Understanding polypharmacy

Despite only being in power for a matter of weeks, the new Government has committed to auditing the NHS over the summer.

The Government has also committed to producing a 10-year plan in 2025, so it clearly has ambitions for improving services. One area that should feature in future plans is ‘polypharmacy’.

What is polypharmacy?

As we age, we are much more likely to live with health conditions like diabetes, heart disease and COPD. We are more likely to experience short-term acute problems, or to have had a recent spell in hospital. These developments can result in older people receiving large amounts of medication and treatments, sometimes for many years. Managing and taking multiple medications is called ‘polypharmacy’.

More harm than good?

Up until our mid-40s, the average number of unique items prescribed per head of population in a typical month is less than two. Over 75, this more than doubles to over five. Within this age group, many older people will be on many more than that. By the age of 80, more than a third of all people are on eight or more medicines.

These medicines will often be critical to managing and maintaining our health. However, not everyone on multiple medicines will be benefiting from them, and in some cases, they could actively be causing harm. For example, different clinicians may be prescribing medicines without the full knowledge of everything a patient is taking. This can mean someone may be taking medicines that do not work well together or that can increase the risk of adverse events.

In other cases, someone may have been taking a medicine for many years without examining if it is still benefiting their health. It is not always clear if the health issue it was originally addressing is still active or if the side effects of that drug are still, on balance, tolerable relative to the benefit it provides.

Age UK examined these issues in our 2019 report More Harm Than Good, which outlined the human cost of medicines not being optimised for older people.

There can be avoidable admissions to hospital due to severe medicines harm, from over-medication to people feeling unable to manage their medicines and not taking what they need. Older people can find their general health and wellbeing undermined by the impact of taking certain medicines that, with the right planning, could be stopped.

The cost to the NHS

The impact on older people and their families is one thing, but there are also significant, and avoidable, costs to the NHS. Whether that’s from hospital care that could have been avoided or from a general deterioration in someone’s health, requiring longer-term health and social care costs. In addition, there’s the question of the overall drugs budget.

These challenges are recognised by those working in the NHS. Shortly after the release of our report in 2019, the Department for Health and Social Care launched the National Overprescribing Review, publishing its findings in 2021. The report called for changes to the system, including basics like making sure information on someone’s medicines are accessible to everyone involved in their care. It was also recognised that there needed to be changes to the culture within healthcare, to move away from an over-readiness to solve issues through medicines.

Age UK has been involved in a follow-up piece of work led by the Health Innovation Networks (HIN) Polypharmacy Programme, which is driving changes in both clinician and patient behaviours to reduce problematic polypharmacy across England.

Structured Medication Reviews (SMRs) are the best way to discuss and make decisions about optimising medicines. However, research shows most people accessing NHS services do not know what a SMR is or what to expect when they are invited for one by their GP or pharmacist.

To help address this need, the Health Innovation Network in partnership with academics, patients and third sector organisations such as Age UK and Mencap co-created and tested a range of patient information resources to help people understand and prepare for their Structured Medication Review.

The resources are now available nationally in 12 languages and include easy read for people with learning disabilities, and audio versions. They include example questions someone may wish to ask their health professional, questions to help them think about their medicines before their review, and an animation to help explain how an SMR can help.

Evaluation from a Primary Care Network in Nottingham reported an 88% increase in patients attending SMRs after receiving the materials. Alongside this, training delivered through the programme to more than 2,600 GPs and Pharmacists since 2022 has helped to develop the skills and confidence to undertake more effective Structured Medication Reviews.

Addressing polypharmacy is extremely important. However, starting a conversation with your GP about what is important to you is also a crucial step in improving shared decision-making, i.e. healthcare that is based on your personal goals, wishes and preferences, combined with the clinical expertise of your healthcare team.

This is the bedrock of a more joined-up, preventative and proactive NHS and one that we hope the new Government will be working to deliver.