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Hello, and welcome back to Everyday Science. Have you ever heard someone complain that they take so many pills they feel like they could rattle? It might be surprising to think that medical professionals would have time to address such concerns, but there is a growing awareness among healthcare providers about the significant issue of polypharmacy, especially among older adults who often find themselves on long-term regimens involving multiple medications taken several times a day.
In response to this concern, the NHS has initiated a program aimed at helping doctors recognize when patients are taking an excessive number of medicines and to evaluate which ones may be doing more harm than good. This approach, known as “deprescribing,” may seem counterintuitive at first, as explained by Clare Howard, a pharmacist in Wessex and the clinical lead for the NHS’s Health Innovation Network’s polypharmacy program. Polypharmacy simply refers to the simultaneous use of multiple medications.
However, it is crucial to understand that all medications come with their own set of risks alongside their benefits. As individuals age, the balance between these risks and benefits can shift. “There’s a growing body of evidence that is beginning to illustrate where we may inadvertently be causing more harm than good,” Howard stated. Recent studies have also highlighted the advantages of deprescribing, particularly for individuals living with dementia, where the risks associated with taking multiple medications can be especially pronounced.
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Regardless of age or health status, healthcare professionals are now being encouraged to carry out structured medicines reviews, proactively assessing whether patients might benefit from reducing or discontinuing certain medications. Patients themselves can also request such reviews, but it is important to emphasize that they should never stop taking any medication without first consulting their doctor.
Identifying Dangerous Side Effects
So, what are the potential pitfalls of taking too many medications? For starters, managing numerous tablets can be a significant inconvenience. Howard notes, “You see patients in their eighties on as many as 13 different medications. One needs to be taken before meals, another after. The burden on patients is truly substantial.”
Moreover, taking multiple medications can pose serious risks, as they may interact with one another and lead to side effects such as nausea or drowsiness, which can increase the likelihood of falls. A recent study from a Liverpool hospital revealed that medication side effects account for one in six emergency hospital admissions, with polypharmacy being a major contributing factor.
A common reason for polypharmacy is that patients often consult various specialists for different health issues—cardiologists for heart problems, nephrologists for kidney issues, and so on. Each specialist may prescribe multiple medications for their specific conditions. Howard explains, “What we do in primary care is take a holistic view of the patient and ask: ‘How are they managing all of this?’”
Ageing also plays a vital role in this issue. As people grow older, physiological changes may necessitate lower doses of medications. For instance, the liver and kidneys, which are responsible for metabolizing and eliminating drugs from the body, may not function as efficiently.
A critical category of medications that warrants review includes those used for managing blood pressure. Blood pressure can fluctuate significantly, and excessively low levels can lead to dizziness and falls. NHS guidelines now advocate for allowing slightly higher blood pressure readings in older adults.
Cognitive Decline and Medication
Another prevalent challenge for older adults is that many medications can impair cognitive function by blocking the activity of a vital brain signaling molecule known as acetylcholine. This includes various antihistamines, certain antidepressants, and some pain relievers. Alarmingly, some of the few medications that have been shown to alleviate memory problems associated with Alzheimer’s disease work by enhancing acetylcholine levels. Thus, it is concerning that many older individuals might be unknowingly taking drugs that have the opposite effect, cautions Dr. Kinda Ibrahim, a primary care researcher at the University of Southampton.
This issue is so widespread that there are now online tools available for doctors to assess a patient’s “anticholinergic burden” based on their current medications. Polypharmacy is particularly problematic for those with dementia, as they may forget to take their medications or mistakenly take excessive doses. “This reliance on family members can add additional stress for caregivers,” Dr. Ibrahim explains. “Patients and their caregivers often express that they avoid going out because they need to adhere to strict medication schedules.”
A comprehensive review of previous research conducted by Dr. Ibrahim found that 27 studies indicated that medication reviews could be safely performed for individuals with dementia, leading to a reduction in the number of medications prescribed without increasing the risk of mortality or the need for hospital care. This review was recently published in the journal Drugs & Aging.
While some GP practices have already started to proactively identify patients who might benefit from deprescribing, the new NHS initiative has developed resources aimed at helping GPs and pharmacists pinpoint medications that could be safely discontinued. “This guide provides healthcare professionals with structured approaches to ensure that medications are used effectively and safely, in line with the goals of the patient,” said Professor Tony Avery, National Clinical Director for Prescribing at NHS England. The project has also made resources available online for patients. “I think patients often feel anxious when we suggest stopping medications. It’s a strange message to convey, as we exist within a medical model that prescribes for every ailment,” Howard noted. “But this is about personalized care—it’s preventative. It’s about addressing issues before they escalate.”
Additional Insights
Recently, I had the opportunity to tour a research laboratory focused on snake venom, where scientists are exploring innovative treatments for strokes, blood clots, and snakebites. If you’re intrigued and can tolerate images of snakes, you can read all about it here.
What I’ve Been Watching
I highly recommend Mickey 17, a new sci-fi film featuring Robert Pattinson as an “expendable” crew member on a space exploration mission. Every time he dies, he can be recreated in a new adult body. This film reminds me of the 2021 movie Don’t Look Up, as it, while primarily a comedy—featuring delightful performances by Mark Ruffalo and Toni Collette—also delves into serious themes.
