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1 in 7 middle-aged adults are prescribed inappropriate medication

Research led by the Clinical Effectiveness Group has revealed that about 1 in 7 (13.9%) people aged 45-64 are prescribed medication that could be inappropriate for them - either because the potential harms outweigh the likely benefits, because safer alternatives exist, or because an additional treatment has been omitted.

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The study team analysed pseudonymised health record data for 1.2 million middle-aged adults across England, accessed via Clinical Practice Research Datalink (CPRD). The analysis revealed that people who received an inappropriate prescription had an increase in GP appointments the following year compared with not having received an inappropriate prescription. On an individual level the increase in appointments was small (around 3%), but across England additional consultations resulting from inappropriate prescribing totalled more than 360,000 a year. Approximately one in every thousand GP appointments could potentially be avoided by eliminating inappropriate prescribing in middle-aged adults.

This study only observed an impact on GP consultations, but there is potential for harm beyond this. In older populations, inappropriate prescribing is associated with increased falls, hospitalisations, and emergency department use.

Patients most likely to be prescribed inappropriate medication were:

  • Prescribed five or more different medicines – this substantially increases the risk of cumulative adverse effects and interactions between drugs
  • Living with multiple long-term conditions
  • From some ethnic minority groups
  • Women

Most safety initiatives designed to avoid inappropriate prescribing focus on people aged 65 years and older. These include Structured Medication Reviews conducted by GPs and pharmacists. The CEG-led study contributes new insight that suggests these initiatives should be considered for high-risk middle-aged adults too. Regular use of five or more medications now affects more than a quarter of all adults, and one third of adults in the most socioeconomically deprived areas of the UK have multiple long-term conditions by their early 50s. 

Lead author Dr Michael Naughton, GP, and Public Health Registrar, says:
“We’ve shown that potentially inappropriate prescribing is common in middle-aged adults, not just older adults. This prescribing is avoidable, potentially harmful, and is diverting healthcare resources away from where they could have benefit. It is particularly concerning that we found an increase in GP appointment usage, which is putting extra strain on an already over-stretched primary care system. 

“There is also unfairness in who receives these prescriptions, with women, some ethnic minority groups, and those who are already living with long-term poor health being more likely to be prescribed this medication by their doctor. We now need to understand how to effectively avoid inappropriate prescriptions being issued in the first place, and to de-prescribe where it has already been initiated.”

Anyone with concerns about their own medications should seek advice from their doctor or pharmacist before stopping any prescription medication.

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