Older adult pharmacy resources

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                50 => "create policy_update content"
                51 => "create promo content"
                52 => "create publication content"
                53 => "create resource content"
                54 => "create resource_series content"
                55 => "create slide content"
                56 => "create system_page content"
                57 => "create team content"
                58 => "create url aliases"
                59 => "create users"
                60 => "create voting_form content"
                61 => "customize shortcut links"
                62 => "delete any blog content"
                63 => "delete any country content"
                64 => "delete any elearning_module content"
                65 => "delete any event content"
                66 => "delete any external_course content"
                67 => "delete any external_event content"
                68 => "delete any form content"
                69 => "delete any front content"
                70 => "delete any group content"
                71 => "delete any member_update content"
                72 => "delete any news content"
                73 => "delete any page content"
                74 => "delete any person content"
                75 => "delete any policy_update content"
                76 => "delete any promo content"
                77 => "delete any publication content"
                78 => "delete any resource content"
                79 => "delete any resource_series content"
                80 => "delete any slide content"
                81 => "delete any system_page content"
                82 => "delete any team content"
                83 => "delete any voting_form content"
                84 => "delete any webform content"
                85 => "delete own blog content"
                86 => "delete own country content"
                87 => "delete own elearning_module content"
                88 => "delete own event content"
                89 => "delete own external_course content"
                90 => "delete own external_event content"
                91 => "delete own form content"
                92 => "delete own front content"
                93 => "delete own group content"
                94 => "delete own member_update content"
                95 => "delete own news content"
                96 => "delete own page content"
                97 => "delete own person content"
                98 => "delete own policy_update content"
                99 => "delete own promo content"
                100 => "delete own publication content"
                101 => "delete own resource content"
                102 => "delete own resource_series content"
                103 => "delete own slide content"
                104 => "delete own system_page content"
                105 => "delete own team content"
                106 => "delete own user revisions"
                107 => "delete own voting_form content"
                108 => "delete own webform content"
                109 => "edit any blog content"
                110 => "edit any country content"
                111 => "edit any elearning_module content"
                112 => "edit any event content"
                113 => "edit any external_course content"
                114 => "edit any external_event content"
                115 => "edit any form content"
                116 => "edit any front content"
                117 => "edit any group content"
                118 => "edit any member_update content"
                119 => "edit any news content"
                120 => "edit any page content"
                121 => "edit any person content"
                122 => "edit any policy_update content"
                123 => "edit any promo content"
                124 => "edit any publication content"
                125 => "edit any resource content"
                126 => "edit any resource_series content"
                127 => "edit any slide content"
                128 => "edit any system_page content"
                129 => "edit any team content"
                130 => "edit any voting_form content"
                131 => "edit any webform content"
                132 => "edit own blog content"
                133 => "edit own country content"
                134 => "edit own elearning_module content"
                135 => "edit own event content"
                136 => "edit own external_course content"
                137 => "edit own external_event content"
                138 => "edit own form content"
                139 => "edit own front content"
                140 => "edit own group content"
                141 => "edit own member_update content"
                142 => "edit own news content"
                143 => "edit own page content"
                144 => "edit own person content"
                145 => "edit own policy_update content"
                146 => "edit own promo content"
                147 => "edit own publication content"
                148 => "edit own resource content"
                149 => "edit own resource_series content"
                150 => "edit own slide content"
                151 => "edit own system_page content"
                152 => "edit own team content"
                153 => "edit own voting_form content"
                154 => "edit own webform content"
                155 => "masquerade as any user"
                156 => "masquerade as super user"
                157 => "notify of path changes"
                158 => "revert own user revisions"
                159 => "run security checks"
                160 => "schedule publishing of nodes"
                161 => "search content"
                162 => "select account cancellation method"
                163 => "switch shortcut sets"
                164 => "switch users"
                165 => "use advanced search"
                166 => "use text format ds_code"
                167 => "use text format filtered_html"
                168 => "use text format full_html"
                169 => "use text format title"
                170 => "view own unpublished content"
                171 => "view own user revisions"
                172 => "view scheduled content"
                173 => "view the administration theme"
              ]
            ]
            "bundle" => "user_role"
          ]
          5 => array:3 [
            "target_id" => "bgs_admin"
            "entity" => array:9 [
              "uuid" => "66d8f893-6e9e-4d75-817e-01586d8df27e"
              "langcode" => "en"
              "status" => true
              "dependencies" => array:2 [
                "config" => array:31 [
                  0 => "node.type.admin_help_page"
                  1 => "node.type.blog"
                  2 => "node.type.country"
                  3 => "node.type.elearning_module"
                  4 => "node.type.event"
                  5 => "node.type.external_course"
                  6 => "node.type.external_event"
                  7 => "node.type.external_jobs"
                  8 => "node.type.faq"
                  9 => "node.type.form"
                  10 => "node.type.front"
                  11 => "node.type.group"
                  12 => "node.type.landing_page"
                  13 => "node.type.member_update"
                  14 => "node.type.news"
                  15 => "node.type.page"
                  16 => "node.type.person"
                  17 => "node.type.policy_update"
                  18 => "node.type.promo"
                  19 => "node.type.publication"
                  20 => "node.type.resource"
                  21 => "node.type.resource_series"
                  22 => "node.type.simpleads"
                  23 => "node.type.slide"
                  24 => "node.type.system_page"
                  25 => "node.type.team"
                  26 => "node.type.vimeo_stream"
                  27 => "node.type.voting_form"
                  28 => "node.type.webform"
                  29 => "workflows.workflow.editorial"
                  30 => "workflows.workflow.external_event_workflow"
                ]
                "module" => array:6 [
                  0 => "admin_toolbar_search"
                  1 => "administerusersbyrole"
                  2 => "content_moderation"
                  3 => "node"
                  4 => "paragraphs_type_permissions"
                  5 => "system"
                ]
              ]
              "id" => "bgs_admin"
              "label" => "BGS admin"
              "weight" => 30
              "is_admin" => null
              "permissions" => array:391 [
                0 => "access content"
                1 => "access content overview"
                2 => "access user profiles"
                3 => "access users overview"
                4 => "administer nodes"
                5 => "administer users"
                6 => "allow empty user mail"
                7 => "bypass paragraphs type content access"
                8 => "cancel account"
                9 => "cancel users by role"
                10 => "change own username"
                11 => "create admin_help_page content"
                12 => "create blog content"
                13 => "create country content"
                14 => "create elearning_module content"
                15 => "create event content"
                16 => "create external_course content"
                17 => "create external_event content"
                18 => "create external_jobs content"
                19 => "create faq content"
                20 => "create form content"
                21 => "create front content"
                22 => "create group content"
                23 => "create landing_page content"
                24 => "create member_update content"
                25 => "create news content"
                26 => "create page content"
                27 => "create paragraph content attachment"
                28 => "create paragraph content attachments"
                29 => "create paragraph content block"
                30 => "create paragraph content call_to_action"
                31 => "create paragraph content faqs"
                32 => "create paragraph content faqs_accordion"
                33 => "create paragraph content feed"
                34 => "create paragraph content form"
                35 => "create paragraph content from_library"
                36 => "create paragraph content gallery"
                37 => "create paragraph content hero_card"
                38 => "create paragraph content home_featured_events"
                39 => "create paragraph content home_featured_items"
                40 => "create paragraph content home_latest"
