Age UK calls for a more considered approach to prescribing medicines for older people
Nearly 2 million older people on 7+ prescription medicines at risk of side effects that are severe in some cases, and occasionally even life threatening.
Age UK launches a new report today that says too many older people in our society are on too many prescribed 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, ‘More Harm than Good’, provides evidence showing 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
- in unsafe combinations
- without the consent or involvement of the older people concerned
- and without the support and help older people need to take them.
Sadly, this causes significant numbers of older people avoidable harm[i] and they are more at risk of this than other age groups as they are much more likely to have more than one health condition and to be on multiple medications.
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.
In England overall more than one in 10 people aged over 65 takes at least eight different prescribed medications weekly, and this increases to one in four among people who are aged over 85[ii].
All these prescriptions are costing our health service a lot of money: the amount the NHS spends on prescriptions has increased by 40 percent since 2010/11[iii].
Access to medicine is often vital to older people’s health and wellbeing and no medicine should ever be stopped without the advice and support of a GP or another clinician. However, research has found that as many as one in five prescriptions for older people living at home may be inappropriate[iv] so it makes sense for them to be regularly reviewed.
Age UK is calling on the Government to take fully into account the harmful effects of inappropriate ‘polypharmacy’ (multiple medicine use) on older people as it carries out a review of overprescribing in the NHS.
Adverse side effects
Many medicines carry additional risks of ‘adverse drug reactions’, more commonly known as side effects. As we age the way our body processes medicines changes, making older people more susceptible to side effects. These adverse reactions can include nausea, dizziness, loss of appetite, low mood, weight loss, muscle weakness and delirium.
Research has found that over a six month period, more than three quarters of people over 70 will experience an adverse drug reaction and the chance of this happening rises as the number of medicines that are taken increases[v].
Adverse drug reactions can have severe consequences for older people and cause nearly 6 percent of unplanned hospital admissions. Between 2008 and 2015 the number of emergency hospital admissions caused by adverse drug reactions increased by 53 percent[vi]. In 1 in 50 cases that reaction proved to be fatal[vii].
Evidence shows that as the number of medicines taken increases, so does the risk of falling, which in turn dramatically increases the likelihood of being admitted to hospital. In fact, nearly 1,000 older people a day are admitted to hospital because of falls[viii], and their chance of falling again increases by 14 percent for every extra medicine they take over the first four[ix].
Pressures on clinicians are a big part of the problem
Age UK’s new report suggests that clinicians can find they:
- are over-stretched and in a hurry so prescribing a drug is a quick and easy thing for them to do to help an older person, whereas if they had longer they might decide another approach would be safer and more effective
- have insufficient knowledge of side-effects associated with older people taking different combinations of medicines, and
- lack the tools to share medical information effectively with other clinicians, such as when hospital doctors are discharging a patient and are unable quickly and easily to send an accurate list of medicines to their GP.
This report points to evidence showing that when GPs prescribe for older people they can overestimate the benefit of a treatment and underestimate the harms[x]. Following the clinical guidelines for each long-term condition can also lead inadvertently to someone being prescribed large numbers of medications[xi], putting them at risk of serious adverse reactions[xii].
Confusion and anxiety
It is estimated that up to 50 percent of all medicines are not taken as they were intended. The more medicines prescribed, the higher the burden to manage, potentially causing confusion and anxiety[xiii]. This can result in older people taking fewer medications or stopping taking them altogether[xiv], so they miss out on treatments that could otherwise be really helpful to them.
Age UK is calling on the NHS to ensure that:
- There is zero tolerance of inappropriate polypharmacy.
- 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 (taking prescribed medicines to treat one or more health conditions) is a core competency of clinicians working with older people.
- Older people, especially those living with dementia, have access to the support they need to manage their medicines.
Caroline Abrahams, Charity Director at Age UK said: “We are incredibly fortunate to live at a time when there are so many effective drugs available to treat older people’s health conditions, but it’s a big potential problem if singly or in combination these drugs produce side effects that ultimately do an older person more harm than good. That’s why it is really important that a clinician, typically your GP, has a good overview of all your medicines and considers from time to time with you whether they are still the best for your health, not only on their own but when taken together with the other medications you are on.
“Our strong advice to older people is never to stop taking any of your medications off your own bat, but to talk to your GP if you have concerns and to ask for a review if you haven’t had one for a year or more. Everyone’s needs change over time and new treatments are always becoming available so it is well worth your doctor looking at whether your medicines are the best they can be and, indeed, whether they are all still necessary. Most older people would agree that the fewer pills they have to pop, the better.
“Getting the medicines right for older people who live in care homes is especially challenging but also all the more crucial, because many residents are coping with multiple health problems, frailty and dementia, meaning they are especially likely to be on multiple treatments that in turn increase the risk of adverse reactions. The NHS Long Term Plan published earlier this year commits to rolling out Enhanced Health Care in every care home in the country over the next few years, including regular medicine reviews for residents and more active support for care home staff from pharmacists and GPs. It is really important that this commitment is put into practice, to protect older people in care homes from the polypharmacy risks many of them face.
