Overprescribing can take a toll on older people's health and independence—here's what can be done

In the United Kingdom, approximately 8 million individuals consume five or more medications daily, a condition known as polypharmacy. An additional 2 million people take ten or more prescription drugs each day. The majority of those on multiple medications are over the age of 65. The issue with polypharmacy arises when a medication is no longer suitable for an individual's circumstances or is ineffective in providing the intended benefit.

This can result in serious consequences for older adults, such as fatigue, dizziness, confusion, or instability, which can impede daily activities, raise the risk of falls, and lead to a decline in independence and hospitalization. As we age, our bodies process drugs differently, and the effectiveness of the kidneys and liver diminishes, allowing medicines to accumulate, thereby increasing the likelihood of side effects and issues arising from concurrent medication use.

The challenges of polypharmacy include the similarity of drug side effects to natural aging processes, making it difficult to discern whether changes in memory, mood, or behavior are caused by the progression of dementia or the medications themselves. This confusion can also burden family caregivers, who may feel responsible for monitoring medication management, scheduling appointments, and evaluating treatment decisions.

A study I conducted in collaboration with colleagues revealed that managing medications is a constant concern for individuals with dementia and their caregivers, who must manage prescription orders, organize tablets, monitor doses, and be vigilant for side effects. Furthermore, caregivers expressed the challenge of differentiating between dementia-related changes and medication-induced alterations in their loved one's memory, mood, or behavior.

These experiences are also illustrated in a short film we produced with family caregivers and people living with dementia, which demonstrates how medication burden can impact daily life, independence, and overall well-being. The film underscores the significance of involving individuals with dementia and their caregivers in prescription decisions and determining whether each prescribed drug is still necessary.

It is essential to remember that not all medications are intended for long-term use, and regular reassessment is crucial as health, priorities, and circumstances evolve. While many prescription drugs remain vital and life-saving, they should not be overlooked as people age and their needs change. Instead of merely adding more treatments, the focus should shift towards supporting independence, well-being, and personal values for older adults with frailty, dementia, or multiple long-term conditions.

Community activities, practical assistance, and meaningful social connections can sometimes offer more benefits than additional prescriptions. Research has shown that it is feasible to reduce the number of medications taken by older individuals safely without increasing the risk of hospitalization or death, even for those with frailty or dementia.

Initiating a conversation with a healthcare provider and requesting a medication review can help identify which medications are essential, which may no longer be required, and whether alternative non-medication approaches such as exercise, social activities, practical support, or social prescribing could be advantageous. Medication reviews provide an opportunity for individuals and their caregivers to ask questions, discuss what matters most, and gain a better understanding of each medication's purpose.

This can foster a sense of being heard and more actively involved in care decisions, ultimately leading to improved health and quality of life.