                41 => "create paragraph content iframe"
                42 => "create paragraph content link_flexi"
                43 => "create paragraph content links"
                44 => "create paragraph content links_flexi_container"
                45 => "create paragraph content map_world"
                46 => "create paragraph content promo"
                47 => "create paragraph content q_a"
                48 => "create paragraph content quote"
                49 => "create paragraph content slider"
                50 => "create paragraph content social_links"
                51 => "create paragraph content stream_day"
                52 => "create paragraph content stream_session"
                53 => "create paragraph content tagged"
                54 => "create paragraph content team"
                55 => "create paragraph content team_member"
                56 => "create paragraph content twitter"
                57 => "create paragraph content video"
                58 => "create paragraph content view"
                59 => "create paragraph content wysiwyg"
                60 => "create person content"
                61 => "create policy_update content"
                62 => "create publication content"
                63 => "create resource content"
                64 => "create resource_series content"
                65 => "create simpleads content"
                66 => "create slide content"
                67 => "create system_page content"
                68 => "create team content"
                69 => "create users"
                70 => "create vimeo_stream content"
                71 => "create voting_form content"
                72 => "create webform content"
                73 => "delete admin_help_page revisions"
                74 => "delete any admin_help_page content"
                75 => "delete any blog content"
                76 => "delete any country content"
                77 => "delete any elearning_module content"
                78 => "delete any event content"
                79 => "delete any external_course content"
                80 => "delete any external_event content"
                81 => "delete any external_jobs content"
                82 => "delete any faq content"
                83 => "delete any form content"
                84 => "delete any front content"
                85 => "delete any group content"
                86 => "delete any landing_page content"
                87 => "delete any member_update content"
                88 => "delete any news content"
                89 => "delete any page content"
                90 => "delete any person content"
                91 => "delete any policy_update content"
                92 => "delete any promo content"
                93 => "delete any publication content"
                94 => "delete any resource content"
                95 => "delete any resource_series content"
                96 => "delete any simpleads content"
                97 => "delete any slide content"
                98 => "delete any system_page content"
                99 => "delete any team content"
                100 => "delete any vimeo_stream content"
                101 => "delete any voting_form content"
                102 => "delete any webform content"
                103 => "delete blog revisions"
                104 => "delete country revisions"
                105 => "delete elearning_module revisions"
                106 => "delete event revisions"
                107 => "delete external_course revisions"
                108 => "delete external_event revisions"
                109 => "delete external_jobs revisions"
                110 => "delete faq revisions"
                111 => "delete form revisions"
                112 => "delete front revisions"
                113 => "delete group revisions"
                114 => "delete landing_page revisions"
                115 => "delete member_update revisions"
                116 => "delete news revisions"
                117 => "delete own admin_help_page content"
                118 => "delete own blog content"
                119 => "delete own country content"
                120 => "delete own elearning_module content"
                121 => "delete own event content"
                122 => "delete own external_course content"
                123 => "delete own external_event content"
                124 => "delete own external_jobs content"
                125 => "delete own faq content"
                126 => "delete own form content"
                127 => "delete own front content"
                128 => "delete own group content"
                129 => "delete own landing_page content"
                130 => "delete own member_update content"
                131 => "delete own news content"
                132 => "delete own page content"
                133 => "delete own person content"
                134 => "delete own policy_update content"
                135 => "delete own promo content"
                136 => "delete own publication content"
                137 => "delete own resource content"
                138 => "delete own resource_series content"
                139 => "delete own simpleads content"
                140 => "delete own slide content"
                141 => "delete own system_page content"
                142 => "delete own team content"
                143 => "delete own vimeo_stream content"
                144 => "delete own voting_form content"
                145 => "delete own webform content"
                146 => "delete page revisions"
                147 => "delete paragraph content attachment"
                148 => "delete paragraph content attachments"
                149 => "delete paragraph content block"
                150 => "delete paragraph content call_to_action"
                151 => "delete paragraph content faqs"
                152 => "delete paragraph content faqs_accordion"
                153 => "delete paragraph content feed"
                154 => "delete paragraph content form"
                155 => "delete paragraph content from_library"
                156 => "delete paragraph content gallery"
                157 => "delete paragraph content hero_card"
                158 => "delete paragraph content home_featured_events"
                159 => "delete paragraph content home_featured_items"
                160 => "delete paragraph content home_latest"
                161 => "delete paragraph content iframe"
                162 => "delete paragraph content link_flexi"
                163 => "delete paragraph content links"
                164 => "delete paragraph content links_flexi_container"
                165 => "delete paragraph content map_world"
                166 => "delete paragraph content promo"
                167 => "delete paragraph content q_a"
                168 => "delete paragraph content quote"
                169 => "delete paragraph content slider"
                170 => "delete paragraph content social_links"
                171 => "delete paragraph content stream_day"
                172 => "delete paragraph content stream_session"
                173 => "delete paragraph content tagged"
                174 => "delete paragraph content team"
                175 => "delete paragraph content team_member"
                176 => "delete paragraph content twitter"
                177 => "delete paragraph content video"
                178 => "delete paragraph content view"
                179 => "delete paragraph content wysiwyg"
                180 => "delete person revisions"
                181 => "delete policy_update revisions"
                182 => "delete promo revisions"
                183 => "delete publication revisions"
                184 => "delete resource revisions"
                185 => "delete resource_series revisions"
                186 => "delete simpleads revisions"
                187 => "delete slide revisions"
                188 => "delete system_page revisions"
                189 => "delete team revisions"
                190 => "delete vimeo_stream revisions"
                191 => "delete voting_form revisions"
                192 => "delete webform revisions"
                193 => "edit any admin_help_page content"
                194 => "edit any blog content"
                195 => "edit any country content"
                196 => "edit any elearning_module content"
                197 => "edit any event content"
                198 => "edit any external_course content"
                199 => "edit any external_event content"
                200 => "edit any external_jobs content"
                201 => "edit any faq content"
                202 => "edit any form content"
                203 => "edit any front content"
                204 => "edit any group content"
                205 => "edit any landing_page content"
                206 => "edit any member_update content"
                207 => "edit any news content"
                208 => "edit any page content"
                209 => "edit any person content"
                210 => "edit any policy_update content"
                211 => "edit any promo content"
                212 => "edit any publication content"
                213 => "edit any resource content"
                214 => "edit any resource_series content"
                215 => "edit any simpleads content"
                216 => "edit any slide content"
                217 => "edit any system_page content"
                218 => "edit any team content"
                219 => "edit any vimeo_stream content"
                220 => "edit any voting_form content"
                221 => "edit any webform content"
                222 => "edit own admin_help_page content"
                223 => "edit own blog content"
                224 => "edit own country content"
                225 => "edit own elearning_module content"
                226 => "edit own event content"
                227 => "edit own external_course content"
                228 => "edit own external_event content"
                229 => "edit own external_jobs content"
                230 => "edit own faq content"
                231 => "edit own form content"
                232 => "edit own front content"
                233 => "edit own group content"
                234 => "edit own landing_page content"
                235 => "edit own member_update content"
                236 => "edit own news content"
                237 => "edit own page content"
                238 => "edit own person content"
                239 => "edit own policy_update content"
                240 => "edit own promo content"
                241 => "edit own publication content"
                242 => "edit own resource content"
