Polypharmacy putting millions of older people at risk
Author: Mark Gould
As the NHS carries out a review of overprescribing a new report from Age UK is calling on the government to take fully into account the harmful effects of inappropriate polypharmacy on older people.
In December health secretary Matt Hancock ordered a review that will focus in patients on multiple medications to ensure they are receiving appropriate care.
Age UK's new report More Harm than Good concludes that nearly two million over 65s are on seven or more medicines, putting them at risk of side effects that in a worrying number of cases can lead to falls and a range of other serious harms.
The report concludes that work pressures on GPs, lack of knowledge of drug interactions, and poor communication between hospitals and general practice are a big part of the problem.
It says that when GPs prescribe for older people they can overestimate the benefit of a treatment and underestimate the harms. Following the clinical guidelines for each long-term condition can also lead inadvertently to someone being prescribed large numbers of medications, putting them at risk of serious adverse reactions.
And it says that prescribing more drugs isn’t always the best option, particularly when it comes to older people. It also demonstrates that at the moment medicines are sometimes being prescribed in excessive numbers and unsafe combinations, often without the consent or involvement of patients.
Age UK estimates that almost two million people over 65 are likely to be taking at least seven prescribed medicines. This number doubles to approaching four million for those taking at least five medicines. As well as being potentially unsafe Age UK says unnecessary prescribing is also wasteful; the amount the NHS spends on prescriptions has increased by 40 percent since 2010.
Age UK is calling on the NHS to ensure "zero tolerance of inappropriate polypharmacy". It recommends:
- Older people are fully supported and involved in decisions about their medicines.
- High quality medicine reviews are routine for all older people taking medicines on a long-term basis.
- Care planning and new prescribing decisions take full account of existing medicines.
- Care homes maintain an appropriate clinical pharmacy lead and an accurate record of medicines.
- Polypharmacy is a core competency of clinicians working with older people.
Age UK director Caroline Abrahams said the NHS review of overprescribing is happening "not before time because the problem is not new and, as our report shows, it can have a really damaging impact on older people’s lives".
"We will look forward to seeing the outcomes and we are confident that there is much more that can be done to ensure every older person gets the medicines they really need – neither too many nor too few – which given the NHS’s spiralling drugs bill will be good for us all as taxpayers as well.”
Dr Henry Woodford, the chair of the drugs and prescribing special interest group at the British Geriatrics Society, said he recognised the picture painted in the report. “It’s something I see on a day to day basis,” he said. “It’s a complex problem. Older people accumulate a lot of diseases over time. Medications are prescribed because that’s in the guidelines for the disease.”