Development of a modified Medication-Related Burden Quality of Life (mMRB-QoL) short form tool for older people with multimorbidity and polypharmacy: a mixed-methods study.

BACKGROUND

Polypharmacy and multimorbidity are common in older adults, increasing the risk of adverse drug events, treatment burden, and reduced quality of life. However, no patient-reported outcome measure (PROM) is specifically designed to measure medication-related burden in older people. The original Medication-Related Burden Quality of Life (MRB-QoL) tool has limitations in older populations due to length, complexity, and questionable relevance of some items. This study aimed to develop a modified short-form MRB-QoL (mMRB-QoL) suitable for older adults with multimorbidity and polypharmacy.

METHODS

A mixed-methods design included five distinct phases, ensuring the conceptual model was maintained, content validity was preserved, and psychometric properties were retained: psychometric analysis of MRB-QoL in adults ≥65 years; qualitative research with end-users; multidisciplinary expert analysis of MRB-QoL; modified Nominal Group Technique (mNGT), a validated consensus method (involving pharmacists, geriatricians, general practitioners) and patient/public involvement.

RESULTS

mNGT achieved strong consensus (>80%) on an 18-item mMRB-QoL. Of the original 31 items, 10 were removed, 7 were incorporated into other items, and 14 were revised for clarity and clinical relevance. New items were added, reflecting domains particularly relevant to older adults, including cognitive function and managing healthcare. The original subscale structure and Likert response format were retained for comparability.

CONCLUSION

mMRB-QoL is the first PROM specifically designed to assess medication-related burden in older people with multimorbidity and polypharmacy. Developed through a rigorous, transparent process, it retained core elements of the original while new items reflect the specific needs of older people. Further internal and external validation is required before clinical and research application.