                243 => "edit own resource_series content"
                244 => "edit own simpleads content"
                245 => "edit own slide content"
                246 => "edit own system_page content"
                247 => "edit own team content"
                248 => "edit own vimeo_stream content"
                249 => "edit own voting_form content"
                250 => "edit own webform content"
                251 => "edit users by role"
                252 => "revert admin_help_page revisions"
                253 => "revert all revisions"
                254 => "revert blog revisions"
                255 => "revert country revisions"
                256 => "revert elearning_module revisions"
                257 => "revert event revisions"
                258 => "revert external_course revisions"
                259 => "revert external_event revisions"
                260 => "revert external_jobs revisions"
                261 => "revert faq revisions"
                262 => "revert form revisions"
                263 => "revert front revisions"
                264 => "revert group revisions"
                265 => "revert landing_page revisions"
                266 => "revert member_update revisions"
                267 => "revert news revisions"
                268 => "revert page revisions"
                269 => "revert person revisions"
                270 => "revert policy_update revisions"
                271 => "revert promo revisions"
                272 => "revert publication revisions"
                273 => "revert resource revisions"
                274 => "revert resource_series revisions"
                275 => "revert simpleads revisions"
                276 => "revert slide revisions"
                277 => "revert system_page revisions"
                278 => "revert team revisions"
                279 => "revert vimeo_stream revisions"
                280 => "revert voting_form revisions"
                281 => "revert webform revisions"
                282 => "select account cancellation method"
                283 => "update paragraph content attachment"
                284 => "update paragraph content attachments"
                285 => "update paragraph content block"
                286 => "update paragraph content call_to_action"
                287 => "update paragraph content faqs"
                288 => "update paragraph content faqs_accordion"
                289 => "update paragraph content feed"
                290 => "update paragraph content form"
                291 => "update paragraph content from_library"
                292 => "update paragraph content gallery"
                293 => "update paragraph content hero_card"
                294 => "update paragraph content home_featured_events"
                295 => "update paragraph content home_featured_items"
                296 => "update paragraph content home_latest"
                297 => "update paragraph content iframe"
                298 => "update paragraph content link_flexi"
                299 => "update paragraph content links"
                300 => "update paragraph content links_flexi_container"
                301 => "update paragraph content map_world"
                302 => "update paragraph content promo"
                303 => "update paragraph content q_a"
                304 => "update paragraph content quote"
                305 => "update paragraph content slider"
                306 => "update paragraph content social_links"
                307 => "update paragraph content stream_day"
                308 => "update paragraph content stream_session"
                309 => "update paragraph content tagged"
                310 => "update paragraph content team"
                311 => "update paragraph content team_member"
                312 => "update paragraph content twitter"
                313 => "update paragraph content video"
                314 => "update paragraph content view"
                315 => "update paragraph content wysiwyg"
                316 => "use admin toolbar search"
                317 => "use editorial transition archive"
                318 => "use editorial transition archived_draft"
                319 => "use editorial transition archived_published"
                320 => "use editorial transition create_new_draft"
                321 => "use editorial transition publish"
                322 => "use external_event_workflow transition create_new_draft"
                323 => "use external_event_workflow transition publish"
                324 => "view admin_help_page revisions"
                325 => "view all revisions"
                326 => "view any unpublished content"
                327 => "view blog revisions"
                328 => "view country revisions"
                329 => "view elearning_module revisions"
                330 => "view event revisions"
                331 => "view external_course revisions"
                332 => "view external_event revisions"
                333 => "view external_jobs revisions"
                334 => "view faq revisions"
                335 => "view form revisions"
                336 => "view front revisions"
                337 => "view group revisions"
                338 => "view landing_page revisions"
                339 => "view latest version"
                340 => "view member_update revisions"
                341 => "view news revisions"
                342 => "view own unpublished content"
                343 => "view page revisions"
                344 => "view paragraph content attachment"
                345 => "view paragraph content attachments"
                346 => "view paragraph content block"
                347 => "view paragraph content call_to_action"
                348 => "view paragraph content faqs"
                349 => "view paragraph content faqs_accordion"
                350 => "view paragraph content feed"
                351 => "view paragraph content form"
                352 => "view paragraph content from_library"
                353 => "view paragraph content gallery"
                354 => "view paragraph content hero_card"
                355 => "view paragraph content home_featured_events"
                356 => "view paragraph content home_featured_items"
                357 => "view paragraph content home_latest"
                358 => "view paragraph content iframe"
                359 => "view paragraph content link_flexi"
                360 => "view paragraph content links"
                361 => "view paragraph content links_flexi_container"
                362 => "view paragraph content map_world"
                363 => "view paragraph content promo"
                364 => "view paragraph content q_a"
                365 => "view paragraph content quote"
                366 => "view paragraph content slider"
                367 => "view paragraph content social_links"
                368 => "view paragraph content stream_day"
                369 => "view paragraph content stream_session"
                370 => "view paragraph content tagged"
                371 => "view paragraph content team"
                372 => "view paragraph content team_member"
                373 => "view paragraph content twitter"
                374 => "view paragraph content video"
                375 => "view paragraph content view"
                376 => "view paragraph content wysiwyg"
                377 => "view person revisions"
                378 => "view policy_update revisions"
                379 => "view promo revisions"
                380 => "view publication revisions"
                381 => "view resource revisions"
                382 => "view resource_series revisions"
                383 => "view simpleads revisions"
                384 => "view slide revisions"
                385 => "view system_page revisions"
                386 => "view team revisions"
                387 => "view user email addresses"
                388 => "view vimeo_stream revisions"
                389 => "view voting_form revisions"
                390 => "view webform revisions"
              ]
            ]
            "bundle" => "user_role"
          ]
        ]
        "default_langcode" => array:1 [
          0 => array:1 [
            "value" => "1"
          ]
        ]
        "revision_default" => array:1 [
          0 => array:1 [
            "value" => "1"
          ]
        ]
        "revision_translation_affected" => array:1 [
          0 => array:1 [
            "value" => "1"
          ]
        ]
        "metatag" => array:3 [
          0 => array:2 [
            "tag" => "meta"
            "attributes" => array:2 [
              "name" => "title"
              "content" => "publishing | British Geriatrics Society"
            ]
          ]
          1 => array:2 [
            "tag" => "meta"
            "attributes" => array:2 [
              "name" => "description"
              "content" => "British Geriatrics Society"
            ]
          ]
          2 => array:2 [
            "tag" => "link"
            "attributes" => array:2 [
              "rel" => "canonical"
              "href" => "https://d10upgrade.bgs.org.uk/users/amy-brewerton"
            ]
          ]
        ]
        "role_change" => array:1 [
          0 => array:1 [
            "target_id" => "__role_delegation_empty_field_value__"
          ]
        ]
        "revision_created" => array:1 [
          0 => array:1 [
            "value" => "1729758232"
          ]
        ]
        "revision_user" => array:1 [
          0 => array:3 [
            "target_id" => "595"
            "entity" => array:46 [
              "uid" => array:1 [
                0 => array:1 [
                  "value" => "595"
                ]
              ]
              "uuid" => array:1 [
                0 => array:1 [
                  "value" => "828a2101-4c0b-4778-92c8-0e09787fa62d"
                ]
              ]
              "revision_id" => array:1 [
                0 => array:1 [
                  "value" => "83207"
                ]
              ]
              "langcode" => array:1 [
                0 => array:1 [
                  "value" => "en"
                ]
              ]
              "preferred_langcode" => array:1 [
                0 => array:1 [
                  "value" => "en"
                ]
              ]
              "preferred_admin_langcode" => []
              "name" => array:1 [
                0 => array:1 [
                  "value" => "conferences_595"
                ]
              ]
              "pass" => array:1 [
                0 => array:1 [
                  "value" => "$2y$10$uFzYB0jigm2RajHGB7TJaOHtCWsZB7e/fMAJCxXJZRr5roW6a3LSy"
                ]
              ]
              "mail" => array:1 [
                0 => array:1 [
