Risks of polypharmacy.

Families responsible for the care of older relatives must be alert to the serious health risks posed by polypharmacy, the excessive consumption of multiple prescription drugs.

Growing concern about polypharmacy follows a 2019 report, More Harm Than Good, by charity, Age UK, which warns that many older people are taking too many prescribed medicines, putting them at risk of side effects that can lead to serious harm or even be life threatening.

In the report, Age UK estimates that almost two million people aged more than 65 take at least seven prescribed remedies. This doubles to almost four million for those using at least five medicines.

More Harm Than Good also warns that half of all medicines prescribed for older people are not taken as intended because the more that are prescribed, the harder they are for older people to manage correctly, potentially causing confusion and anxiety.

Age UK says that if older people have difficulty swallowing, or lose track of what they have taken, they can feel unable, or unwilling, to take their medicine, leaving their condition unmanaged, which can lead to a rapid decline in their wellbeing.

The charity adds that, while it is beneficial that more medicines are available to alleviate a wider range of health problems, prescribing more drugs isn’t necessarily the best option for older people as they are sometimes prescribed excessively; in unsafe combinations and without the patient’s consent or the support they need to take them.

Research has also found that up to one-in-five prescriptions for older people living at home may be inappropriate and need to be regularly reviewed.

As we age, how our bodies process medicines changes, making older people more susceptible to side effects including nausea, dizziness, loss of appetite, low mood, weight loss, muscle weakness and delirium and Age UK says that during a six-month period more than three quarters of people aged over 70 will suffer an adverse drug reactions.

These can have severe consequences and cause nearly six per cent of unplanned hospital admissions, which increased by 53 per cent between 2008 and 2015. In one-in-50 cases the reaction proved fatal.

According to Age UK evidence shows that, as the number of medicines taken increases, so does the risk of older people falling, which dramatically increases the likelihood of being admitted to hospital. Almost 1,000 older people are admitted daily because of falls, and their chance of falling again increases by 14 per cent for every extra medicine they take over the first four.  

Age UK suggests that polypharmacy arises because busy medical staff, who often do not appreciate the side effects associated with older people taking different combinations of medicines, find prescribing medicine an easy way to help them while, with more time, they may decide a different approach would be safer and more effective.

The report, which urges the NHS to scrutinize polypharmacy as part of its review into over prescribing, also highlights evidence that GPs can overestimate a treatment’s benefits and underestimate its potential harm for older people.

Caring for older people is often complex and stressful, especially when juggled alongside a career and raising children but Age UK has highlighted relatively simple ways that families can help if they suspect that an older relative, or neighbour, is suffering through polypharmacy.           

- Firstly, they can encourage the older person to seek a medicine review if they haven’t had one for a year or more. If the older person is living with dementia, or needs help in asking for a review, the carer can gain consent to talk to the doctor for them.

- They can then help the older person to be prepared with questions about their medications before the review. This should include what is most important to them and how their medicines can help them achieve this.

- Older people can also be encouraged to discuss with their GP, or prescriber, how the drugs are making them feel and helped to play a central role in decisions about stopping a medicine, or seeking an alternative treatment, and to consider the benefits and risks of each remedy.

- Age UK says that the older person should be as involved as possible in decisions about how to dispense and manage their medicines, such as if they require any aids, or devices, to make taking them more manageable. If the carer helps them take their medicines, they should also be part of these discussions.

- Families also need to be aware that getting medication right for older people in care homes is also crucial as many residents often cope with multiple health problems, frailty and dementia, and are especially likely to be on multiple treatments and cared for by busy, and sometimes temporary, staff.

- Even when older people are in residential care, Age UK says that it is important to ensure relatives have regular medicine reviews and help with taking their medicines. Relatives or carers should speak to care home staff if they have any concerns.

However, access to medicine is often vital to older people’s health and wellbeing and Age UK stresses that no medicine should ever be stopped without the advice and support of a GP or another clinician