Around 8 million people in the UK take five or more medications each day (known as polypharmacy), with a further 2 million people taking ten or more prescription drugs daily. The majority of people who take multiple medications each day are aged over 65 .
Author
- Kinda Ibrahim
Associate Professor, Primary Care, University of Southampton
Taking multiple prescription drugs is not necessarily a problem. But it can become problematic when a medicine is overprescribed . This means someone is taking a drug that’s no longer appropriate for a their circumstances, does not deliver the intended benefit, conflicts with their wishes or when a better non-medicine option is available.
In some cases, the consequences of overprescribing can be serious . It may leave people feeling tired, dizzy, confused or unsteady. This can make everyday activities harder and increase the risk of falls, loss of independence and hospital admission . For older adults living with frailty or dementia, these effects can be particularly harmful .
The reason this overlap of medications becomes especially dangerous as we age is because our body processes these drugs very differently than it does when we’re younger.
For older adults, the kidneys and liver may not remove medicines from the body as effectively as they once did. This means medicines can build up in the body , increasing the risk of side-effects and problems caused by taking several medicines together. Medicines that once caused few problems can begin to affect balance, concentration, appetite and energy levels.
One of the biggest challenges with polypharmacy is that drug side-effects can look a lot like ageing. Feeling tired, forgetful, dizzy or unsteady is often put down to getting older, or to dementia itself. But medicines can sometimes contribute to these problems .
This is especially important for people living with dementia, who often take medicines for several other health conditions . For families, it can be hard to know whether changes in memory, mood or behaviour are caused by dementia progressing or by the medicines being taken.
The impact of overprescribing and polypharmacy also goes far beyond physical side-effects.
In research I conducted with colleagues, people living with dementia and family carers described how managing medicines had become part of daily life. Ordering prescriptions, organising tablets, remembering doses and watching for side-effects required constant attention. Many carers felt responsible for spotting problems, attending appointments and supporting treatment decisions – yet this often went unrecognised.
Carers also described the challenge of knowing whether changes in memory, mood or behaviour were caused by dementia itself or by medicines. Many spoke about balancing safety with independence, helping their loved one while preserving as much autonomy as possible.
These experiences were also captured in a short film we produced with family carers and people living with dementia.
Our film highlights how medication burden can affect daily life, independence and wellbeing. It also emphasises the importance of involving people with dementia and their carers in decisions about prescriptions, and asking what matters most to them and whether every prescription drug is still needed.
This does not mean people should stop taking medicines without speaking to their doctor first. Many prescription drugs remain essential and life-saving. But medicines prescribed years ago are not always reviewed as people’s health, priorities and circumstances change over time.
Medication reviews
As we live longer, helping people live well is becoming just as important as helping them live longer. For older adults living with frailty, dementia or several long-term conditions, the focus is not simply on adding more treatments, but on supporting independence, wellbeing and what matters most to them.
Connecting people with community activities , practical support and meaningful social connections can sometimes be the solution to polypharmacy and overprescribing. After all, better health does not always come from another prescription. Sometimes, staying active, feeling connected and getting the right support can make more difference than adding another pill.
My research has also found that it’s possible to the reduce number of medications taken by older people in a safe way without increasing risk of hospitalisation or death. This was true even for those living with frailty or dementia.
If you or someone you care for is taking a large number of prescription drugs, it’s worth starting a conversation with your doctor and asking for a medication review . This can help identify which prescription drugs remain important, which may no longer be needed and whether non-medication approaches such as exercise, social activities, practical support or other forms of social prescribing could be helpful.
Medication reviews can help ensure that every prescription drug a person takes is still needed and doing more good than harm. By reducing unnecessary medicines, people may experience fewer side-effects, a simpler daily routine and may improve quality of life.
My research found that medication reviews give people and their carers an opportunity to ask questions, discuss what matters most to them and better understand what each medicine is for. This can help people feel listened to and more involved in decisions about their care.
