Reviewing long term medications

The iSIMPATHY project aims to support the best and most sustainable use of medicines for each individual.

As populations age across the globe there is a growing public health challenge to meet the needs of older adults. The average person aged over 70-years lives with at least three long term conditions and is likely to take multiple medications, also known as Polypharmacy. Whilst taking several medicines can be beneficial to some patients individual patient needs change over time, and the impact of multiple medicines can be different as time goes on.

While a medicine might be the right choice for a patient at the time of prescription, things do change and there is need for regular reviews of any prescribed medication. There may be a change to an existing condition, side effects from a prescribed medicine, the development of a new condition, or more effective medicines may become available to treat the condition. There can also be side effects or reactions between different prescribed medicines. Older or more frail people tend to experience worse, or cumulative, side effects of medicines and are less likely to see intended benefits from their existing or new treatments.

In addition, the more medicines a person is taking means they are less likely to take the medicines as intended. Fifty percent of people taking four or more medicines don’t take them as prescribed. This could stop them receiving the intended benefit from the prescribed medicine. At times people stop taking  prescribed medicines because they don’t feel they are helping them, suggesting they may not be the right medicine for that person at that current time. Most seriously, older people may be hospitalised due to an adverse drug reaction, a serious side effect. Recent figures show that 50% of hospital admissions due to adverse drug reactions are preventable, and 70% of these are in patients who are aged 65 years and over and on 5 or more medicines.

This highlights why regular medicine reviews are so important, and that they are centred around what matters to the patient. What someone wants from their treatment may change as they get older, or as their condition changes.  Older people often express what matters most to them in terms of relationships and autonomy. How might what’s important to them impact on the treatment they choose? Do they want more time at home with family or to maintain their independence?

The iSIMPATHY project (this link will take you away from our website) aims to address the challenges of polypharmacy, through training pharmacists and healthcare professionals to deliver medicine reviews with at risk groups of patients, including older adults. iSIMPATHY (implementing Stimulating Innovation in the Management of Polypharmacy and Adherence Through the Years) is a three year EU funded project in Northern Ireland, Scotland and the Republic of Ireland, that aims to support the best and most sustainable use of medicines and ensure people get the most benefits from medicines whilst minimising harm.

Awareness and education about polypharmacy should be part of inter-professional training for all practitioners who care for people with multiple conditions or frailty. iSIMPATHY also seeks to share learning from the project, and create a shared approach to medicine reviews between individuals and their health care practitioner.

It is understandable that both patients and their healthcare practitioners may be unsure about changing or stopping some medications, especially if this means choosing to stop something a specialist has prescribed. iSIMPATHY training for healthcare practitioners, alongside the use of decision support tools (developed for patients and prescribers) aim to allay some of these reservations by encouraging regular reviews of how an individual’s medicines are working for them. By finding out what matters to individuals we can ensure people receive the right treatment that suits their individual needs at that time and aim to reduce their risk of harm from prescription medicines.

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