What makes medication management in older people with dementia such a complex challenge, and how can realist approaches help us make sense of it?Alejandro is joined by Professor Ian Maidment, whose career spans over two decades in pharmacy practice, mental health, and dementia care, alongside leading NIHR-funded realist research.Ian shares his journey from NHS pharmacist to realist researcher, explaining how he discovered realist evaluation and why it became essential for unpacking the complexity of medication safety in older populations. Drawing on flagship projects like MEMORABLE, he reflects on what realist synthesis and evaluation reveal about hidden burdens, particularly for family carers, and why understanding “what works, for whom, and why” is critical in this field.From the power of realist interviews and stakeholder engagement to navigating limited literature and co-producing meaningful findings, Ian offers practical insights grounded in both clinical experience and methodological expertise.Whether you’re a clinician, researcher, or policymaker, thisepisode provides valuable lessons on embracing complexity, translating findings into practice, and using realist approaches to improve care for vulnerable populations.

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