Polypharmacy Guidance by NHS Scotland

The NHS Scotland proposed a 7-step model and breaks down the issue by medicine or BNF organ system, as well as examining the effectiveness of some critical drugs using NNT. 

Step 1. What matters to the patient?

Step 2. Identify essential drug therapy 

Step 3. Does the patient take unnecessary drug therapy (“STOP” drugs)?

Step 4. Are therapeutic objectives being achieved (“START” drugs)?

Step 5. Is the patient at risk of ADRs or suffers from actual ADRs?

Step 6. Is drug therapy cost-effective?

Step 7. Is the patient willing and able to take drug therapy as intended?

Drugs with anticholinergic effects and risk of cognitive impairment, falls and all-cause mortality

Drugs with anticholinergic effects are associated with an increased risk of cognitive impairment and all-cause mortality in older people, and some drugs were linked to an increased risk of falls.

Examples of drugs

Parkinson’s disease
Overactive bladder
Chronic obstructive pulmonary disease
Sedating antihistamines for nausea and vomiting
Tricyclic antidepressants
Anti-psychotics

Side-effects of drugs with anticholinergic effects

constipation
dry mouth
dry eyes
urinary retention
confusion
falls
agitation

NICE guidance on falls and dementia assessment

Falls

Carry out medication review as part of a multifactorial risk assessment.
Check for drugs that increase risk of falling such as psychotropic medications (including neuroleptics, sedatives, hypnotics and antidepressants)

Dementia

A diagnosis of dementia should be made only after a comprehensive assessment, including a medication review to identify and minimise use of drugs that may adversely affect cognitive functioning.