Addressing Polypharmacy in Older Adults: Dementia, Medication Reviews and Deprescribing in the UK

Overview

Around 8 million people in the UK take five or more medications daily, with a further 2 million taking ten or more prescriptions. This article discusses how polypharmacy can become dangerous when medicines are overprescribed, particularly for older adults living with frailty or dementia, and highlights the potential of medication reviews and non-drug interventions to reduce burden and improve quality of life.

• Dementia and polypharmacy: medicines can mimic ageing and worsen cognitive and balance problems
• Medication reviews can safely reduce the number of prescriptions
• Non-pharmacological approaches such as exercise, social activities and practical support can be impactful
• Carers describe day-to-day management of prescriptions and the need for recognition of their role

Overview

The article highlights that in the UK around 8 million people take five or more medications daily and approximately 2 million take ten or more prescriptions each day. The majority of those affected are aged over 65. Taking multiple prescription drugs is not inherently problematic, but issues arise when a medicine is overprescribed. Overprescribing means a drug is no longer appropriate for a person’s circumstances, does not deliver the intended benefit, conflicts with their wishes, or when a better non-medicinal option exists. The consequences of overprescribing can be serious, including fatigue, dizziness, confusion or unsteadiness, which can hinder daily activities, increase the risk of falls, loss of independence and hospital admission. This is especially harmful for older adults living with frailty or dementia, where these effects can be more severe.

The piece explains that aging changes how the body processes medicines, with kidneys and liver often less effective at clearing drugs in older age. Medicines may accumulate in the body, increasing the risk of side effects and adverse interactions. Side effects often resemble signs of ageing or dementia, leading to misattribution and delayed recognition of medicine-related problems. For people living with dementia, the complexity increases because many health conditions require multiple medications, making it harder for families to disentangle whether memory or mood changes are due to dementia progression or drug effects.

Carers’ Experiences and Medicine Burden

In their research, the author and colleagues found that families caring for someone with dementia described managing medicines as an integral, daily responsibility. Tasks included ordering prescriptions, organizing tablets, remembering doses and monitoring for side effects. Carers often felt they bore the risk of spotting problems and guiding treatment decisions, yet their contributions remained under-recognised within the healthcare system. They also highlighted the challenge of distinguishing whether changes in memory, mood or behaviour arise from dementia itself or medicines, and described balancing safety with autonomy for their loved ones.

Medicine Reviews as a Safe Pathway to Deprescribing

The author’s research suggests that it is possible to reduce the number of medications taken by older people in a safe way without increasing the risk of hospitalisation or death, including those living with frailty or dementia. Medication reviews can identify which drugs remain important, which ones can be reduced or stopped, and whether non-medication approaches such as exercise, social activities or social prescribing could be helpful. Importantly, the process supports conversations about what matters most to the person and what each medicine is for, helping patients and carers feel heard and involved in care decisions.

Practical Steps for Patients and Carers

The article emphasises that stopping medicines without medical advice is not advised; many prescriptions remain essential. Nevertheless, medicines prescribed years ago may no longer suit a person’s changing health, priorities and circumstances. It recommends initiating a conversation with a clinician to request a medication review, which can clarify which drugs remain necessary and whether non-drug strategies might be effective. An NHS resource on medication reviews is provided to guide families through this process.

Community and the “Right Kind” of Health

Beyond reducing medicines, the piece highlights connecting people to community activities, practical support and meaningful social connections as potential solutions to polypharmacy and overprescribing. It argues that better health does not always come from another prescription and that staying active and socially connected can yield significant benefits for independence and quality of life.

Author’s Research and Implications

The author notes that her work demonstrates that medication reviews can empower patients and carers to ask questions and better understand the purpose of each drug. This involvement can lead to more person-centered care, with better alignment between prescriptions and what matters to those receiving care. The article also points to the broader implication for dementia and elder care, urging healthcare systems to acknowledge the medication management role of carers and to integrate non-pharmacological approaches into standard care where appropriate.

Takeaways for Practice

For individuals taking a large number of prescription drugs, starting with a medication review can help determine which drugs remain essential and which may be safely reduced or replaced with non-pharmacological strategies. The ultimate goal is to preserve independence and quality of life while minimising side effects and treatment burden. The piece advocates for patient and carer involvement in prescription decisions, emphasizing what truly matters to those living with dementia or frailty.

Original publisher: Future Factual