Polypharmacy — typically defined as regularly taking 5 or more medicines — affects approximately 50% of people over 75 in the UK. With each additional medicine, the risk of drug interactions, adverse effects, and non-adherence rises. Yet polypharmacy is often appropriate (multiple conditions each requiring medication); the problem is not the number of medicines per se but whether each continues to provide more benefit than harm — and whether the cumulative burden is managed safely and regularly reviewed.
Why Polypharmacy Is So Common in Older Adults
Two principal drivers: multiple chronic conditions (comorbidity) — the average 75-year-old in the UK has 3–4 long-term conditions; and the single-disease clinical guidelines that drive prescribing — each specialist writes guidelines for their condition without integrating with other conditions’ treatment. The result: excellent guidelines for diabetes, heart failure, COPD, osteoporosis and hypertension individually, applied simultaneously, can generate a prescription list of 10+ medicines. Additionally, medicines prescribed for one condition can cause side effects that are then treated with additional medicines — the “prescribing cascade.”
The Risks of Polypharmacy
Drug interactions: the number of potential drug interactions increases exponentially with the number of medicines. At 5 medicines, 10 possible two-drug interactions exist; at 10 medicines, 45. Clinically significant interactions — bleeding from warfarin potentiation, hypoglycaemia from combined antidiabetic agents, bradycardia from beta-blocker/digoxin combination — are common. Adverse drug reactions (ADRs): ADRs are responsible for approximately 6–7% of hospital admissions in older adults — and many are preventable. Falls: multiple medication classes (psychotropics, antihypertensives, diuretics) increase fall risk cumulatively. Reduced cognition: anticholinergic burden from multiple medicines with anticholinergic properties (antihistamines, bladder agents, tricyclic antidepressants, some antiemetics) cumulatively impairs cognition in older adults. Non-adherence: complex regimens are difficult to follow; adherence falls significantly with increasing numbers of medicines. Reduced quality of life: pill burden, side effects, and the medicalisation of daily life all reduce wellbeing.
What You Can Do
Structured Medication Review (SMR): an NHS service available through GP practices, conducted by a clinical pharmacist or GP. Reviews all medicines for continued appropriateness, identifies interactions and redundant medications, and recommends stopping, reducing, or substituting where appropriate. Ask your GP for an SMR, particularly if you are taking 5+ medicines. Keep an up-to-date medicines list: a written list of all medicines (name, dose, indication, prescriber) should be taken to every healthcare appointment. Know why you’re taking each medicine: you are entitled to ask your prescriber what each medicine is for and what benefit you’re expected to experience. Report side effects: many adverse effects of medicines in older adults are attributed to “getting older” rather than investigated as drug effects.
Frequently Asked Questions About Polypharmacy
What is deprescribing and is it safe?
Deprescribing is the systematic process of reducing or stopping medicines that are no longer appropriate — where the risk-benefit balance has shifted due to age, changed health status, or changed treatment goals. It is not stopping medicines arbitrarily — it is evidence-based optimisation. Research consistently shows that deprescribing (particularly of psychotropics, PPIs, antihypertensives in frail older adults, and statins in those with limited life expectancy) is safe and often improves quality of life, cognition and fall risk.
My doctor keeps adding medicines — how do I raise concerns?
You have the right to ask your prescriber to explain the expected benefit, likely side effects, and any alternatives for any new medicine. You can explicitly request a medication review if you feel your prescription list has grown complex. Asking “Is this medicine still helping me more than it might be harming me?” is a legitimate and important question at any age.
Visit Huncoat Pharmacy for a free medication review consultation with our clinical pharmacist. Related: Medicines Safety, Falls Prevention, Ageing Well.
At Huncoat Pharmacy: Pharmacy First – medication review, NHS medicines review service, Nominate us for your NHS prescriptions.