Deprescribing in Elderly Patients

We see it all the time, an elderly patient is prescribed a medication for one issue, then another medication to treat the side effects of the first one, and before you know it, they’re on a dozen prescriptions a day.

Doctors are hesitant to change anything. Families are nervous about stopping medications. And the patient? They're often dealing with brain fog, fatigue, or frequent falls, and no one’s looking at their medication list.

That’s where deprescribing comes in. It’s not about cutting corners. It’s about cutting unnecessary risk, with a clinical, structured, patient-focused approach.

Nearly 40% of older adults take five or more prescription medications—a trend known as polypharmacy. Many of those medications were prescribed for temporary conditions or outdated diagnoses, but they’re still being taken years later.

And here’s the issue: the more medications a patient is on, the higher the risk for adverse drug events (ADEs), falls, confusion, and hospitalization. It’s a vicious cycle and often, completely preventable.

There are a few big barriers to deprescribing in long-term care and hospital settings:

Deprescribing is a structured clinical process that identifies and removes medications that may no longer be necessary, effective, or safe. It’s not about abruptly pulling medications or leaving patients without care.

According to guidelines from Deprescribing.org, the process typically involves:
✅ Reviewing all current medications.
✅ Identifying those that may no longer be appropriate.
✅ Planning safe dose reductions or discontinuation.
✅ Monitoring patient outcomes closely after each change.

It’s a collaborative effort that should always involve the care team and the patient or family.

In long-term care and hospital settings, the clinical consultant pharmacist plays a vital role in medication safety. My job is to:

Studies show that interdisciplinary deprescribing interventions led by pharmacists significantly reduce inappropriate medication use without compromising care.

If you’re caring for a loved one in a hospital or long-term care setting, you can (and should) advocate for a deprescribing review.

Ask:
🔹 “Has my loved one’s medication list been reviewed recently?”
🔹 “Are any of these medications no longer necessary?”
🔹 “Can a consultant pharmacist take a look?”

Be especially alert to confusion, balance problems, sleep changes, or sudden fatigue—these are often medication-related.

Deprescribing is not about denying care—it’s about making sure medications are helping, not harming. In my work, I’ve seen incredible changes in patients’ cognition, energy, and quality of life simply by removing one or two unnecessary drugs.

As we age, less truly can be more. More safety. More clarity. More dignity.