Singapore explains the risks of older people taking multiple medications
In Singapore, specialists in pharmacy and elderly care recommend regularly reviewing treatment regimens for patients who take five or more medications at the same time. As Channel NewsAsia reports, this list should include not only tablets, but also ointments, patches, drops, inhalers, injections, vitamins, herbal and traditional remedies.
According to a 2019 SingHealth study involving nearly 1,500 older people over the age of 66, 14.5% of participants took more than five different prescription medications daily. On average, they took 6.3 medications per day. The simultaneous use of five or more medicines is called polypharmacy.
Why treatment regimens should be reviewed
Older people often have several chronic conditions, including hypertension, high cholesterol, diabetes or heart disease, and may therefore be prescribed several medications. At the same time, kidney and liver function may decline with age, body composition may change, and sensitivity to certain medicines may increase. This may raise susceptibility to adverse reactions.
Among the signs that warrant discussing treatment with a doctor or pharmacist, specialists named recurrent falls, excessive drowsiness, the onset of confusion or worsening memory, constipation, low blood sugar and frequent hospitalizations. Changes in blood pressure or heart rate may also be grounds for assessing a treatment regimen. Symptoms are sometimes mistakenly attributed solely to age, although they may be linked to a new medication, a dose change or the addition of another remedy.
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How to organize medication use more safely
Pharmacists recommend conducting a full medication review at least once a year for patients who take several medicines over a long period, as well as more often after hospitalization or a significant change in health status. After discharge from hospital, new medications are sometimes added to a regimen without reviewing or discontinuing the previous ones.
Treatment should not be stopped or changed independently, as some medicines require gradual dose reduction. Relatives are advised to keep an up-to-date list of all remedies, including their names, dosages, frequency of use and the name of the doctor who prescribed the medication. This list should be brought to every appointment, while pill organizers and phone reminders can be used to maintain the schedule.
When a new remedy is prescribed, caregivers are advised to clarify its purpose, duration of use, possible side effects, interactions with other medicines and supplements, restrictions during treatment, and what to do if a dose is missed. Specialists also warned against independently doubling a dose after a missed one unless such instructions were given by a doctor or pharmacist.
In particular, the risk of bleeding may increase when warfarin and aspirin are taken together. Combining several medicines that cause drowsiness, including sleeping pills, antidepressants and strong painkillers, may increase drowsiness, impaired balance, confusion and the risk of falls.
