Preliminary development of a Risk Factor Index to identify older adults at risk of adverse medication-related outcomes: A Delphi Study

Background Older adults remain susceptible to medication-related harm, particularly in the context of chronic disease management. Patients' beliefs and health literacy have been shown to influence medication-related outcomes. However, existing strategies do not incorporate these factors into efforts to minimise adverse outcomes. This study therefore aimed to develop a Risk Factor Index that can be used by clinicians to identify older adults at risk of adverse medication-related outcomes. Methods A Delphi technique was employed to achieve expert consensus in developing an index to identify older adults (≥65 years) at risk of adverse medication-related outcomes. A multidisciplinary panel of clinicians and researchers were recruited via professional networks. Participants completed an online questionnaire, drawing on their expertise. Statements reaching ≥80% agreement were retained for subsequent rounds. Open-ended responses were thematically analysed using NVivo 15. Results Thirty-seven experts completed Round 1 and twenty-nine completed Round 2. Participants included pharmacists, doctors, nurses and academics. Consensus was reached on 7 of 15 statements in Round 1 (83.7%–97.3%) and all statements in Round 2 (82.7%–100%). Thematic analysis identified six key risk factors: age-related functional decline, multimorbidity and pharmacological complexity, barriers to understanding, economic and financial concerns, healthcare interactions, and suboptimal medicine use. Conclusion This study identified key social and individual factors contributing to inappropriate medication use and adverse outcomes in older adults. Informed by expert consensus, the index was developed to help identify at-risk individuals. While promising, the index requires validation. Findings highlight the need for a socially informed, person-centred approach to medication management in routine practice.