“This 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.”
To read the full findings of the report on Polypharmacy visit: ‘More Harm than Good’ visit: [Insert web link]
If you are concerned your prescribed medicines are no longer required, or are causing unexpected or unpleasant side-effects, arrange a medicine review with your GP. Annual medicine reviews are recommended.
For further information on getting the most from medicines visit: https://www.ageuk.org.uk/information-advice/health-wellbeing/health-services/getting-the-most-from-your-medicines/ or call Age UK’s information and advice line on 0800 055 6112.
Anne is 84 years old and lives alone. She has to take 19 medicines every day to help manage her medical conditions, which include ulcerative colitis, hypertension, asthma, osteoarthritis. Anne was recently admitted to hospital, where several changes were made to her medications. When she was discharged from hospital a package of care was arranged that included carers giving her medication. Although three bags of medication were sent home with her there was no Medicines Administration Record given and so the carers were unable to record what medicines they were giving to Anne and when. On top of that, no discharge letter was sent to the GP detailing Anne’s new prescriptions. This meant that when Anne ran out of her medicines there was no record of what some of them were.
[i] J Clin Pharm Ther. 2013 Oct;38(5):360-72. doi: 10.1111/jcpt.12059. Epub 2013 Apr 2.Application of the STOPP/START criteria: a systematic review of the prevalence of potentially inappropriate prescribing in older adults, and evidence of clinical, humanistic and economic impact. Hill-Taylor B1, Sketris I, Hayden J, Byrne S, O’Sullivan D, Christie R.
[ii] NHS Digital Health Survey for England – 2016: Prescribed medicines – table 1 https://files.digital.nhs.uk/excel/4/2/hse2016-pres-med.xlsx
[iii] NHS spent more on prescription medicines than ever before – £18.2 billion NHS Digital. Prescribing Costs in Hospitals and the Community, England 2017/18. November 2018. https://digital.nhs.uk/data-and-information/publications/statistical/prescribing-costs-in-hospitals-and-the-community/2017-18
[iv] D Opondo et al. Inappropriateness of medication prescriptions to elderly patients in the primary care setting: a systematic review. PLoS ONE 2012;7(8):e43617
[v] Cahir C et al (2014). Potentially inappropriate prescribing and adverse health outcomes in community dwelling older patients. Br J Clin Pharmacol. 2014 Jan; 77(1): 201–210.
[vi] Parekh, N, et al, Incidence and cost of medication harm in older adults following hospital discharge: a multicentre prospective study in the UK, Br J Clin Pharmacol (2018) 84 1789–1797
[vii] Pirmohamed Munir, James Sally, Meakin Shaun, Green Chris, Scott Andrew K, Walley Thomas J et al. Adverse drug reactions as cause of admission to hospital: prospective analysis of 18 820 patients BMJ 2004; 329 :15
[ix] Freeland KN et al. (2012). Medication use and associated risk of falling in geriatric outpatient population. Ann Pharmacother. 2012 Sep;46(9):1188-92
[x] Parekh N, et al., Incidence and cost of medication harm in older adults following hospital discharge: a multicentre prospective study in the UK. Br J Clin Pharmacol. 2018 Aug; 84(8): 1789–1797.
[xi] Hughes LD et al (2013). Guidelines for people not for diseases: the challenges of applying UK clinical guidelines to people with multimorbidity. Age Ageing. 2013 Jan;42(1):62-9
xiii] Dumbreck S et al (2015). Drug-disease and drug-drug interactions: systematic examination of recommendations in 12 UK national clinical guidelines. BMJ. 2015; 350: h949
[xiv] Pasina L et al (2014). Medication non-adherence among elderly patients newly discharged and receiving polypharmacy. Drugs Aging. 2014 Apr;31(4):283-9. Brown MT and Bussell JK (2011). Medication Adherence: WHO Cares?. Mayo Clin Proc. 2011 Apr; 86(4): 304–314.
Notes to editors
Financial impact of wasted medicines
In 2017/18,the NHS spent £18.2 billion on prescription medicines which is more than ever before. However, many of these medicines aren’t needed or are simply wasted, costing the NHS an estimated £300 million a year according to Pharmaceutical waste reduction in the NHS, NHS England, 2016.
There are also the additional costs relating to avoidable hospital admissions and GP appointments for adverse health problems which could have been preventable. NICE calculated that adverse drug reactions that resulted in avoidable hospital admissions costs a further £530 million a year and an extra 2.2 million bed-days:
NICE (2015). Costing statement: Medicines optimisation: Implementing the NICE guideline on medicines optimisation (NG5). https://www.nice.org.uk/guidance/ng5/resources/costing-statement-6916717
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