Medicines in older adults: reviews, deprescribing and falls

Ageing alters how the body handles medicines. Kidney and liver function often decline, body composition changes, and sensitivity to certain effects such as drowsiness or low blood pressure can increase. Older people also tend to have several conditions at once, which leads to several prescriptions and a greater chance of interactions.

Many medicines are started for good reasons and continue long after the original purpose has faded. A review looks at whether benefit still outweighs harm for this person now, which is different from asking whether the medicine was right when first prescribed.

Healthcare Improvement Scotland describes a person-centred sequence that can be used to correct inappropriate prescribing, prevent it when new medicines are started, and manage transitions between care settings. The steps are worth knowing so that you can recognise them in a review.

• Aims: what matters to the person about their conditions and their life.

• Need: which medicines are essential for the person's aims.

• Need: which medicines may be unnecessary.

• Effectiveness: whether the treatment goals are being achieved.

• Safety: whether side effects are occurring and whether the person understands their medicines.

• Sustainability: cost-effectiveness and environmental impact.

• Person-centredness: whether the person is willing and able to take the medicines as prescribed.

Deprescribing means reducing or stopping a medicine under supervision when harms outweigh benefits. The Scottish guidance covers it alongside the prescribing cascade, where a side effect of one medicine is mistaken for a new condition and treated with another. A common example is a new symptom appearing after a new prescription and prompting a second medicine rather than a review of the first.

Stopping is not always the answer. Some medicines need tapering, some conditions flare if treatment ends abruptly, and some people value a medicine for reasons clinicians might underweight. The key is a shared decision, a written plan and a follow-up date.

Many medicines have anticholinergic effects as a side effect rather than as their purpose, and Healthcare Improvement Scotland cites tricyclic antidepressants and antihistamines as examples. The effects add up across medicines. Guidance links higher cumulative burden with cognitive decline, impaired memory, increased falls, functional decline, blurred vision, urinary retention and constipation, as well as longer hospital stays and institutionalisation.

Some anticholinergic medicines are appropriate for bladder or bowel problems, Parkinson's disease or COPD, so the goal is to avoid unnecessary accumulation, not to ban the group. Sensitivity varies and effects are dose-dependent.

The NHS lists medicine side effects, low blood pressure, weak muscles, vision and hearing problems and conditions such as stroke and Parkinson's disease among causes of falls. It advises speaking to a GP or pharmacist if you think medicines could be affecting your balance, and mentions local falls services accessed through integrated care boards.

Medicines that cause drowsiness, dizziness on standing or confusion deserve special scrutiny after a fall. Report any new dizziness or unsteadiness promptly rather than assuming it is simply age.

Keep a single up-to-date list of everything taken, including creams, patches, eye drops, vitamins and herbal products, and bring it to appointments. Ask for a medication review if you take several medicines or have had a recent hospital stay, and ask what each medicine is for and when it should next be reviewed.

Tell the prescriber how you actually take your medicines, including if swallowing is hard or doses are skipped. Honest information allows simplification, such as fewer daily dose times, rather than adding another medicine to compensate. The pharmacy can also advise on compliance aids where suitable.