Concerns over the rising risks associated with polypharmacy—the simultaneous use of multiple medications—have prompted calls for renewed focus on managing prescriptions among older adults. As the population ages and individuals live longer with multiple chronic conditions, the accumulation of medicines prescribed over time increases the potential for harmful drug interactions, adverse effects, and hospital admissions.
Experts emphasize that addressing polypharmacy should not be approached simply by reducing the number of medications prescribed. Instead, medication reviews conducted by pharmacists within primary care settings are critical to ensuring each drug remains necessary, effective, and safe for the patient. Tase Oputu, president of the Royal College of Pharmacy, highlighted that these reviews can enhance patient safety, improve quality of life, and reduce medical waste. However, she warned that such consultations are being deprioritized in some parts of the National Health Service (NHS), urging healthcare leaders to invest more support and time for pharmacists, general practitioners (GPs), and other professionals to perform this work.
While overprescribing has received considerable attention, the issue of non-adherence—patients not taking their medications as prescribed—also poses a substantial challenge. David Sinclair, CEO of the International Longevity Centre UK, pointed out that adherence rates for chronic conditions in developed countries can be as low as 50 percent. This non-adherence contributes to approximately 10 percent of hospital admissions among older individuals and imposes a significant economic burden, estimated at €125 billion annually across Europe. Unlike overprescribing, few nations actively monitor medication adherence, with some exceptions such as hypertension programs in Sweden, Croatia, and Italy.
Several factors drive the trend toward increased prescribing. Andrew Cairns, a retired GP from Liss, Hampshire, identified the UK’s Quality and Outcomes Framework (QOF)—which incentivizes GPs to meet targets related to conditions like hypertension, high cholesterol, and diabetes—and the cardiovascular risk assessment tool QRisk3 as major contributors. Cairns argued that this framework has led to pressure on almost every patient over 65, particularly men, to take multiple medications that may produce significant side effects, raising concerns that longevity is being prioritized over quality of life.
Addressing this complex issue requires adequate professional training and a balanced approach to prescribing. Steve Williams, lead clinical pharmacist for the Poole Bay and Bournemouth Primary Care Network, noted that around 6,000 clinical pharmacists already collaborate with GPs on annual medication reviews. He emphasized the need for all prescribers—including doctors, pharmacists, nurses, and allied health professionals—to receive enhanced training to effectively communicate the risks and benefits of medications as treatment regimens grow more complex. Williams advocated adherence to the established four stages of prescribing—consider, start, review, and stop—and cautioned against the unchecked addition of medicines without appropriate reassessment.
The question of who is best placed to oversee medication management also emerged in the debate. Dr. Jane Stanford, a London-based physician, suggested that family doctors remain the most suitable professionals to monitor polypharmacy in elderly patients. She argued that hospital admissions for medication-related issues could often be avoided by improving access to primary care, but noted that time constraints within GP consultations sometimes limit effective medication review.
As the challenges of polypharmacy and medication adherence continue to affect the aging population, experts agree that coordinated efforts across healthcare disciplines are essential to optimize treatment, enhance patient safety, and maintain quality of life.