Every year, millions of older adults take medications that may no longer be helping them - and might even be hurting them. It’s not that doctors made a mistake. Often, these drugs were prescribed for a condition that’s since changed, or for prevention when the person’s life expectancy has shifted. The result? A cluttered medicine cabinet filled with pills that no longer fit the person’s current needs. This is where deprescribing comes in - not as a mistake or a failure, but as a deliberate, safe, and necessary step to protect health.
What Is Deprescribing?
Deprescribing isn’t just stopping a pill. It’s a planned, step-by-step process of reviewing a person’s entire medication list and deciding which ones can be safely reduced or stopped. The goal? To reduce harm, improve quality of life, and align treatment with what matters most to the patient. This approach was first formally introduced in 2003 by Australian clinician Michael Woodward, and since then, it’s become a cornerstone of modern geriatric care.Think of it like this: when a doctor prescribes a new medication, they expect it to do something - lower blood pressure, ease pain, prevent a stroke. But when that same medication is renewed year after year, no one stops to ask: Is it still doing what it should? Is the risk worth it now? Deprescribing flips that script. It treats stopping a medication as seriously as starting one.
Why It Matters More Than Ever
In Australia, more than one in three older adults takes five or more medications regularly. In the U.S., that number jumped from 14% in 1994 to over 42% by 2014. These aren’t just numbers - they’re real people juggling dozens of pills a day, with side effects that can include dizziness, confusion, falls, kidney stress, and even internal bleeding.One study found that nearly 17% of hospital admissions for older adults were caused by medication problems. Many of those cases involved drugs that were no longer needed - or were dangerous in combination. The financial cost? In the U.S. alone, adverse drug events in seniors cost about $30 billion a year. And the human cost? Lost independence, repeated hospital trips, and a life that feels heavier than it should.
When Should Medication Reviews Happen?
There are clear moments when a medication review isn’t just a good idea - it’s urgent.- When new symptoms appear. A sudden fall, confusion, nausea, or fatigue might not be aging - it could be a drug reaction. Many seniors are told, “It’s just getting older,” when the real culprit is a medication that’s no longer safe at their current health stage.
- When health changes significantly. If someone is diagnosed with advanced dementia, terminal illness, or severe frailty, many preventive drugs lose their purpose. A cholesterol pill meant to prevent a heart attack in 10 years doesn’t make sense if life expectancy is now measured in months.
- When high-risk drugs are still in use. Some medications are known to be especially dangerous for older people. These include long-term proton pump inhibitors (PPIs) for heartburn, sleeping pills like benzodiazepines, antipsychotics used for behavior control in dementia, and certain diabetes or blood pressure drugs that can cause dangerous drops in blood sugar or pressure.
- When preventive drugs are taken with no clear benefit. Aspirin for heart protection? Statins for cholesterol? These are often continued for years, even when the person has no history of heart disease and their life expectancy is short. The benefit of these drugs fades quickly when the risk of side effects grows.
How Deprescribing Works - Step by Step
Deprescribing isn’t a one-time decision. It’s a process.- Review the full list. Every pill, patch, and injection should be on the table - including over-the-counter drugs, supplements, and herbal products. Many seniors don’t tell their doctors about these, but they can interact dangerously with prescriptions.
- Identify what’s unnecessary. Tools like the Beers Criteria and STOPP (Screening Tool of Older Persons’ Potentially Inappropriate Prescriptions) help clinicians spot drugs that are risky for older adults. For example, long-term use of anticholinergics (used for allergies, overactive bladder, or depression) is linked to higher dementia risk.
- Match goals to treatment. What matters most to the patient? Is it staying independent? Avoiding hospital stays? Feeling alert in the morning? Treatment should serve those goals, not just medical charts.
- Stop one at a time. Never cut multiple drugs at once. That makes it impossible to know which change caused a symptom. If a drug is stopped and the person feels better - no dizziness, clearer thinking - that’s a win.
- Monitor closely. Withdrawal symptoms can happen. Blood pressure might rise. Pain might return. But if it does, it’s better to see it early and adjust than to keep a harmful drug going blindly.
Who Should Lead the Review?
While your GP is a good starting point, the most effective reviews involve a team. Clinical pharmacists specialize in medication safety and are trained to spot interactions, redundancies, and risks. Geriatricians focus specifically on aging bodies. In Australia, pharmacists in community pharmacies now routinely offer free medication reviews for seniors under the government’s Medication Management Plan. These aren’t just consultations - they’re full assessments with written plans and follow-ups.Studies show that when pharmacists lead these reviews, inappropriate medication use drops by 20-40%. Hospitals that use pharmacist-led deprescribing see fewer readmissions. And patients? They report feeling more in control and less overwhelmed.
