Are you being overly medicated?

According to Age UK, here in England, more than one in ten people aged over 65 take at least eight different prescribed drugs every week. For people aged over 85, this increases to nearly one in four. In 2017/18, the NHS spent more on prescription medicines than ever before – £18.2 billion; a staggering 40 per cent up on what was spent in 2010/11. Meanwhile, more than 60% of the prescriptions made in the community are for people in the 60 plus age group.

Disturbing stats

It is estimated that up to 50 per cent of all medicines for long term conditions are not taken as intended, and around one in five prescriptions for older people living at home may even be inappropriate.

Without access to to the right medications – taken at the right time and in the right dose – many older people would be living in poorer health. However, we risk undoing the many benefits of medicines and treatments if they are; prescribed in excessive numbers (where this is not clinically justified or safe), in unsafe combinations; without the consent and involvement of the older person themselves; and without support to use them properly.

Disturbingly, this is the situation too many older people find themselves in – and it is causing harm that could be avoided. For instance, older people are being admitted to hospital as an emergency from totally avoidable health problems including an increased risk of falls and confusion.

Bad reactions

These can follow adverse reactions to medications or be caused by unchecked prescribing of multiple medications that each cause dizziness or nausea, or that affects cognition, having a serious cumulative effect. Between 2008 and 2015, there was a 53% increase in the number of emergency admissions due to “adverse drug reactions”.

Many older people are simply missing out on treatment because the burden of taking multiple medications (or “polypharmacy” as it’s known), can lead to them to take none at all. Also, prescribing is happening in a way that doesn’t account for any practical barriers such as the ability to open the med packs in the first place, and juggle large volumes of different pills.

Lack of information & guidance

This is leading to poorly managed health – and significant waste for the NHS. Whilst clinicians are working in the best interests of their patients, they often lack the time, information and awareness of issues relating to multiple medicines. Information on existing medicines is not always complete or accessible, and prescribers are not always sufficiently aware of the impact of using a particular medicine on top of another.

Clinical guidance is also unclear on treating multiple conditions, failing to fully account for the multiple medications that may arise as a result. Older people are particularly at risk as not only are they more likely to live with multiple health conditions, but also because of the impact of ageing on how our bodies absorb and respond to medicines.

Older people are also more likely to be living with frailty, dementia, and be at risk of malnutrition, all of which create significant additional challenges.

Long term plan

The NHS Long Term Plan recognises the challenge of poor medicine management, and is committed to expanding access to high quality medicines reviews, and to making sure pharmacists are part of local community health teams. NHS England’s comprehensive model for personalised care has also committed to expanding social prescribing – enabling GPs, nurses and other health care professionals to refer people to a range of non drug-based treatments – eg, healthy eating diet plans and psychical activity.

Practical steps we can take

If you’re in anyway concerned about the medications that you’re on, especially if you are suffering from such things as dizziness, nausea, constipation/diarrhoea, drowsiness, pain and skin reactions, here are some helpful suggestions:

• Make a list of all the medications you take regularly, including prescription and over-the-counter medications, and not forgetting any supplements or vitamins.
• Make an appointment to see your GP to discuss your concerns regarding your meds. They may well be able to recommend alternatives that could help reduce those side effects.
• Also, ask your doctor if it’s possible to gradually reduce the dosage of any of the meds you’re taking – this too can can sometimes help reduce side effects.
• Discuss with your doctor if any of the meds on your list can be stopped safely and replaced with non-drug therapies. Sometimes, lifestyle changes or alternative therapies can be really effective in treating certain health conditions.
• Ask your doctor if it’s possible to simplify your medication schedule. So for example, you may be able to combine certain meds or take them at different times of the day to make your regimen more manageable and easy to follow.
• Also talk about your concerns with your local pharmacist. Pharmacists are highly trained, and can provide information on the appropriate use of medications – and help you develop a plan to make your medication regimen more manageable.

But don’t forget, reducing the number of meds you’re on should always be done in consultation with your healthcare provider. Stopping a medication abruptly, or changing the dose can have unintended consequences, so always follow your doctor’s advice.