Innovative Blood Test Aims to Prevent Dangerous Medication Overload in Elderly Patients

A new blood test could help doctors to determine the safest and most effective medications for elderly patients who are prescribed several pills daily. Polypharmacy, defined as being prescribed at least five different medications to manage different health problems, is on the rise among older Emirati adults, including substantial use of non-prescribed medicines and supplements.

A study by the Ras Al Khaimah College of Nursing found that of the 200 patients over the age of 60 surveyed in the emirate's primary care centres, 60 per cent took at least five different medications, with 40 per cent taking 10 or more. Millions of older people around the world already take anticholinergics – a class of medicines used to treat psychiatric disorders, bladder and stomach problems or lung conditions – but research has shown that mixing anticholinergics raises the risk of dementia. Also, as medications accumulate and interact, the body reacts differently than it does when the medicine is taken alone.

An ageing population problem

Dr Arya Ayyappan, a specialist in internal medicine at NMC Royal Hospital Abu Dhabi, said polypharmacy was a big issue in seniors. “This is common, particularly in those with diabetes, hypertension or cardiac issues,” she said. “Elderly patients will keep seeing different doctors, and each one will add on different medicines for certain ailments.” As the global population ages, the number of people aged 60 and over is projected to almost double by 2050, rising to 22 per cent of the world’s population.

Dr Yasmeen Ajaz, a consultant endocrinologist at Medcare Al Safa, said problems arise when the overall combination becomes difficult to manage, medicine is duplicated, or the risks and side-effects outweigh the benefits. “As the number of medicines increases, so does the possibility of drug interactions, dosing errors and unwanted side effects,” he said. “This is why regular medication reviews are particularly important for older adults and anyone taking several long-term medicines. Older people can be more vulnerable because the body processes medicines differently with age, and kidney and liver function may gradually change. The answer is not necessarily to reduce the number of medicines, but to make sure every medicine is appropriate, necessary and monitored.”

A £3 million ($3.9 million) UK research programme funded by the National Institute for Health and Care Research (NIHR) will explore how genetic information could form part of routine prescription. Prof Diana Baralle, co-director at the NIHR Biomedical Research Centre, said the research was an important step towards bringing the benefits of genomic medicine into everyday healthcare. It aims to avoid adverse effects such as dizziness, nausea, or more serious problems that become dangerous in the elderly and lead to fall-related fractures.

Zenia Noronha, who is a pharmacist living in Dubai, said her mother, Margaret d’Souza, 85, was prescribed several medications. “We have tried to move my mum away from allopathy into alternative medicine because I know the ill effects of over-prescribing,” she said. “Recently we travelled to Canada for my niece's wedding, and mum was quite anxious and took ill before leaving. The doctor was very quick to prescribe her with an asthmatic inhaler as she had developed a minor cough and cold, despite her existing medications for diabetes and blood pressure. When we visit the doctor, they usually write a prescription and that also affects the insurance. There should be a regular review of what someone is taking.”

Technology is also helping doctors to avoid prescribing medicine that may have negative interactions. Malaffi is the region’s first Health Information Exchange platform, a centralised database of unified patient records. It safely and securely connects public and private healthcare providers in Abu Dhabi to enable real-time exchange of important patient health information. “Plenty of other patients take over-the-counter medications, even vitamins, supplements or homeopathic medicines,” said Dr Ayyappan. “We should understand that they can also impact the patient's day-to-day life as well.”