A simple review of prescription medications, known as a structured medication review (SMR), can unlock significant health benefits for patients, including weight loss, improved sleep, and increased mobility, while also offering substantial savings for healthcare systems. The process, often referred to as a 'medicine MOT,' is designed to identify and eliminate unnecessary or harmful medications, a growing concern known as polypharmacy, where individuals take multiple drugs concurrently.
Ron Rigby, an 88-year-old retired heating engineer, experienced a dramatic improvement in his quality of life after undergoing an SMR. Previously struggling with swollen feet, insomnia, and limited mobility, Rigby had been taking 14 medications daily. Following his review, his regimen was reduced to nine pills. This adjustment led to the discontinuation of lacidipine, a blood pressure medication that contributed to his edema, and anti-diuretics that were disrupting his sleep and impacting his kidney function. Now, Rigby reports regained mobility, a stone's weight loss, and improved sleep, allowing him to resume activities like golfing and traveling.
Rigby's situation highlights a widespread issue. In the UK, millions of individuals regularly take five or more medications, with a significant number taking eight or more. This polypharmacy can lead to a vicious cycle where one drug's side effects necessitate another prescription, further complicating a patient's health. According to the Health Innovation Network, approximately one million emergency hospital admissions in England annually are due to harmful medication side effects, with at least 40% of these being preventable. Older adults are particularly vulnerable due to age-related changes in how the body processes medications.
The Need for Deprescribing
The concept of 'deprescribing'—the systematic process of reducing or stopping medications—is gaining traction as a solution. The Polypharmacy Programme, initiated in Wessex in 2008, developed a structured approach involving identifying patients needing reviews, educating clinicians on deprescribing, and running patient awareness campaigns. This initiative has shown that reducing unnecessary medications not only improves patient outcomes but also leads to significant cost savings for the National Health Service (NHS) through reduced drug costs and fewer hospital admissions.
However, the program has faced funding challenges, with its future uncertain despite its demonstrated success. While charitable donations have provided a temporary reprieve until March 2027, a lack of sustained government support jeopardizes the continuation of training and momentum.
Identifying and Addressing Risks
Certain medications are more likely to lead to emergency hospital admissions in older adults taking multiple drugs. These include non-steroidal anti-inflammatory drugs (NSAIDs), blood thinners, diuretics, strong painkillers, blood pressure medications, and certain antidepressants and antipsychotics. Prolonged use of NSAIDs can cause ulcers and bleeding, while blood thinners increase the risk of severe internal bleeding. Diuretics can lead to dehydration and dangerous drops in blood pressure. Opiates can cause severe constipation and sedation, and antihypertensives may result in dizziness and fainting. Antidepressants and antipsychotics can induce drowsiness and confusion.
Experts emphasize that patients should not stop medications without professional advice. Instead, they should contact their GP surgery and request a structured medication review to ensure their prescriptions remain appropriate and effective. The current system, which tends to incentivize prescribing rather than deprescribing, needs reform to better support patients in managing their medication regimens and achieving optimal health outcomes.
Tracy Smith, a 59-year-old retired nurse, is another example of the benefits of SMRs. Previously taking 21 medications daily for various conditions, she experienced side effects like dry mouth, weight gain, and brain fog. After a gradual deprescribing process, her medication count has reduced to eight daily. She reports feeling significantly better mentally and physically, no longer experiencing brain fog and maintaining her pain levels despite reducing pain medication. She credits the process with making her feel heard and supported.