Older people and drugs: Q and A

New research has suggested that a combination of common drugs could increase the risk of decline and death for older people. The research found that there were risks from over-the-counter and prescription drugs, including antihistamines, painkillers, blood thinners and eye drops for glaucoma.

However the researchers themselves have called for more work to be done and warned patients against stopping taking any drugs abruptly.

Channel 4 News spoke to Dr Finbarr Martin, President of the British Geriatrics Society and a consultant geriatrician at Guys and St Thomas’ Hospital, about what this research means for older people and their families.

Question: What’s your advice for people worried about the findings of this research?

My advice is the same as that of Clare Gerada of the Royal College of GPs: for many people, the medications they have been prescribed will have clear-cut benefits which outweigh the risks highlighted by this study.

If you are taking medicines other than those prescribed – either by a secondary prescriber or over the counter medicines – that increases the risk of adverse effects because of drug interaction but also because there is an accumulation of side effects.

There are some medications where the side effects of stopping suddenly can be really quite bad. So you should arrange to see your GP. Dr Finbarr Martin

All medicines that people are taking should be reviewed by a healthcare professional, who will look at the risks and the benefits, so you can make an informed choice.

What should people who are worried they are taking too many medicines do?

The best course of action is to change nothing. These results are from observing large numbers of people over a long period of time. There is not a danger to you today or tomorrow. Therefore, even if there is some risk, it is not any more of a risk if you keep taking the medications for one more day or one more week.

Secondly, there are some medications where the side effects of stopping suddenly can be really quite bad – particularly the modern anti-depressants. There can be unpleasant withdrawal symptoms and to stop suddenly is unwise.

So you should arrange to see your GP and talk it through. Particularly for older people, and people on many drugs, their medication should be reviewed every six months.

The science behind the study
"The findings of this latest study are persuasive - but not conclusive," writes Channel 4 News Science Correspondent Tom Clarke.
"Previous studies have pointed to a link between these types of anticholinergic drugs and dementia, but this is the first to show that the more of the drugs you take, the greater the effect. Scientifically speaking, that's an important step. 
"This study followed 13,000 over-65s for two years gathering information about their general health, but also recording what medicines they took and testing their mental health. A sample that big means the results are more convincing than many research studies. 
"But although they show a definite correlation between taking too many of these common drugs and an increased risk of death and dementia, they don't prove a link. People taking a large number of medications may be at an increased risk of dying earlier for other reasons not caused by the drugs themselves. Moreover general health can have an impact on mental ability so it's also possible people taking multiple drugs because they are less well would have experienced mental decline anyway.
"To confirm their findings the researchers stress that they need to find evidence in the brain, or elsewhere, for how anticholinergic drugs might be causing damage. Finding a mechanism that underlies this suspected trend would make the case against the overuse of these common medicines much stronger. This latest research is based on data gathered in the early 1990s. The team say they are now updating the research with the most recent data to see if the effect is as pronounced. They suspect it might be. Many over 65s take even more medicines now than they used to."

What about older people in care homes or their families who are worried?

Older people in care homes absolutely have a need for their medication to be reviewed when they are admitted and then every six months after. The benefits and the risks of their medication are affected by the underlying health of the person, and as that changes it has to be re-examined. So their advocates, be they relatives or not, definitely have the right to approach the GP and be involved in a review of their medication amid a general review of their health care goals.

Are the results of this study new?

There have been several studies of the risks of poly-pharmacy for older people. These days, many individual conditions need several different medications. So a person could be on three or four medications after a stroke. So GPs following the evidence could have a person on seven or eight medications and at that point a minor side effect can become a major side effect because of the accumulation, or the interaction between the drugs. So sometimes GPs need to prioritise, as the risks can build up. It’s about an individualised approach.

Why does the problem of older people being on lots of medication arise?

The main reason older people are on lots of medicines is because they have a lot of indications for them. But when a person is unable to visit the GP or is in a care home, they can become invisible. The routine systems can break down. Primary care has tried to address this in the last year.

Susceptibility to drugs changes – for example drugs with a small anticholinergic effect which would not matter to you or I – when you have had a stroke you are more susceptible so even though your condition may be the same, the condition for which you were prescribed the drug may remain, your susceptibility to adverse effects may change.