University of Aberdeen researchers looking to limit the health risks for older people on multiple different medicines say patients themselves need to be able to ask the right questions to reduce overprescribing.

Data from across the NHS shows more people are living with more than one condition and the number taking multiple medicines – known as polypharmacy – is growing and, while taking multiple medicines can be beneficial, there can also be potential harms.

A team at Aberdeen says one potential risk is around anticholinergic medicines, with around half of all older adults in the UK use – prescribed them for various conditions including allergies, irritable bladder and nausea.

However, the more of these medicines a person takes, the greater their risk of heart attack, dementia, falls and death – with older people particularly vulnerable to these effects. 

Previous attempts to reduce over-prescribing of these medications focused solely on the prescriber’s behaviour and has had limited success.

The team of researchers led by the University of Aberdeen’s Professor Phyo Myint, is investigating a new approach of empowering the patient to ask questions when they are on medicines for a long time.

Project manager, Dr Carrie Stewart explained this approach targets the patient to “initiating change”, allowing them greater control by providing a say in the decisions around their health:

“We know that too much of these types of medicine can be very harmful to older people but so far, we haven't been able to find the best way to reduce their use amongst older people.  

“Empowerment allows patients to have greater control by having a say in the decisions and actions taken in relation to their health.  

“We need people who have experience of these common medications to get in touch with us so that we can talk directly to them and get a real insight into how we can get on top of this – what better person to ask than the people involved.”

She added that this aligns with both the UK and Scottish government health policy ambitions, particularly Scotland’s realistic medicine campaign to promote shared decision-making, improve social prescribing and reduce unnecessary medicines use.

Dr Stewart said that this research will inform and improve prescribing practice which could lead to “significant” improvements to older people’s health and quality-of-life.

Pharmacists and polypharmacy

Community Pharmacy Scotland’s Chief Executive Matt Barclay told healthandcare.scot that pharmacists’ involvement is vital to research on multiple prescriptions and reducing patient risk.

He explained that pharmacists are trained to support patients in managing medicines and identify when a medicine is not suitable:

“Pharmacists are the experts in medicines and therefore where polypharmacy is at play, it is vital for community pharmacy input to be included to help reduce these types of medicine-related risks.

“Community pharmacies have long-standing relationships with their patients and often are the first point of contact for anyone experiencing side effects from their medicine.

“Opening the research to include community pharmacy teams would therefore be advantageous for patients and encourage multidisciplinary working within the healthcare team, which would ultimately lead to reduced risk and better outcomes.”

The Royal College of General Practice’s Vice Chair Dr Chris Williams said that primary care research is “enormously valuable” and can answer several important questions for shifting services.

He told healthandcare.scot that severe underinvestment has held back primary and community health services in delivering research in Scotland which is a “missed opportunity” to build capacity and improve care.

Laura Wilson, Royal Pharmaceutical Society Director for Scotland added that while pharmacy teams already provide a range of community-based services, additional resources could help them deliver greater change:

“With additional support and resources, for example read/write access to shared patient data to ensure pharmacists have access to all the information they need to treat patients in the community, and access to training opportunities, there is the potential for pharmacy teams to expand these services.

“We would welcome discussions with Scottish government and other key stakeholders about any proposed expansion to these services with the aim of transforming patient care.”

Getting involved

Aberdeen researchers are inviting people aged 65 years and older prescribed one or more anticholinergic medicines now or in the past year, to take part in the research.

Anyone who has cared for an eligible adult can also take part.  

Volunteers will have the opportunity to chat with the team and give their views on the medications and how they can feel empowered to ask questions about the medicine they are given.

The team says that while study is already underway, they are looking for eligible patients to get in touch to expand the insights they can gain.

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