                  "value" => "conferences@bgs.org.uk"
                ]
              ]
              "timezone" => array:1 [
                0 => array:1 [
                  "value" => "Europe/London"
                ]
              ]
              "status" => array:1 [
                0 => array:1 [
                  "value" => "1"
                ]
              ]
              "created" => array:1 [
                0 => array:1 [
                  "value" => "1707470531"
                ]
              ]
              "changed" => array:1 [
                0 => array:1 [
                  "value" => "1731926076"
                ]
              ]
              "access" => array:1 [
                0 => array:1 [
                  "value" => "1732526987"
                ]
              ]
              "login" => array:1 [
                0 => array:1 [
                  "value" => "1732523261"
                ]
              ]
              "init" => []
              "roles" => array:10 [
                0 => array:3 [
                  "target_id" => "member"
                  "message" => "Recursion detected."
                  "array_path" => "uid.0.entity.roles.0.entity"
                ]
                1 => array:3 [
                  "target_id" => "administrator"
                  "message" => "Recursion detected."
                  "array_path" => "uid.0.entity.roles.1.entity"
                ]
                2 => array:3 [
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              <h2 class="sidebar-nav">General polypharmacy guidance</h2>\r\n
              \r\n
              <p class="larger-text">Within this section you will find links to guidance for conducting effective polypharmacy reviews.</p>\r\n
              \r\n
              <ul>\r\n
              \t<li><a href="https://managemeds.scot.nhs.uk/"><strong>Polypharmacy Guidance - NHS Scotland and The Scottish Government (2012,&nbsp;updated )&nbsp;</strong></a><br />\r\n
              \t\tIncluding the 7 steps to medication review, realistic prescribing, numbers needed to treat information. Also&nbsp;available to download as app.<br />\r\n
              \t\t&nbsp;</li>\r\n
              \t<li><a href="https://www.prescqipp.info/our-resources/webkits/polypharmacy-and-deprescribing/"><strong>PrescQIPP Polypharmacy and deprescribing toolkit</strong></a><br />\r\n
              \t\tSafe and appropriate medicines use, polypharmacy and deprescribing resources.<br />\r\n
              \t\t&nbsp;</li>\r\n
              \t<li><a href="https://thehealthinnovationnetwork.co.uk/programmes/medicines/polypharmacy/#:~:text=The%20AHSN%20Network%20national%20polypharmacy,Organisation%27s%20Global%20Patient%20Safety%20Challenge."><strong>Health Innovation Network (previously Academic Health Science Network) Polypharmacy Programme</strong></a><br />\r\n
              \t\tNational polypharmacy programme aimed at creating clinical, multi-stakeholder communities of practice across England, focusing on problematic polypharmacy within local areas.<br />\r\n
              \t\t&nbsp;</li>\r\n
              \t<li><a href="https://www.sps.nhs.uk/category/guidance/polypharmacy-guidance/"><strong>NHS Specialist Pharmacy Services Polypharmacy Resources</strong></a><br />\r\n
              \t\tResources complied by SPS on behalf of NHS England including tools which are useful to support medication reviews.<br />\r\n
              \t\t&nbsp;</li>\r\n
              \t<li><strong><a href="https://www.deprescribingnetwork.ca/">Canadian Medication Appropriateness and Deprescribing Network and Deprescribing.org</a></strong><br />\r\n
              \t\tDeprescribing resources including tools and algorithms for specific medicine groups, patient information and educational resources.&nbsp;<br />\r\n
              \t\t&nbsp;</li>\r\n
              \t<li><a href="https://www.nswtag.org.au/deprescribing-tools/"><strong>New South Wales Therapeutic Advisory Group Deprescribing resources</strong></a><br />\r\n
              \t\tIncluding guidance for deprescribing specific groups of medicines and information for patients.<br />\r\n
              \t\t&nbsp;</li>\r\n
              \t<li><a href="https://www.primaryhealthtas.com.au/resources/deprescribing-resources/"><strong>Deprescribing Guidance - Primary Care Tazmania</strong></a><br />\r\n
              \t\tGeneral information on deprescribing including a flowchart and guidance on stopping specific medicines or groups of medicines.<br />\r\n
              \t\t&nbsp;</li>\r\n
              \t<li><a href="https://gmmmg.nhs.uk/wp-content/uploads/2023/02/GMMMG-Polypharmacy-resource-pack-v3.0.pdf"><strong>Greater Manchester Medicines Management Group Polypharmacy Resource Pack</strong></a><br />\r\n
              \t\tResources on polypharmacy, deprescribing and structured medication reviews including resources for specific therapeutic areas, people living with frailty and in care homes.<br />\r\n
              \t\t&nbsp;</li>\r\n
              \t<li><a href="https://rightdecisions.scot.nhs.uk/media/2276/polypharmacy-review.pdf"><strong>Polypharmacy in older people - A guide for healthcare professionals</strong></a><br />\r\n
              \t\t&nbsp;All Wales Therapeutics and Toxicology Centre (nhs.wales) - a really helpful practical tool for deprescribing.</li>\r\n
              </ul>\r\n
              \r\n
              <hr />\r\n
              <h2 class="sidebar-nav">Explicit tools</h2>\r\n
              \r\n
              <p class="larger-text">These&nbsp;provide background, context and evidence-based framework for optimal use of medicines to support safe reviews (criterion based).</p>\r\n
              \r\n
              <ul>\r\n
              \t<li><a href="https://link.springer.com/article/10.1007/s41999-023-00784-z"><strong>STOPP/START tool vs3 2023&nbsp;</strong></a><br />\r\n
              \t\tSTOPP/START version 3 represents an updated explicit list of potentially inappropriate medications and potential prescribing omissions aimed at optimizing medication and minimizing adverse drug reactions and events during medication review in older people, particularly those with multimorbidity and polypharmacy.<br />\r\n
              \t\t&nbsp;</li>\r\n
              \t<li><a href="https://academic.oup.com/ageing/article/50/2/465/5913318"><strong>Deprescribing in older people approaching end-of-life: development and validation of STOPPFrail version 2</strong></a><br />\r\n
              \t\t<span style="font-size:13.5pt"><span style="line-height:107%"><span style="color:#595959">STOPPFrail comprises 27 criteria relating to medications that are potentially inappropriate in frail older patients with limited life expectancy. STOPPFrail may assist physicians in deprescribing medications in these patients.</span></span></span><br />\r\n
              \t\t&nbsp;</li>\r\n
              \t<li><strong><a href="https://academic.oup.com/ageing/article/50/4/1189/6043386">STOPPFall 2020 STOPPFall (Screening Tool of Older Persons Prescriptions in older adults with high fall risk): a Delphi study by the EuGMS Task and Finish Group on Fall-Risk-Increasing Drugs</a></strong><br />\r\n
              \t\tSTOPPFall was created using an expert Delphi consensus process and combined with a practical deprescribing tool designed to optimise medication review for patients who are at risk of falls.<br />\r\n
              \t\t&nbsp;</li>\r\n
              \t<li><a href="https://geriatricscareonline.org/ProductAbstract/american-geriatrics-society-updated-beers-criteria/CL001/?param2=search"><strong>Beers Criteria (Updated 2019)</strong></a><br />\r\n
              \t\tThe American Geriatric Society &ldquo;Beers&rdquo; criteria, first developed in 1992, provides a list of medications and types of medications that are either potentially inappropriate or should be used with caution in older people, including people with specific health conditions or poor kidney function.<br />\r\n
              \t\t&nbsp;</li>\r\n
              \t<li><a href="https://doi.org/10.1111/ggi.13062"><strong>LESS-CHRON 2017 Spain Geriatr Gerontol Int 2017; 17: 2200&ndash;2207&nbsp;</strong></a><br />\r\n
              \t\tThe &ldquo;LESS-CHRON (List of Evidence-baSed depreScribing for CHRONic patients) criteria&rdquo; identify clinical situations for deprescribing drugs in chronic patients with multimorbidity.<br />\r\n
              \t\t&nbsp;</li>\r\n
              \t<li><a href="https://www.prescqipp.info/our-resources/bulletins/bulletin-268-impact/"><strong>IMPACT (Improving Medicines and Polypharmacy Appropriateness Clinical Tool)&nbsp;</strong></a><br />\r\n
              \t\tThis bulletin provides suggestions for consideration by commissioning organisations and clinicians to optimise medicines use and provide practical advice (where it is available) about how to safely stop/ discontinue/withdraw a medicine and issues to consider.<br />\r\n
              \t\t&nbsp;</li>\r\n
              \t<li><a href="https://www.amjmed.com/article/S0002-9343(11)00901-6/fulltext"><strong>10 step framework for Minimizing Inappropriate Medications in Older Populations</strong></a><br />\r\n
              \t\tThe framework aims to reduce drug use in older patients to the minimum number of essential drugs, and its utility is demonstrated in reference to a hypothetical case study.<br />\r\n
              \t\t&nbsp;</li>\r\n
              \t<li><a href="https://link.springer.com/article/10.1007/s40266-022-00922-5"><strong>The FORTA (Fit fOR The Aged) List 2021: Fourth Version of a Validated Clinical Aid for Improved Pharmacotherapy in Older Adults</strong></a><br />\r\n
              \t\tFORTA list addresses both over- and undertreatment, leading to patients&rsquo; medical needs being comprehensively met, detecting both potentially inappropriate medicines and potentially omitted medicines.&nbsp;</li>\r\n
              </ul>\r\n
              \r\n
              <hr />\r\n
              <h2 class="sidebar-nav">Implicit tools (judgement based)</h2>\r\n
              \r\n
              <p class="larger-text">Implicit tools require judgement, which means they can be subjective and demand more time and clinical expertise.</p>\r\n
              \r\n
              <ul>\r\n
              \t<li><a href="https://pubmed.ncbi.nlm.nih.gov/1474400/"><strong>Medication appropriateness index</strong>&nbsp;</a><br />\r\n
              \t\tLists 10 criteria that evaluate various aspects of medication appropriateness (e.g. indication, effectiveness, dose).<br />\r\n
              \t\t&nbsp;</li>\r\n
              \t<li><a href="http://www.dr-g.co.il/articles/drugs/GARFINKEL'SPROCEDUREinNursingDepartments.pdf"><strong>GARFINKEL&#39;S PROCEDURE in Nursing Departments (drugstop.co.il)</strong></a>\r\n
