The Older Person and Polypharmacy, when should we cut down on medicines?

Older persons are more likely to have chronic medical conditions such as high blood pressure, diabetes, heart disease, stroke, dementia and osteoporosis. They may be on five or more medicines, known as polypharmacy.

An older person can range from being very fit to very frail and dependent on others. In the fitter older person, their treatment targets for blood pressure and blood sugar can be similar to younger people. However, in frailer older persons, they are more likely to suffer from low blood pressure episodes (hypotension) and low blood sugar (hypoglycaemia) with symptoms of tiredness, dizziness and confusion. The doctor may decide on a less strict treatment target for older frailer persons.

An older person may require fewer medicines due to the reasons below

• reduced kidney and liver function
• reduced body weight and muscle mass
• side effects of medicines
• symptoms of overtreatment as described above
• the original condition has resolved (eg allergies, gastric and skin conditions)
• their lifestyles may have changed with retirement with less stress and salt, sugar and fat intake when eating out less
• repeated falls from blood pressure that is too tightly controlled, leading to postural hypotension after standing or walking for a prolonged period
• swallow problems leading to difficulties with pills or tablets. Some medicines can be converted to injection (eg osteoporosis) or skin patch form (dementia and chronic pain)
• dementia where the older person has difficulty reporting their symptoms and is reliant on their carer to monitor and detect symptoms
• severe frailty where the person is approaching end-of-life care, fully bedbound and unable to interact with others
• the cost of treatment is too high
• multiple pills affecting the person’s quality of life and psychologically

If you feel that you or your loved ones will benefit from cutting down on medicines, please speak to your healthcare professional about it.