Managing medications in older adults is one of the greatest challenges in primary care today.
Polypharmacy—commonly defined as taking five or more regular medications—often reflects multimorbidity. While sometimes clinically appropriate, it frequently leads to more harm than benefit, particularly in frail older adults.
The Risks of Polypharmacy
- Adverse drug events (ADEs) and drug‑drug interactions become increasingly likely with every additional medication. Older adults are especially vulnerable due to altered metabolism, comorbidities, and higher sensitivity to medication effects.
- Increased risk of falls, cognitive decline, hospital admissions, and reduced quality of life—each medication adds to cumulative risk.
- Prescribing cascades: new drugs are sometimes prescribed to treat side-effects of existing medications, creating further unnecessary prescribing cycles.
- Poor adherence and burden of dosing, especially when regimens become complex. High pill burden may reduce effectiveness and lead to errors.
How NMPs Can Identify Unnecessary Medications
Non-medical prescribers (NMPs)—such as prescribing nurses and pharmacists working in primary care—play a vital role in medication review and deprescribing:
- Conduct structured medication reviews, particularly for patients on ≥5 medications or with frailty. Use explicit tools such as STOPP/START criteria or Beers list to identify potentially inappropriate medications (PIMs).
- Engage in shared decision-making with patients (and caregivers) to understand treatment goals, priorities, and concerns. Surveys show that around 77 % of older patients are willing to reduce medications if suggested, though fewer caregivers feel comfortable with stopping drugs.
- Prioritise deprescribing as a stepwise process: for each medication, consider if it’s still needed, beneficial, or poses more risk than benefit. Deprescribing plans should include tapering schedules where needed, safety-netting, and follow-up plans.
- Collaborate with multidisciplinary teams, including GPs and pharmacists, especially when frailty or multimorbidity complicate decisions. Evidence from systematic reviews shows deprescribing interventions often result in reductions of 2–3 medications per patient and decreases in PIMs, with high acceptance rates by clinicians and patients.
Clinical Benefits of Deprescribing
- Reduction in medication burden: many interventions lead to robust reductions in medication count and inappropriate prescribing, with acceptance rates of deprescribing recommendations reaching 72–91 %.
- Low risk of harm: most studies have not identified increased adverse events or hospitalisations after deprescribing; some even suggest improvements in cognition, mood, or functional status.
- While evidence on mortality or falls reduction remains mixed, deprescribing aligns with person-centred goals and avoids unnecessary treatments.
Practical Steps for NMP-Led Deprescribing
- Start with patient‑centred medication review, focusing on priorities, goals, and willingness to reduce medications.
- Use established tools (e.g., STOPP/START, Beers) to screen for PIMs.
- Discontinue medicines that no longer align with goals, are duplicative, or present more risk than benefit.
- Set out a plan for tapering, monitoring for withdrawal or return of symptoms.
- Arrange appropriate follow-up, ideally within weeks to assess response.
- Document decisions clearly and communicate with GP colleagues and carers to support continuity.
Enhance Your Skills with UK‑accredited Theory Courses
While practical experience often develops in supervised clinical settings, these accredited online Practitioner Development UK courses offer up‑to‑date theoretical frameworks and guideline-based skills for deprescribing in older patients:
- Confident Deprescribing: Practical Skills for Safer Prescribing in Older People
Grounded in current evidence and UK best practice, this course equips clinicians—including NMPs—with frameworks and tools for safely reducing inappropriate medicines in older adults. Explore this Course - NMP V300 Annual Update Course
Refresh your knowledge on prescribing competency—including medicine optimisation, polypharmacy, deprescribing, and patient safety in older adults. Ideal for maintaining prescribing excellence – Explore this course.
These courses provide strong theory, frameworks, tools, and clinical reasoning strategies—but do not include hands‑on supervised clinical practice.
References
- Guthrie, B. et al., 2021. Polypharmacy and medicine regimens in adults in residential aged care: prevalence, risks and outcomes. Archives of Gerontology and Geriatrics, 98, p.104517. Available at: https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-021-02208-8 [Accessed 5 August 2025].
- Page, A., Potter, K., Lee, G., Almutairi, H. & Lee, K., 2020. An overview of prevalence, determinants and health outcomes of polypharmacy. Therapeutic Advances in Drug Safety, 11, p.204209862093374. Available at: https://doi.org/10.1177/2042098620933740 [Accessed 5 August 2025].