              \t\t<p style="margin-bottom:0cm"><span style="font-size:13.5pt"><span style="line-height:107%"><span style="color:#595959">Geriatric palliative methodology study aiming to identify and stop&nbsp;</span></span></span><span style="font-size:13.5pt"><span style="line-height:107%"><span style="color:#595959">medication in frail patients and assessing intervention vs control group </span></span></span><span style="font-size:13.5pt"><span style="line-height:107%"><span style="color:#595959">for reduction in mortality rates and referrals to acute care facilities, </span></span></span><span style="font-size:13.5pt"><span style="line-height:107%"><span style="color:#595959">costs and quality of living.</span></span></span><br />\r\n
              \t\t\t&nbsp;</p>\r\n
              \t</li>\r\n
              \t<li><a href="https://www.hmpgloballearningnetwork.com/site/altc/content/armor-a-tool-evaluate-polypharmacy-elderly-persons"><strong>ARMOR</strong></a><br />\r\n
              \t\tThe ARMOR tool (Assess, Review, Minimize, Optimize, Reassess) is an interactive tool which aims to combine recommendation from Beers&rsquo; criteria and patient&rsquo;s functional state and clinical state aiming to balance evidence-based practice with altered physiological reserves.<br />\r\n
              \t\t&nbsp;</li>\r\n
              \t<li><a href="https://www.bmj.com/content/329/7463/434"><strong>NO TEARS</strong>&nbsp;</a><br />\r\n
              \t\tThe NO TEARS tool goes through process of medication review covering need and indication, open questions, tests and monitoring, evidence and guidelines, adverse events, risk reduction or prevention and simplification and switches.</li>\r\n
              </ul>\r\n
              \r\n
              <hr />\r\n
              <h2 class="sidebar-nav">Prescribing cascades</h2>\r\n
              \r\n
              <p class="larger-text"><span style="font-size:13.5pt"><span style="line-height:107%"><span style="color:#595959">Prescribing cascades occur when a drug is prescribed to manage side effects of another drug, typically when a side effect is misinterpreted as a new condition. </span></span></span></p>\r\n
              \r\n
              <ul>\r\n
              \t<li><a href="https://link.springer.com/article/10.1007/s40266-022-00964-9"><strong>ThinkCascades: A Tool for Identifying Clinically Important Prescribing Cascades Affecting Older People</strong></a><br />\r\n
              \t\t<span style="font-size:13.5pt"><span style="line-height:107%"><span style="color:#595959">A nine-item consensus-based list of clinically important prescribing cascades, representing potentially inappropriate prescribing obtained via Delphi process.</span></span></span><br />\r\n
              \t\t&nbsp;</li>\r\n
              \t<li style="margin-bottom:0cm"><strong><a href="https://www.deprescribingnetwork.ca/blog/prescribing-cascade"><span style="font-size:13.5pt"><span style="line-height:107%"><span style="color:#c00000">Are you the victim of a prescribing cascade? &mdash; Do I still need this medication? Is deprescribing for you? (deprescribingnetwork.ca)</span></span></span></a></strong><br />\r\n
              \t\t<span style="font-size:13.5pt"><span style="line-height:107%"><span style="font-family:&quot;Aptos&quot;,sans-serif"><span style="color:#595959">Canadian website aimed at patients explaining what prescribing cascades are and how to manage them.</span></span></span></span></li>\r\n
              </ul>\r\n
              \r\n
              <hr />\r\n
              <h2 class="sidebar-nav">Shared decision making</h2>\r\n
              \r\n
              <p class="larger-text"><span style="background:white"><span style="font-size:13.5pt"><span style="line-height:107%"><span style="color:#595959">Shared decision-making ensures that individuals are supported to make decisions that are right for them. It is a collaborative process through which a clinician supports a patient to reach a decision about their treatment. The conversation brings togethert t</span></span></span></span><span style="background:white"><span style="font-size:13.5pt"><span style="line-height:107%"><span style="color:#595959">he clinician&rsquo;s expertise (such as treatment options, evidence, risks and benefits)&nbsp;with w</span></span></span></span><span style="background:white"><span style="font-size:13.5pt"><span style="line-height:107%"><span style="color:#595959">hat the patient knows best (their preferences, personal circumstances, goals, values and beliefs).</span></span></span></span></p>\r\n
              \r\n
              <ul>\r\n
              \t<li><a href="https://www.aomrc.org.uk/projects-and-programmes/choosing-wisely/"><strong>Choosing Wisely&nbsp;</strong></a><br />\r\n
              \t\tChoosing Wisely campaign aims to spark conversations between clinicians and patients about what tests, treatments, and procedures are needed &ndash; and which ones are not.<br />\r\n
              \t\t&nbsp;</li>\r\n
              \t<li><a href="https://meandmymedicines.org.uk/"><strong>Me &amp; My Medicines, Medicines Communication Charter, It&#39;s OK to Ask</strong></a><br />\r\n
              \t\t&lsquo;Me and My Medicines&rsquo; is a campaign led by patients and supported by clinical staff to help people raise concerns and use their medicines better.<br />\r\n
              \t\t&nbsp;</li>\r\n
              \t<li><a href="https://realisticmedicine.scot/"><strong>Realistic Medicine</strong></a><br />\r\n
              \t\tRealistic medicine aims to encourage meaningful conversations between health and social care professionals and their service users to base care around what matters most to people, with a shared understanding of what healthcare might realistically contribute to this.</li>\r\n
              </ul>\r\n
              \r\n
              <hr />\r\n
              <h2 class="sidebar-nav">Medicines and falls resources</h2>\r\n
              \r\n
              <p class="larger-text"><span style="font-size:13.5pt"><span style="line-height:107%"><span style="color:#595959">Medication review forms an essential part of multifactorial falls risk assessment. Below are useful resources for health care professionals undertaking this activity.</span></span></span></p>\r\n
              \r\n
              <ul>\r\n
              \t<li><strong><a href="https://www.rpharms.com/Portals/0/RPS%20document%20library/Open%20access/Pharmacy%20guide%20docs/Medicines%20and%20falls%209%2023%20(RPSendorsed).pdf?ver=kHy696ZEbkwR7eopGgbkFw%3d%3d">Medicines and Falls National Falls Prevention Co-ordination Group endorsed by Royal Pharmaceutical Society</a></strong><br />\r\n
              \t\tGuidance to support medication review by healthcare professionals in patients at risk of falls, created on behalf of National Falls Prevention Coordination Group.<br />\r\n
              \t\t&nbsp;</li>\r\n
              \t<li><a href="https://www.cdc.gov/steadi/hcp/clinical-resources/pharmacy-care.html"><strong>STEADi</strong></a><br />\r\n
              \t\t<span style="font-size:13.5pt"><span style="line-height:107%"><span style="font-family:&quot;Aptos&quot;,sans-serif"><span style="color:#595959">STEADI-R</span></span></span></span><sub><span style="font-size:11.0pt"><span style="line-height:107%"><span style="font-family:&quot;Aptos&quot;,sans-serif"><span style="color:#595959">x</span></span></span></span></sub><span style="font-size:13.5pt"><span style="line-height:107%"><span style="font-family:&quot;Aptos&quot;,sans-serif"><span style="color:#595959"> was designed to improve collaboration between healthcare providers and pharmacists and is based on CDC&#39;s </span></span></span></span><span style="font-size:11.0pt"><span style="line-height:107%"><span style="font-family:&quot;Aptos&quot;,sans-serif"><a href="https://www.cdc.gov/steadi/index.html"><span style="font-size:13.5pt"><span style="line-height:107%"><span style="color:#595959">STEADI (Stopping Elderly Accidents, Deaths, &amp; Injuries)</span></span></span></a></span></span></span><span style="font-size:13.5pt"><span style="line-height:107%"><span style="font-family:&quot;Aptos&quot;,sans-serif"><span style="color:#595959"> initiative. STEADI-R</span></span></span></span><sub><span style="font-size:11.0pt"><span style="line-height:107%"><span style="font-family:&quot;Aptos&quot;,sans-serif"><span style="color:#595959">x </span></span></span></span></sub><span style="font-size:13.5pt"><span style="line-height:107%"><span style="font-family:&quot;Aptos&quot;,sans-serif"><span style="color:#595959">provides guidance to pharmacists on how to screen pharmacy patients, assess their medications, and intervene to reduce fall risk. </span></span></span></span><br />\r\n
              \t\t&nbsp;</li>\r\n
              \t<li><a href="https://academic.oup.com/ageing/article/50/4/1189/6043386"><strong>STOPPFall&nbsp;</strong></a><span style="font-size:11.0pt"><span style="line-height:107%"><span style="font-family:&quot;Aptos&quot;,sans-serif">(<a href="https://academic.oup.com/ageing/article/50/4/1189/6043386"><b><span style="font-size:13.5pt"><span style="line-height:107%"><span style="color:#c63663">Screening Tool of Older Persons Prescriptions in older adults with high fall risk to help identify and review falls risk increasing drugs)</span></span></span></b></a></span></span></span><br />\r\n
              \t\tSTOPPFall was created using an expert Delphi consensus process and combined with a practical deprescribing tool designed to optimise medication review in patients at risk of falls.<br />\r\n
              \t\t&nbsp;</li>\r\n
              \t<li><a href="https://www.prescqipp.info/our-resources/bulletins/bulletin-300-medication-and-falls/"><strong>Medication and falls - PresQUIPP</strong></a><br />\r\n
              \t\t<span style="font-size:13.5pt"><span style="line-height:107%"><span style="font-family:&quot;Aptos&quot;,sans-serif"><span style="color:#595959">This bulletin and resources highlight medicines that can increase the risk of falls in older people. Guidance is provided on deprescribing Fall-Risk-Increasing Drugs (FRIDs) and when deciding whether to initiate medicines in older people at risk of falls.</span></span></span></span></li>\r\n
              </ul>\r\n
              \r\n
              <hr />\r\n
              <h2 class="sidebar-nav">Fracture risk assessment and bone health</h2>\r\n
              \r\n
              <p class="larger-text">Fracture risk assessment and management of bone health forms an integral part of frailty care. Below are useful tools and guidance to aid decision making and treatment choice.</p>\r\n
              \r\n
              <ul>\r\n
              \t<li><a href="https://frax.shef.ac.uk/FRAX/tool.aspx"><strong>FRAX&nbsp;&reg;Fracture Risk Assessment Tool</strong></a><br />\r\n
              \t\tUK calculator used to estimate 10-year major osteoporotic fracture risk and hip fracture risk based upon demographic, lifestyle and clinical data.</li>\r\n
