Are We Medicating People Into Frailty?
- Gary Moller
- 1 minute ago
- 3 min read
The treatment was a success, however the patient died!
I have worked in health for more than 50 years. Now that I'm in my 70s, and still in good health, I feel better qualified to speak with some authority on matters relating to health and ageing.
Polypharmacy
One observation has become increasingly difficult for me to ignore. As people grow older, their medication lists tend to grow longer at precisely the time their bodies are becoming less capable of handling complexity. One prescription becomes three, then five, then eight or even ten. Each may have been prescribed for a perfectly reasonable reason, yet rarely does anyone stand back and ask whether the complete pharmaceutical load is still helping the person live longer and better.
I once jokingly suggested to a woman involved in end-of-life care that perhaps residents were taken off their medicines so they would die sooner. Her reply stopped me cold: "Oh no. If we take them off their medication, they live longer." I do not offer that comment as scientific proof, but it raises a question that deserves far more attention than it receives, and something that I observe almost daily in my role as a health professional: "polypharmacy" - the concurrent us of multiple medicines by one person.
"If we take them off their medication, they live longer"
A medicine prescribed at 52 may still be sitting on the prescription list at 82. Meanwhile the person has lost muscle, weight, renal reserve, appetite and perhaps much of their independence. Another drug may have been added for blood pressure, another for cholesterol, another for bone density, another for reflux, another for pain, another for sleep and another for constipation caused partly by the others. No doctor ever decided this person should end up taking ten medicines. It simply happened, one apparently sensible prescription at a time.
This is what I call the pharmaceutical burden of ageing.
The issue is not that medicines are bad. Many save lives, prevent strokes, control asthma, relieve pain and improve quality of life enormously. The real problem is that the benefit-to-burden equation changes as the person changes. A preventive medicine expected to deliver benefit over five or ten years may make perfect sense at 60. The calculation may look quite different at 88, particularly if the person is frail, poorly nourished, dizzy, losing weight or struggling to walk.
There is another question we should be asking more often: instead of adding another drug, could we improve the person's underlying resilience? Would better nutrition, adequate protein, resistance exercise, walking, balance work, sunlight, sleep, social connection and rehabilitation give them more useful life than another adjustment to a laboratory number?
For me, the most important outcome is not simply lifespan. It is capable life: the years during which a person remains strong enough to get out of a chair, clear-headed enough to manage their affairs, steady enough to walk without falling, and healthy enough to participate in the world around them.
Families should feel comfortable asking doctors some very simple questions. Why is this medicine still necessary? What is the most likely result if it is carefully reduced? What is the worst realistic outcome, and how likely is it? What are the risks of continuing it? Would you start this drug today if Mum or Dad were not already taking it?
I have developed the accompanying white paper, The Pharmaceutical Burden of Ageing, to explore these questions in depth. It examines polypharmacy, frailty, nutrition, drug interactions, time-to-benefit, deprescribing, fragmented specialist care and the possibility that we sometimes become so focused on successfully treating diseases that we lose sight of the person carrying them.
Perhaps the question we should be asking in later life is not, "How many medicines can we justify?"
It is:
Which treatments are giving this person the greatest possible number of strong, capable and worthwhile years?
Medical Disclaimer
This article is provided for educational purposes only and is not intended as personal medical advice, diagnosis or treatment. Prescribed medicines should not be stopped or reduced without appropriate clinical supervision. Some medicines can cause serious harm if withdrawn abruptly.
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