moving forward.

Learn more about Ian Maidment's expertise here: 
https://expertfile.com/experts/drian.maidment

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