              </ul>\r\n
              \r\n
              <div>\r\n
              \t<ul>\r\n
              \t\t<li><strong><a href="https://www.nogg.org.uk/full-guideline">Clinical Guideline for the prevention and treatment of osteoporosis from National Osteoporosis Guideline Group</a></strong><br />\r\n
              \t\t\tThis guideline is used to review the assessment and diagnosis of osteoporosis, the therapeutic interventions available and the approaches for the prevention of fragility fractures, in postmenopausal women, and in men aged 50 years or older.<br />\r\n
              \t\t\t&nbsp;</li>\r\n
              \t\t<li><strong><a href="https://www.sign.ac.uk/our-guidelines/management-of-osteoporosis-and-the-prevention-of-fragility-fractures/">Management of osteoporosis and the prevention of fragility fractures (sign.ac.uk)</a></strong><br />\r\n
              \t\t\tThis guideline provides recommendations based on current evidence for best practice in the management of osteoporosis and prevention of fractures. It addresses risk factors for fracture, commonly used tools for fracture risk assessment, approaches to targeting therapy, pharmacological and non-pharmacological treatments to reduce fracture risk in different patient groups, treatment of painful vertebral fractures and systems of care.<br />\r\n
              \t\t\t&nbsp;</li>\r\n
              \t\t<li><strong><a href="https://qfracture.org/">QFracture</a></strong><br />\r\n
              \t\t\t<span style="font-size:13.5pt"><span style="line-height:107%"><span style="color:#595959">You can use this calculator to work out your risk of developing any osteoporotic (i.e. hip, wrist, shoulder or spine) fracture or hip fracture alone by answering some simple questions intended for use in the UK.</span></span></span></li>\r\n
              \t</ul>\r\n
              </div>\r\n
              \r\n
              <hr />\r\n
              <h2 class="sidebar-nav">End of life</h2>\r\n
              \r\n
              <p class="larger-text">Preparing for the end of life and jointly making decisions about treatment choices are important aspects of care of the older person. The following resources may be useful when undertaking this task.</p>\r\n
              \r\n
              <ul>\r\n
              \t<li><strong><a href="https://nww.lhp.leedsth.nhs.uk/common/guidelines/detail.aspx?ID=7628">Medication Review and Rationalisation of Medicines for Adult Patients with a Limited Prognosis&nbsp;</a></strong><br />\r\n
              \t\tThis guidance is intended for use by healthcare professionals in any care setting when conducting a structured medication review and optimising medication for patients&nbsp; with a <strong>limited prognosis</strong> (days to short years) due to advanced age, frailty, comorbidity and/or disease, where the goals of care are moving towards optimising symptoms and quality of life rather than prolonging survival.</li>\r\n
              </ul>\r\n
              \r\n
              <hr />\r\n
              <h2 class="sidebar-nav">Opioid review</h2>\r\n
              \r\n
              <div>\r\n
              \t<p class="larger-text">Historically, opioids have been prescribed to manage chronic pain; however, the clinical evidence shows limited effectiveness and patient safety concerns due to the risks associated with long-term use of opioids such as fractures and falls, endocrine abnormalities, immunomodulation, opioid induced hyperalgesia and dependence.</p>\r\n
              \r\n
              \t<ul>\r\n
              \t\t<li><strong><a href="https://gmmmg.nhs.uk/wp-content/uploads/2023/12/Opioid-resource-pack-2023-final-for-web.pdf">NHS Greater Manchester Integrated Care - Opioid Prescribing for Chronic Pain: Resource Pack</a></strong><br />\r\n
              \t\t\tThis document brings together several resources clinicians can use to support the appropriate use and review of opioids used for chronic pain.&nbsp; The information in this document does not apply to palliative care and end of life care where use of opioids should follow the World Health Organisation (WHO) pain ladder and relevant guidance.<br />\r\n
              \t\t\t&nbsp;</li>\r\n
              \t\t<li><strong><a href="https://livewellwithpain.co.uk/">Live Well with Pain</a></strong><br />\r\n
              \t\t\tResources aimed at patients who are living with pain and clinical practitioners managing those living with pain.<br />\r\n
              \t\t\t&nbsp;</li>\r\n
              \t\t<li><strong><a href="https://healthinnovation-em.org.uk/our-work/innovations/improving-the-management-of-non-cancer-pain-reducing-harm-from-opioids/1514-improving-the-management-of-non-cancer-pain-reducing-harm-from-opioids">Improving the management of non cancer pain &ndash; reducing harm from opioids</a></strong><br />\r\n
              \t\t\tManagement of &lsquo;chronic non-cancer pain&rsquo; requires personalised care and shared decision making at its core with patients requiring a mixture of biopsychosocial support. A whole system approach is proposed to support people to live well with their &lsquo;chronic non-cancer pain&rsquo; - this website shares impact and outcomes.</li>\r\n
              \t</ul>\r\n
              </div>\r\n
              \r\n
              <hr />\r\n
              <h2 class="sidebar-nav">Reviewing antipsychotics</h2>\r\n
              \r\n
              <p class="larger-text">In some people antipsychotics can eliminate or reduce the intensity of certain symptoms. However, they also have serious side effects for people living with dementia. There is concern over the high rates of antipsychotic prescribing in people with dementia due to the associated risks often outweighing the benefits.&nbsp; As such, antipsychotics should only be considered as a last resort in dementia.</p>\r\n
              \r\n
              <ul>\r\n
              \t<li><strong><a href="http://www.england.nhs.uk/london/wp-content/uploads/sites/8/2022/10/Antipsychotic-Prescribing-Toolkit-for-Dementia.pdf">Guidance for reviewing antipsychotics in people living with dementia</a></strong><br />\r\n
              \t\t<span style="font-size:13.5pt"><span style="line-height:107%"><span style="color:#595959">This toolkit provides expert, evidence-based practical advice and guidance on risk reduction when using antipsychotic medication in patients with dementia and support with deprescribing where appropriate.</span></span></span><strong><a href="http://www.england.nhs.uk/london/wp-content/uploads/sites/8/2022/10/Antipsychotic-Prescribing-Toolkit-for-Dementia.pdf"> </a></strong></li>\r\n
              </ul>\r\n
              \r\n
              <hr />\r\n
              <h2 class="sidebar-nav">Reviewing antidepressants</h2>\r\n
              \r\n
              <div>\r\n
              \t<p class="larger-text">Antidepressants have an important role in the therapeutic management of depression and anxiety, when used appropriately in line with the NICE guidelines. However, antidepressant use can become inappropriate which may lead to patient harm from problematic polypharmacy, adverse-effects, or both.</p>\r\n
              \r\n
              \t<ul>\r\n
              \t\t<li><strong><a href="https://www.sps.nhs.uk/articles/deprescribing-of-antidepressants-for-depression-and-anxiety/">Deprescribing of antidepressants for depression and anxiety &ndash; Specialist Pharmacy Service</a></strong><br />\r\n
              \t\t\tUseful resources that are available free-of-charge to help plan and support deprescribing of antidepressants in practice.<br />\r\n
              \t\t\t&nbsp;</li>\r\n
              \t\t<li><strong><a href="https://pharmaceutical-journal.com/article/ld/case-based-learning-safe-withdrawal-and-tapering-of-antidepressants">Guidance for safe withdrawal of antidepressants</a></strong><br />\r\n
              \t\t\tPharmaceutical Journal article presenting a case of safe antidepressant withdrawal.<br />\r\n
              \t\t\t&nbsp;</li>\r\n
              \t\t<li><a href="http://Stopping antidepressants (rcpsych.ac.uk)"><strong>Stopping antidepressants (rcpsych.ac.uk)</strong></a><br />\r\n
              \t\t\tGuidance from the Royal College of Psychiatrists.</li>\r\n
              \t</ul>\r\n
              </div>\r\n
              \r\n
              <hr />\r\n
              <h2 class="sidebar-nav">Supporting adherence</h2>\r\n
              \r\n
              <div>\r\n
              \t<p class="larger-text">Resources aimed at healthcare professionals to help them discuss options for medicines management (to support adherence) with patients.</p>\r\n
              \r\n
              \t<ul>\r\n
              \t\t<li><strong><a href="https://www.wypartnership.co.uk/our-priorities/primary-and-community-care-services/useful-links-and-resources/managing-medication">Managing medication - a guide to assist health and social care workers in conversations with people</a></strong><br />\r\n
              \t\t\tA guide to assist health and social care practitioners in conversations around medicines management.<br />\r\n
              \t\t\t&nbsp;</li>\r\n
              \t\t<li><strong><a href="https://www.ageuk.org.uk/information-advice/health-wellbeing/health-services/getting-the-most-from-your-medicines/">Getting the most from your medicines - Age UK</a></strong><br />\r\n
              \t\t\tAge UK summary on how to get the most from your medicines and what pharmacy services are available to support patients with safe medication management.<br />\r\n
              \t\t\t&nbsp;</li>\r\n
              \t\t<li><strong><a href="https://www.sps.nhs.uk/articles/defining-and-understanding-medication-adherence/">Defining and understanding medication adherence &ndash; SPS - Specialist Pharmacy Service</a></strong><br />\r\n
              \t\t\tDefinitions, evidence and the importance of effective consultations, with tools and interventions to facilitate medication adherence.<br />\r\n
              \t\t\t&nbsp;</li>\r\n
              \t\t<li><strong><a href="https://www.sps.nhs.uk/home/tools/medicines-in-compliance-aids-stability-tool/">MCA Stability Tool</a></strong><br />\r\n
              \t\t\tMedicines in Compliance Aids Stability Tool</li>\r\n
              \t</ul>\r\n
              </div>\r\n
              \r\n
              <hr />\r\n
              <h2 class="sidebar-nav">Anticholinergic burden</h2>\r\n
              \r\n
              <div>\r\n
              \t<p class="larger-text"><span style="font-size:13.5pt"><span style="line-height:107%"><span style="color:#595959">Many of the medications that we commonly prescribe have anticholinergic properties. In patients over 65 years of age these can cause adverse events, such as confusion, dizziness and falls. </span></span></span></p>\r\n
              \r\n
