3 hours Ago By Clare-wilson
This is Everyday Science with Clare Wilson, a subscriber-only newsletter from The i Paper. If you’d like to get this direct to your inbox, every single week, you can sign up here.Hello, and welcome back to Everyday ScienceHave you ever heard someone say they have to take so many tablets that they feel like they rattle?You might think that doctors would have little time for such complaints.
In fact, there is growing concern among health staff about people, especially older people, who end up on long-term regimens of taking multiple pills, several times a day.if(window.adverts) { window.
adverts.addToArray({"pos": "inread-hb-ros-inews"}); }Now, an NHS scheme has launched to help doctors identify when people are taking too many medicines, and to work out which ones are doing more harm than good.Such “deprescribing” initiatives can seem counterintuitive, said Clare Howard, a pharmacist in Wessex, who is clinical lead for the NHS’s Health Innovation Network’s polypharmacy programme.
(Polypharmacy just means when people take multiple medicines.)But all drugs have risks as well as benefits, and as people get older, sometimes that risk-benefit equation changes, she said. “There’s a growing body of evidence that is starting to show us where we are causing more harm.
”This week, more research was published backing deprescribing, showing that it can also be helpful for people with dementia, where there are particular pitfalls of taking too many medicines.if(window.adverts) { window.
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adverts.addToArray({"pos": "mpu_tablet_l1"}); }#color-context-related-article-3533343 {--inews-color-primary: #E33A11;--inews-color-secondary: #F7F3EF;--inews-color-tertiary: #E33A11;} Read Next square DEMENTIA .inews__post__label__big-reads{background-color: #0a0a0a;color: #ffffff;}Big ReadThe overlooked cause of dementia that doctors can preventRead MoreBut regardless of the person’s age or health status, doctors are being encouraged to proactively check if people could reduce or stop any of their tablets through a process called a structured medicines review.
Patients can also request such a review themselves, although they should not unilaterally stop taking any medicines without discussing it with their doctor.Dangerous side effectsWhat are the pitfalls of taking too many medicines? Firstly, it can simply be annoying and inconvenient to take so many tablets, said Howard. “You see patients who are in their eighties, on 13 medicines,” she said.
“One’s before food, one’s after food. The burden on patients is really, really impactful.”Taking multiple medicines can also be dangerous, as they may interact with each other and cause side effects, such as nausea or drowsiness, which could cause falls.
Medication side effects are responsible for one in six emergency hospital admissions, with polypharmacy being a large driver of this problem, according to a recent study of a Liverpool hospital.A lot of pills take a lot of organising (Photo: Daisy-Daisy/Getty)One reason for polypharmacy is that patients tend to see different hospital doctors for conditions that affect different parts of their body – cardiologists, kidney specialists and so on. “Each specialist will want three drugs for their hypertension, three drugs for their diabetes,” said Howard.
“What we do in primary care is look at the person as a whole and go: ‘Hang on – how do they manage this lot?’”Ageing is another factor. As people get older, their body changes in ways that mean they need lower doses of drugs. For instance, the liver and kidneys, which break down medicines and get rid of them from the body, don’t work as well.
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addToArray({"pos": "mpu_tablet_l2"}); }A key class of medicines for review is blood pressure medicines, as blood pressure can be variable, and if it falls too low, that can cause dizziness and falls. NHS guidelines now recommend that doctors allow higher blood pressure levels in older people.Cognitive slowingAnother common problem for older people is that many types of medicines can make people less mentally sharp because they block activity of an important brain signalling molecule called acetylcholine.
Examples include antihistamines for allergies, certain antidepressants and some pain relievers.In fact some of the few medicines that can reduce the memory problems of Alzheimer’s disease work by boosting acetylcholine. So it is alarming that some older people are unwittingly taking drugs that have the opposite effect, said Dr Kinda Ibrahim, a primary care researcher at the University of Southampton.
This is such a common problem that there are online tools so doctors can check how much of an “anticholinergic burden” someone is experiencing from their meds.Polypharmacy is a particular problem for people with dementia because they are more likely to forget to take their tablets or to accidentally take too many doses. “This means that people rely on their family members, which increases the burden on the family,” said Dr Ibrahim.
“Patients and carers say they don’t go out because they must take medication at a certain time of day.”In a review of past research, Dr Ibrahim found that 27 studies had found medicines reviews could be safely done for people with dementia, and they reduced the number of medications taken without making people more likely to die or need hospital treatment. The review was published in the journal, Drugs & Aging, this week.
While some GP practices already proactively identify patients who may be candidates for deprescribing, the new NHS scheme has developed resources for GPs and pharmacists to help them identify medications that can be stopped.if(window.adverts) { window.
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adverts.addToArray({"pos": "mpu_tablet_l3"}); }“This guide offers healthcare professionals structured approaches to ensure that medicines are being used effectively and safely, aligning with patient goals,” said Professor Tony Avery, National Clinical Director for Prescribing for NHS England.The project has also put resources for patients online.
“I think patients worry when we stop medicines. It’s a weird message, because we’re in this medical model of prescribing for everything,” said Howard. “But it’s personalised care – and it’s prevention.
It’s trying to do things upstream before things go wrong.”I’ve also writtenRecently I had a tour of a snake venom research laboratory, where scientists are trying to develop new treatments for strokes, blood clots and snakebites. If you can handle pictures of snakes, you can read all about it, here.
I’ve been watchingI really recommend Mickey 17, a new sci-fi film starring Robert Pattinson as a space exploration mission’s “expendable” – a crew member who, whenever he dies, can be recreated in a new adult body.It reminds me of the 2021 film Don’t Look Up, in that, while ostensibly a comedy – with wonderful pantomime-villain performances from Mark Ruffalo and Toni Collette – it explores serious themes..