What Happens When You Stop a Drug?
Many people fear that stopping a medication will make them sicker. But often, the opposite is true.Take PPIs - drugs like omeprazole used for heartburn. They’re commonly prescribed for months or years, even though guidelines say they should be used for only 4-8 weeks. Long-term use increases the risk of bone fractures, kidney damage, and infections. A 2022 study found that 60% of older adults who stopped PPIs after a guided taper didn’t have their symptoms return - and they felt better overall.
Another example: sleeping pills. Benzodiazepines like temazepam or zopiclone are often used for insomnia, but they increase fall risk by up to 50% in seniors. When patients slowly weaned off these with support, most improved their sleep naturally - and their balance, memory, and mood improved too.
It’s not about going cold turkey. It’s about a slow, supported withdrawal. A doctor might reduce a dose by 25% every two weeks, then monitor for changes. If symptoms return, they can adjust. If they don’t, the patient is one pill lighter - and one step safer.
Barriers to Deprescribing - And How to Overcome Them
There’s a big gap between what we know and what we do. Many doctors don’t feel trained to stop medications. Patients are afraid. Family members worry, “What if they need it?”One major barrier? Guidelines. Most medical guidelines tell you how to start a drug - but very few tell you how to stop it. That’s changing. The Deprescribing.org platform, developed by researchers in Canada and Australia, now offers free, evidence-based guides for five common drug classes - including PPIs, statins, diabetes meds, antipsychotics, and blood thinners. Each guide includes a decision tool, a patient pamphlet, and even a short video you can watch together.
Another barrier? Time. A 10-minute appointment isn’t enough to untangle a 15-drug regimen. That’s why some clinics now schedule dedicated “medication review” visits - 30 to 60 minutes just for pills.
And patients? They need permission to ask. If you’re a senior or a caregiver, say this: “I’ve been taking this for years. I’d like to know if it’s still helping - or if it might be doing more harm than good.” That’s not a challenge. It’s a smart health move.
The Bigger Picture
Deprescribing isn’t just about cutting pills. It’s about shifting how we think about aging and care. Instead of adding more drugs to manage every new symptom, we should ask: What’s the real problem? And is this the best way to solve it?The World Health Organization now lists deprescribing as a global priority. Australia’s Medicare system has started rewarding GPs who conduct regular medication reviews. And research shows that when done right, deprescribing reduces hospital visits by up to 25%, lowers drug costs, and - most importantly - helps seniors feel more alert, mobile, and in charge of their own lives.
This isn’t about giving up on treatment. It’s about choosing better treatment. Sometimes, the most powerful medicine is the one you don’t take.
Is it safe to stop taking medication without a doctor’s advice?
No. Stopping certain medications suddenly - like blood pressure pills, antidepressants, or steroids - can cause serious harm. Even if a drug seems harmless, always talk to a doctor or pharmacist first. They can help you taper off safely, if it’s appropriate.
Can deprescribing make someone sicker?
Sometimes, symptoms return after stopping a drug - but that doesn’t mean the drug was necessary. Often, the body readjusts, and the symptoms fade. The key is to stop one drug at a time and monitor closely. Studies show that for most seniors, deprescribing leads to fewer side effects, better sleep, less confusion, and fewer falls - not worse health.
What if my doctor says I need to keep all my meds?
You have the right to ask questions. Say: “Can we review each of these? I’d like to understand what each one is for and whether it’s still right for me now.” Bring a full list of everything you take - including supplements. If your doctor resists, ask for a referral to a clinical pharmacist or geriatric specialist. Many community pharmacies offer free reviews.
Are there tools or apps that help with deprescribing?
Yes. The website Deprescribing.org offers free, evidence-based guides for common medications, including printable checklists, patient handouts, and short videos. These were created by Australian and Canadian researchers and are used in clinics worldwide. Some apps also integrate with electronic health records to flag potentially inappropriate drugs.
How often should a senior have a medication review?
At least once a year - and more often if there’s a change in health, a new diagnosis, a hospital stay, or new symptoms. In Australia, Medicare supports a free Medication Management Plan every 12 months for people taking five or more medications. Don’t wait for a crisis. Make it part of your regular health check.