              \t<ul>\r\n
              \t\t<li><strong><a href="https://www.deprescribingnetwork.ca/blog/anticholinergic-medications">Canadian Medication Appropriateness and Deprescribing Network - do I still need this medicine (anticholinergics)</a></strong><br />\r\n
              \t\t\tCanadian website aimed at patients explaining what anticholinergics are and how to address the risk if you are taking these medicines.<br />\r\n
              \t\t\t&nbsp;</li>\r\n
              \t\t<li><strong><a href="https://www.acbcalc.com/">ACB Calculator (calculates total anticholinergic burden including peripheral effects)</a></strong><br />\r\n
              \t\t\tABC Calculator allows end user to calculate total anticholinergic burden including peripheral effects and was created using the German Anticholinergic Burden score and the Anticholinergic Cognitive Burden scale.<br />\r\n
              \t\t\t&nbsp;</li>\r\n
              \t\t<li><a href="https://medichec.com/"><strong>Anticholinergic Effect on Cognition Tool (calculates central anticholinergic burden)</strong></a><br />\r\n
              \t\t\tMedicheck Calculator allows end user to calculate central anticholinergic burden and provides information on QTc prolongation, hyponatraemia, bleeding, dizziness, drowsiness and constipation.</li>\r\n
              \t</ul>\r\n
              </div>\r\n
              \r\n
              <hr />\r\n
              <h2 class="sidebar-nav">Monitoring specific medicines/groups of medicines</h2>\r\n
              \r\n
              <div>\r\n
              \t<p class="larger-text">As part of effective medicines optimisation care, it is important to note monitoring requirements and in particular how these may change in older patients. The following resources provide further information on this subject.</p>\r\n
              \r\n
              \t<ul>\r\n
              \t\t<li><a href="https://www.sps.nhs.uk/home/tools/drug-monitoring/"><strong>Specialist Pharmacy - Service&nbsp;Drug monitoring&nbsp;</strong></a><br />\r\n
              \t\t\tSummarised recommendations and guidance for medication requiring monitoring with drug specific advice.<br />\r\n
              \t\t\t&nbsp;</li>\r\n
              \t\t<li><a href="https://www.sps.nhs.uk/category/care-setting/care-of-the-elderly-care-setting/"><strong>Care of the elderly &ndash; SPS - Specialist Pharmacy Service &ndash; Management of specific conditions in older patients</strong></a>\r\n
              \t\t\t<p style="margin-bottom:0cm"><span style="font-size:13.5pt"><span style="line-height:107%"><span style="color:#595959">Condition-specific guidance focused on the needs of older patients for multiple cardiovascular conditions and polypharmacy documents including taking a person-centred approach to managing polypharmacy.</span></span></span><br />\r\n
              \t\t\t\t&nbsp;</p>\r\n
              \t\t</li>\r\n
              \t\t<li><strong><a href="https://bnf.nice.org.uk/medicines-guidance/prescribing-in-the-elderly/">NICE BNF Medicines guidance - Prescribing in the elderly</a></strong><br />\r\n
              \t\t\tBNF summary on safe prescribing advice in older patients including discussion on forms, adverse drug reactions, pharmacokinetics and particular groups of drugs associated with harm.<br />\r\n
              \t\t\t&nbsp;</li>\r\n
              \t\t<li><strong><a href="https://drug-interactions.medicine.iu.edu/MainTable.aspx">Drug Interactions Flockhart Table &trade;</a></strong><br />\r\n
              \t\t\tThis table is designed as a teaching and reference tool for health care providers and researchers interested in drug interactions that are mediated by cytochrome P450 enzymes.<br />\r\n
              \t\t\t&nbsp;</li>\r\n
              \t\t<li><strong><a href="https://www.renaldrugdatabase.com/s/">Renal Drug Database</a></strong><br />\r\n
              \t\t\tThe Renal Drug Database is a digital tool for pharmacists, clinicians, and other healthcare professionals prescribing for patients with renal disease and who receive renal replacement therapy. (Requires subscription to access).<br />\r\n
              \t\t\t&nbsp;</li>\r\n
              \t\t<li><strong><a href="https://crediblemeds.org/">CredibleMeds</a></strong><br />\r\n
              \t\t\t<a href="https://crediblemeds.org/druglist"><b><span style="font-size:13.5pt"><span style="line-height:107%"><span style="color:#595959">QT Drugs List</span></span></span></b></a><b><span style="font-size:13.5pt"><span style="line-height:107%"><span style="color:#595959">:</span></span></span></b><span style="font-size:13.5pt"><span style="line-height:107%"><span style="color:#595959">&nbsp; This portal includes </span></span></span><a href="https://crediblemeds.org/druglist"><span style="font-size:13.5pt"><span style="line-height:107%"><span style="color:#595959">QTdrugs.org,</span></span></span></a><span style="font-size:13.5pt"><span style="line-height:107%"><span style="color:#595959"> a list of drugs categorized by their potential to cause QT prolongation and/or Torsades de pointes (TdP).&nbsp; </span></span></span></li>\r\n
              \t</ul>\r\n
              </div>\r\n
              \r\n
              <hr />\r\n
              <h2 class="sidebar-nav">Cardiovascular risk and medication</h2>\r\n
              \r\n
              <div>\r\n
              \t<p class="larger-text">Useful references when assessing cardiovascular risk and considering polypharmacy in frailty patients is listed below.</p>\r\n
              \r\n
              \t<ul>\r\n
              \t\t<li><strong><a href="https://qrisk.org/">QRISK&reg;3-2018 risk calculator</a></strong><br />\r\n
              \t\t\tThis site estimates a person&#39;s risk of developing a heart attack or stroke over the next 10 years.<br />\r\n
              \t\t\t&nbsp;</li>\r\n
              \t\t<li><strong><a href="https://www.england.nhs.uk/aac/wp-content/uploads/sites/50/2020/04/statin-intolerance-pathway-v2.pdf">Statin Intolerance Pathway - NHS England</a></strong><br />\r\n
              \t\t\tPathway for managing patients at high risk of CVD events who report statin intolerance.<br />\r\n
              \t\t\t&nbsp;</li>\r\n
              \t\t<li><strong><a href="http://sparctool.com/">SPARCtool</a></strong><br />\r\n
              \t\t\tLink to calculators which allow patients and clinicians to estimate cardiac events risk.<br />\r\n
              \t\t\t&nbsp;</li>\r\n
              \t\t<li><strong><a href="https://u-prevent.com/">U-prevent</a></strong><br />\r\n
              \t\t\tLink to calculators which allow patients and clinicians to estimate cardiac events risk.<br />\r\n
              \t\t\t&nbsp;</li>\r\n
              \t\t<li><strong><a href="https://www.sps.nhs.uk/?s=frailty&amp;orderby=&amp;order=DESC&amp;cat%5B%5D=2981">&lsquo;Frailty&rsquo; in Care of the elderly &ndash; SPS - Specialist Pharmacy Service</a></strong><br />\r\n
              \t\t\tGuidance on management of cardiovascular conditions in frail patients.</li>\r\n
              \t</ul>\r\n
              </div>\r\n
              \r\n
              <hr />\r\n
              <h2 class="sidebar-nav">Swallowing difficulties</h2>\r\n
              \r\n
              <div>\r\n
              \t<p class="larger-text"><span style="font-size:13.5pt"><span style="line-height:107%"><span style="color:#3d0b37">Patients who have swallowing difficulties are commonly encountered in frailty. Resources below offer advice on managing medication in this cohort.</span></span></span></p>\r\n
              \r\n
              \t<ul>\r\n
              \t\t<li><strong><a href="https://www.sps.nhs.uk/home/guidance/swallowing-difficulties/">Swallowing difficulties &ndash; SPS - Specialist Pharmacy Service</a></strong><br />\r\n
              \t\t\t<span style="font-size:13.5pt"><span style="line-height:107%"><span style="color:#53565a">Series of articles on swallowing difficulties including choosing the correct formulation, preparing and administering medicines, examples of treatment modification in certain conditions, thickeners and enteral tubes.</span></span></span></li>\r\n
              \t</ul>\r\n
              </div>\r\n
              \r\n
              <hr />\r\n
              <h2 class="sidebar-nav">Enteral feeding</h2>\r\n
              \r\n
              <div>\r\n
              \t<p class="larger-text"><span style="font-size:13.5pt"><span style="line-height:107%"><span style="color:#595959">Use of enteral feeding and administration of medicines via enteral tubes resources.</span></span></span></p>\r\n
              \r\n
              \t<ul>\r\n
              \t\t<li><strong><a href="https://www.cqc.org.uk/guidance-providers/adult-social-care/enteral-feeding-medicines-administration">Enteral feeding and medicines administration - CQC</a></strong><br />\r\n
              \t\t\tCQC advice on considerations to note with regards to medicines administration via enteral tubes.<br />\r\n
              \t\t\t&nbsp;</li>\r\n
              \t\t<li><strong><a href="http://www.rlandrews.org/pdf_files/handbk_of_enteralfeeding.pdf">Handbook of Drug Administration via Enteral Feeding Tubes</a></strong><br />\r\n
              \t\t\tThe information provided in this resource is intended to support healthcare professionals in the safe and effective prescribing and administration of drugs via enteral feeding tubes. It is a comprehensive guide covering the legal, practical and technical aspects that healthcare professionals should consider before attempting to prescribe or administer drugs via an enteral feeding tube.<br />\r\n
              \t\t\t&nbsp;</li>\r\n
              \t\t<li><strong><a href="https://www.rosemontpharma.com">Rosemont</a></strong><br />\r\n
              \t\t\tCatalogue of liquid medication available including licenced and special preparations.</li>\r\n
              \t</ul>\r\n
              </div>\r\n
              \r\n
              <hr />\r\n
              <h2 class="sidebar-nav">Inhalers</h2>\r\n
              \r\n
              <div>\r\n
              \t<p class="larger-text">Multiple inhaler options and combinations are available for treatment of respiratory conditions &ndash; the following are useful resources for patients and prescribers.</p>\r\n
              \r\n
              \t<ul>\r\n
              \t\t<li><strong><a href="https://www.asthmaandlung.org.uk/living-with/inhaler-videos/spacer-tidal">How to use a pMDI inhaler with a spacer &ndash; tidal breathing | Asthma + Lung UK (asthmaandlung.org.uk)</a></strong><br />\r\n
              \t\t\tAsthma UK guide on correct use methodology for inhalers with a spacer.<br />\r\n
              \t\t\t&nbsp;</li>\r\n
              \t\t<li><strong><a href="https://www.rightbreathe.com/">RightBreathe</a></strong><br />\r\n
