Towards the end of our lives we are likely to take more medicines than we ever have before. Many of us will end up taking a dozen or more drugs a day. Is it necessary? A new initiative backed by prestigious medical colleges and a range of health and patient-related organisations wants patients to realise that it’s often not — that it’s one of many situations where more medicine may not be better.
The example about excessive medicine at the end of life came from the Royal College of General Practitioners. Its submission said: ‘If you are particularly frail or have been told you have less than a year to live you should try to decrease the number of medicines you take to only those used to control your symptoms.’
The prescription of many medicines has little utility in many such patients for whom the focus should be on quality of life. A decrease in such prescription medications reduces the risk of unwanted side effects, adverse drug reactions and unanticipated drug interactions. Such adverse drug reactions account for 10 per cent of visits to A&E and the risk of interactions increases with increasing age, eg a 36 per cent risk in all those over 80 years. With every additional medication the risk of interaction increases. With six or more medications there is an 82 per cent likelihood of an interaction affecting 20 per cent of all patients.
Ultimately, this is what healthcare professionals refer to as ‘shared decision making’, summed up by the phrase ‘no decision about me, without me’.