Polypharmacy

Also called Multiple medicines, Medication review, Deprescribing

Taking many medicines, some of which are no longer helping. A structured review is one of the highest-value appointments in older people's health.

What it is

Taking multiple medicines. It is not automatically bad: somebody with several long-term conditions may need many drugs, all of them helping.

The problem is **problematic polypharmacy**: medicines continued after the reason has gone, prescribed to treat the side effects of other medicines, no longer appropriate as a person becomes frailer, or simply never reviewed.

The scale is substantial. A large proportion of people over 65 take five or more medicines, and a significant number take ten or more. Adverse drug reactions account for a meaningful share of emergency admissions in older people, and most are avoidable.

**Prescribing cascades are the pattern worth recognising**: a calcium channel blocker causes ankle swelling, a diuretic is added, the diuretic causes urinary urgency, an anticholinergic is added, the anticholinergic causes confusion and falls. Each step is logical and the whole is harmful.

Anticholinergic burden is the single most useful concept here. Many common drugs, some antidepressants, antihistamines, bladder drugs, antipsychotics and antisickness drugs, have anticholinergic effects, and the cumulative burden is associated with confusion, falls, constipation, urinary retention, dry mouth and, on some evidence, dementia.

**Deprescribing is active treatment, not giving up.** As people become frail or approach the end of life, the balance shifts: statins, tight blood pressure targets and tight glucose targets may cause more harm than benefit, and stopping them is good medicine.

Signs you might notice

Signs that a review is needed: five or more regular medicines; a recent fall; new confusion; drowsiness; dizziness on standing; constipation; incontinence; a poor appetite; a recent hospital admission; or a new symptom shortly after a new medicine.

Signs of a prescribing cascade: a medicine started to treat a symptom that appeared after another medicine.

Practical warning signs: medicines nobody can explain the reason for; different lists in different places; boxes accumulating unused; and doses the person cannot manage.

Urgent: confusion, drowsiness, a fall, or a rapid deterioration shortly after a medication change.

Also: any medicine that requires monitoring, such as lithium, methotrexate, warfarin, amiodarone or DMARDs, where the blood tests have lapsed.

How it can affect day-to-day life

The structured medication review is the intervention, and it works best when the person or their family comes prepared: bring every box, including things bought over the counter and herbal products, and a list of what actually gets taken rather than what is prescribed.

Ask three questions about each medicine: what is it for, is it still doing that, and what would happen if it stopped.

Sick day rules matter: several common medicines should be paused during illness with vomiting, diarrhoea or dehydration. Having that written down before it is needed prevents acute kidney injury.

Hospital discharge is the highest-risk moment. Medicines are stopped, started and changed, and the GP record frequently does not match the discharge letter. Checking the two against each other after any admission catches real errors.

Deprescribing should be planned, one drug at a time, with a monitoring plan and a clear route back if symptoms return.

Compliance aids help some people and hide problems for others; they are not a substitute for reviewing whether the medicines are right.

Supporting someone well

Ask for a structured medication review, by name, for anybody on five or more medicines.

Bring everything: all boxes, over-the-counter items and supplements, plus what is actually taken.

Ask of each medicine: what is it for, is it still working, and what happens if we stop it.

Look for prescribing cascades: a drug treating another drug's side effect.

Ask about anticholinergic burden, especially where there is confusion or falls.

Get sick day rules written down before they are needed.

Reconcile the discharge letter with the GP record after every admission.

Treat deprescribing as active care, particularly in frailty and at end of life.

Check that monitoring bloods for high-risk drugs are up to date.

Report any new symptom appearing after a medication change.

Where to get help

A GP practice or practice pharmacist for a structured medication review; many practices have a pharmacist who does exactly this.

A community pharmacist, who can review over-the-counter and prescribed medicines together.

The hospital pharmacy team after an admission.

Age UK on 0800 678 1602 for support in asking for a review.