Challenges and solutions to family engagement in the medication management of older adults during transitions of care: a qualitative exploratory study

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Abstract Background The presence of multimorbidity and polypharmacy in older adults (aged 65 years and older) increases their susceptibility to medication harm, particularly during transitions of care. Family members are a source of continuity throughout transitions of care, but their medication competence remains largely underutilized. We sought to explore family members’ perspectives regarding the challenges and possible solutions for improving their engagement in the medication management of older adults during transitions of care. Methods In this qualitative exploratory study, we conducted semi-structured interviews with family members at four hospitals, between October 2024 and January 2025. Interviews were centered around information-seeking, medication decision-making, and medication management. Interviews were audio recorded, transcribed verbatim, and analyzed using Framework Method analysis. Themes and sub-themes were conceptualized from the data. Results In all, 66 family members completed an interview. Three themes were developed: (1) Disconnect between family members’ medication management expectations and the operational limitations of the healthcare system; (2) Relationship between accessibility to medication information and preparedness for post-discharge medication management; and (3) Opportunity to enhance family members’ capacity and need to engage in medication management. Family members reported that their engagement was restricted by hospital workflow challenges, such as time constraints and staff shortages. They also experienced accessibility challenges. Physicians were not readily contactable, so, as a solution, families suggested having a dedicated telephone line staffed by personnel available to answer medication questions. Where older adults were independent, families questioned the need for their engagement, but suggested that these older adults carry a wallet medication card for emergencies. Conclusion Many challenges experienced by family members were associated with system pressures, such as rushed hospital discharges. Healthcare professionals and policymakers should consider delegating some medication decision-making responsibility to families, which may help to alleviate pressure on the healthcare system, and create a more family-centered approach to care. Trial registration Registered in ANZCTR (registration number: ACTRN12624000901505) on the 24th of July 2024.