              \t\t\tThere are over 120 inhaler device &amp; drug combinations licensed for the treatment of respiratory disease in the UK and it can be challenging for clinicians and patients to identify the product which best meets individual needs. RightBreathe is a web-based resource which provides detailed information on all UK-licensed inhaler products. It is designed to support joint decision-making about product choice and to facilitate appropriate prescribing.</li>\r\n
              \t</ul>\r\n
              </div>\r\n
              \r\n
              <div>\r\n
              \t<hr />\r\n
              \t<h2 class="sidebar-nav">Medication withdrawal</h2>\r\n
              \r\n
              \t<p class="larger-text"><span style="font-size:13.5pt"><span style="line-height:107%"><span style="color:#595959">Useful references to aid shared decision making when deprescribing in frailty.</span></span></span></p>\r\n
              \r\n
              \t<ul>\r\n
              \t\t<li><strong><a href="https://g-care.glos.nhs.uk/uploads/files/DePrescribing%20in%20Frailty.pdf">DePrescribing in Frailty</a></strong><br />\r\n
              \t\t\tA summary of deprescribing advice based around therapeutic areas and clinical frailty from Gloucestershire Medicines Management team.<br />\r\n
              \t\t\t&nbsp;</li>\r\n
              \t\t<li style="margin-bottom:0cm"><strong><a href="https://wchh.onlinelibrary.wiley.com/doi/pdf/10.1002/psb.2137"><span style="font-size:13.5pt"><span style="line-height:107%"><span style="color:#c00000">Deprescribing in People Living with Frailty, Multimorbidity and Polypharmacy</span></span></span></a></strong><br />\r\n
              \t\t\t<span style="font-size:13.5pt"><span style="line-height:107%"><span style="color:#595959">Review article of best practice for clinical teams undertaking deprescribing activities.</span></span></span></li>\r\n
              \t</ul>\r\n
              </div>\r\n
              \r\n
              <hr />\r\n
              <h2 class="sidebar-nav">Sleep</h2>\r\n
              \r\n
              <div>\r\n
              \t<p class="larger-text">Sleep problems are commonly reported by patients. Below is a list of resources aimed at healthcare professionals and patients on addressing insomnia.</p>\r\n
              \r\n
              \t<ul>\r\n
              \t\t<li><strong><a href="https://www.nice.org.uk/guidance/mtg70">Sleepio to treat insomnia and insomnia symptoms - NICE</a></strong><br />\r\n
              \t\t\tNICE Medical Technology Guidance for using Sleepio in primary care. See also&nbsp;<a href="https://www.sleepio.com/sleepio/nhsinform/333#1/1"><em>Onboarding Sleep Test - Sleepio</em></a>.&nbsp;<br />\r\n
              \t\t\t&nbsp;</li>\r\n
              \t\t<li><strong><a href="https://awttc.nhs.wales/medicines-optimisation-and-safety/medicines-optimisation-guidance-resources-and-data/prescribing-guidance/material-to-support-appropriate-prescribing-of-hypnotics-and-anxiolytics-across-wales/"><span style="font-size:13.5pt"><span style="line-height:107%"><span style="color:#c00000">Material to support appropriate prescribing of hypnotics and anxiolytics across Wales - All Wales Therapeutics and Toxicology Centre (nhs.wales)</span></span></span></a></strong><br />\r\n
              \t\t\tThis educational pack aims to support the appropriate prescribing of hypnotics and anxiolytics across Wales by providing key health professionals with a practical approach for the initiation and review of hypnotic and anxiolytic prescribing. It includes examples of support material which can be used or adapted for this purpose.<br />\r\n
              \t\t\t&nbsp;</li>\r\n
              \t\t<li><strong><a href="https://www.nhsinform.scot/illnesses-and-conditions/mental-health/mental-health-self-help-guides/sleep-problems-and-insomnia-self-help-guide">Sleep problems and insomnia self-help guide -&nbsp;NHS inform</a></strong><br />\r\n
              \t\t\tWork through a self-help guide that uses cognitive behavioural therapy (CBT) and expert advice to manage sleep problems.<br />\r\n
              \t\t\t&nbsp;</li>\r\n
              \t\t<li><strong><a href="https://www.nhs.uk/every-mind-matters/mental-wellbeing-tips/how-to-fall-asleep-faster-and-sleep-better/">Fall asleep faster and sleep better - Every Mind Matters - NHS&nbsp;</a></strong><br />\r\n
              \t\t\t<span style="font-size:13.5pt"><span style="line-height:107%"><span style="color:#53565a">Resource aimed at patients with advice</span></span></span><span style="font-size:13.5pt"><span style="line-height:107%"><span style="color:#595959"> on ways to help sleep, including sleep hygiene, and expert video advice from a professor of sleep medicine at the University of Oxford.</span></span></span></li>\r\n
              \t</ul>\r\n
              </div>\r\n
              \r\n
              <hr />\r\n
              <h2 class="sidebar-nav">Medication podcasts on care of the older adult</h2>\r\n
              \r\n
              <div>\r\n
              \t<p class="larger-text"><span style="font-size:13.5pt"><span style="line-height:107%"><span style="color:#595959">Podcasts are available discussing issues of polypharmacy, deprescribing and care of older patients.</span></span></span></p>\r\n
              \r\n
              \t<ul>\r\n
              \t\t<li style="margin-bottom:0cm"><strong><a href="https://thehearingaidpodcasts.org.uk/medicationcollection/"><span style="font-size:13.5pt"><span style="line-height:107%"><span style="color:#c63663">Medication &ndash; The Hearing Aid Podcasts</span></span></span></a></strong><br />\r\n
              \t\t\t<span style="font-size:13.5pt"><span style="line-height:107%"><span style="color:#53565a">MD Tea Podcasts focused on pain control, polypharmacy and describing a day in the life of pharmacist.</span></span></span><br />\r\n
              \t\t\t&nbsp;</li>\r\n
              \t\t<li style="margin-bottom:0cm"><strong><a href="https://www.kcl.ac.uk/humanising-healthcare-podcast-personalising-the-use-of-medicines-in-older-people"><span style="font-size:13.5pt"><span style="line-height:107%"><span style="color:#c00000">Humanising Healthcare podcast - Personalising the use of medicines in older people | Feature from King&#39;s College London (kcl.ac.uk)</span></span></span></a></strong><br />\r\n
              \t\t\t<span style="font-size:13.5pt"><span style="line-height:107%"><span style="color:#5a6369">Manasi is joined by Dr Jennifer Stevenson, Lead Pharmacist Older Adults/Honorary Senior Lecturer and Dr Carly Welch, Clinical Senior Lecturer on the episode &lsquo;Personalising the use of medicines in older people.&rsquo; They discussed polypharmacy, the move towards &lsquo;deprescribing&rsquo; medicine, and how ageing can affect the way the body absorbs medicines.</span></span></span><br />\r\n
              \t\t\t&nbsp;</li>\r\n
              \t\t<li style="margin-bottom:0cm"><a href="https://www.theauralapothecary.com/"><strong>The Aural Apothecary</strong></a><br />\r\n
              \t\t\tAn authentic yet lighthearted take on the world of medicines and healthcare in the UK.</li>\r\n
              \t</ul>\r\n
              </div>\r\n
              \r\n
              <hr />\r\n
              <h2 class="sidebar-nav">Treatment targets</h2>\r\n
              \r\n
              <div>\r\n
              \t<p class="larger-text">Treatment targets in guidelines do not always account for frailty state and how diminished reserves affect response to treatment. The following articles provide some guidance around treatment targets in frailty.</p>\r\n
              \r\n
              \t<ul>\r\n
              \t\t<li style="margin-bottom:0cm"><a href="http://www.sps.nhs.uk/articles/hypertension-management-in-frail-older-people/"><strong><span style="font-size:13.5pt"><span style="line-height:107%"><span style="color:#c63663">Hypertension management in frail older people</span></span></span> <span style="font-size:13.5pt"><span style="line-height:107%"><span style="color:#c00000">- SPS &ndash; Specialist Pharmacy Services</span></span></span></strong></a><br />\r\n
              \t\t\t<span style="font-size:13.5pt"><span style="line-height:107%"><span style="color:#595959">Guidance on targets for blood pressure in frailty.</span></span></span><br />\r\n
              \t\t\t&nbsp;</li>\r\n
              \t\t<li style="margin-bottom:0cm"><a href="https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Elevated-Blood-Pressure-and-Hypertension"><strong><span style="font-size:13.5pt"><span style="line-height:107%"><span style="color:#c00000">2024 ESC Guidelines for the management of elevated blood pressure and hypertension</span></span></span></strong></a><br />\r\n
              \t\t\t<span style="font-size:13.5pt"><span style="line-height:107%"><span style="color:#595959">European Guidelines with advice for adjustment in frailty.</span></span></span><br />\r\n
              \t\t\t&nbsp;</li>\r\n
              \t\t<li style="margin-bottom:0cm"><strong><a href="https://abcd.care/sites/default/files/site_uploads/Resources/Position-Papers/ABCD-Position-Paper-Frailty.pdf"><span style="font-size:13.5pt"><span style="line-height:107%"><span style="color:#c63663">Managing frailty and associated comorbidities in older adults with diabetes: Position Statement on behalf of the Association of British Clinical Diabetologists (ABCD)</span></span></span></a></strong><br />\r\n
              \t\t\t<span style="font-size:13.5pt"><span style="line-height:107%"><span style="color:#595959">The Association of British Clinical Diabetologists has produced this Position Statement in order for its recommendations to be implemented within the NHS in the UK, to promote improved quality care for older people with diabetes and frailty, as well as guidance on managing the inevitable comorbidities that are present.</span></span></span><br />\r\n
              \t\t\t&nbsp;</li>\r\n
              \t\t<li style="margin-bottom:0cm"><strong><a href="https://abcd.care/sites/default/files/site_uploads/JBDS_Guidelines_Current/JBDS_15_Inpatient_Care_of_the%20Frail_Older_Adult_with_Diabetes_with_QR_code_February_2023.pdf"><span style="font-size:13.5pt"><span style="line-height:107%"><span style="color:#c63663">Inpatient Care of the Frail Older Adult with Diabetes - JBDS</span></span></span></a></strong><br />\r\n
              \t\t\t<span style="font-size:13.5pt"><span style="line-height:107%"><span style="color:#595959">JBDS has produced this guideline in order for its recommendations to be implemented within the NHS in the United Kingdom to promote improved quality care for older inpatients with diabetes and frailty, since evidence is emerging that frailty has a significant impact on inpatients in terms of increased adverse outcomes and reduced survival.</span></span></span></li>\r\n
              \t</ul>\r\n
              </div>\r\n
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