Drug monitoring and suitability for older people

Back to all Motions

2014 National Retired Members Conference
16 June 2014
Carried as Amended

Conference recognises that as we get older, medically more things are prone to go wrong. Fortunately, both well established and new drugs can be prescribed which assist in the management of acute and chronic conditions in older people. We can continue to lead active, useful and interesting lives long after our parents would have succumbed to unmanaged illness and disease.

Unfortunately the outcome of taking prescribed drugs is not always as intended. In pharmacological terms older people are not just older adults. It cannot be assumed that the understanding of how a drug works in an adult is automatically applicable to either children or older people. In older people kidney or liver function may have declined so how the body processes the drug or reacts to it will not replicate that of “adults”. This may lead to increased risk of accumulation and toxicity.

Older people are far more prone to having a range of medical problems each of which has a drug prescribed to alleviate symptoms etc. Even if appropriate “older person” medication is prescribed, the effects and side effects and interaction of one drug with another has not usually been researched. Few clinical trials deliberately include older people or those on multiple medications with several medical conditions. Age and assumed frailty are the predominant reasons for excluding older people from randomised clinical trials – a catch 22 situation.

Treatment guidelines for both General Practitioners and Hospital based prescribers appear to be more disease-driven than patient centred and specific guidance on drug treatment of older people is often lacking. This can lead to either over or under prescribing – both are harmful.

However, due to demographic changes pharmaceutical companies are beginning to see a profit in developing drugs safe for older people and with full guidance on which drugs are suitable to use together. Whilst welcoming this action, it is common knowledge that for very good reason, it takes many years for drug research, development, clinical trials and approval by the NHS before a new drug can be prescribed. In the meantime we have a potentially unsafe situation to manage.

Conference also recognises that the very convenient system of repeat prescriptions may be compounding the problem by lack of monitoring side effects of single or multiple medications. Some practices and individual GPs have a maximum time for a prescription to be repeated but there is no maximum time set down by regulation. It is generally accepted that older people “do not want to create a fuss” so will be the least likely to question the repeat prescription and will wait until the GP recalls the patient rather than complain of side effects or ask for a review.

Conference instructs the NRMC to

1. ask the General Medical Council to

A. promote good medical practice by reminding Doctors of the need to ensure prescriptions for older people are suitable for them as far as is known;

B. promote good medical practice by ensuring Doctors recognise the possible hazards of prescribing multiple medications

C. ensure Doctors frequently monitor patients issued with repeat prescriptions as part of their good care responsibilities to the patient;

2. promote an information campaign amongst Members, the National Pensioners Convention and the Scottish Pensioners Forum aimed at advising older people that they are entitled to a review of their medication whenever they consider it necessary.