An ageing population, multimorbidity, frailty and polypharmacy are all contributing to an increase in the complexity of patients managed by the NHS in the UK and by health systems in other countries. Moreover, the interaction of these factors can lead to a “complexity cycle” which further increases the risks to patients and the pressures on the NHS.
The convergence of these factors has shifted the NHS landscape from managing isolated illnesses to navigating patients with multiple complex health needs. This complexity arises because frail patients with multiple long-term conditions often require numerous medications, which significantly increases the risk of adverse drug interactions and hospitalisations.
Consequently, the NHS is aiming to move away from traditional, single-disease specialist models toward integrated, person-centred care that prioritises holistic assessment and strategic deprescribing to maintain patient independence and safety.
To support this transition, we also need to move away from single-disease trials toward studies that include complex, older populations with multimorbidity. Many clinical guidelines are based on younger, healthier cohorts; making it difficult to use them appropriately for people with frailty and polypharmacy.
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