Medication Reviews: When Seniors Should Stop or Deprescribe Medicines

Every year, millions of older adults take medications they no longer need. Some were prescribed years ago for a condition that’s now resolved. Others are copies of copies-refilled automatically, never questioned. For many seniors, the medicine cabinet is more crowded than the pantry. And that’s not just inconvenient-it’s dangerous.

Why More Medicines Isn’t Better

It’s easy to assume that more drugs mean better care. But for seniors, that logic falls apart. Taking five or more medications-what doctors call polypharmacy-is now the norm for nearly half of adults over 65 in the U.S. That’s up from just 14% in 1994. And while some of those pills are essential, many aren’t. The problem isn’t just the number. It’s the risk.

Older bodies process drugs differently. Kidneys slow down. Liver function declines. Muscle mass drops. All of this means medications stick around longer, build up in the system, and can cause side effects that look like aging-but aren’t. Dizziness? Could be a blood pressure pill. Confusion? Maybe a sleep aid. Falls? Often tied to sedatives or anticholinergics. These aren’t inevitable parts of getting older. They’re often side effects of medicines that should have been stopped.

What Is Deprescribing?

Deprescribing isn’t just stopping meds. It’s a careful, planned process of reducing or removing drugs that no longer help-or might be hurting. The term was first defined in 2003 by an Australian doctor who saw how often elderly patients were drowning in pills. Since then, it’s become a formal part of geriatric care.

Think of it like this: when a doctor prescribes a new drug, they don’t just hand it over and walk away. They explain why, set goals, watch for side effects, and adjust. Deprescribing does the same thing-but backwards. It asks: Is this medicine still doing what it’s supposed to? If not, and if the risks outweigh the benefits, it’s time to stop.

This isn’t about cutting corners. It’s about precision. One study showed that when deprescribing was done right, adverse drug events dropped by 17% to 30%. Hospital readmissions fell by up to 25%. Quality of life improved-without making chronic conditions worse.

When It’s Time to Talk About Stopping

There are clear moments when a medication review should happen. Don’t wait for a crisis. Look for these signs:

• New symptoms appear. If your loved one suddenly feels dizzy, confused, weak, or has unexplained falls, one of their meds might be the cause. These aren’t normal aging signs-they’re red flags.
• Life goals have changed. If someone has advanced dementia, is in end-stage heart failure, or can no longer get out of bed, the goal shifts from long-term prevention to comfort and quality of life. Drugs meant to prevent heart attacks or diabetes complications years from now don’t make sense anymore.
• High-risk drugs are still in use. Certain medications are known to be dangerous for seniors. The Beers Criteria, updated regularly by the American Geriatrics Society, lists drugs like benzodiazepines (e.g., Valium, Xanax), anticholinergics (e.g., Benadryl, some bladder pills), and long-term proton pump inhibitors (PPIs) like omeprazole. These should be reviewed at least once a year.
• Preventive meds are being taken for no clear reason. Statins for someone with limited life expectancy? Blood thinners for someone who rarely leaves the house? Aspirin for primary prevention in someone over 70 with no history of heart disease? These are common examples where the benefits are tiny and the risks-like bleeding-are real.

Who Should Be Involved?

Deprescribing isn’t something a patient should do alone. It’s a team effort. The best results come when doctors, pharmacists, and families work together.

Clinical pharmacists are especially valuable. They’re trained to spot drug interactions, outdated prescriptions, and unnecessary duplicates. In one study, pharmacist-led reviews cut inappropriate meds by up to 40% in just six months. Many hospitals and community clinics now offer free medication reviews-ask your local pharmacy or senior center.

Family caregivers play a key role too. They’re often the ones who notice changes in behavior, appetite, or energy. They can keep track of what’s being taken, when, and how the person feels after a change. Keep a written list of every pill, supplement, and over-the-counter drug. Include dosages and why it was prescribed. Bring it to every appointment.

How It’s Done-Step by Step

Deprescribing isn’t a one-time event. It’s a process:

1. Review the full list. Get every prescription, OTC drug, vitamin, and herbal supplement. Don’t leave anything out. Even a daily aspirin or melatonin can interact.
2. Identify the targets. Use tools like the Beers Criteria or STOPP guidelines to flag high-risk or low-benefit drugs. Focus on ones with the highest risk-to-benefit ratio.
3. Start with one. Never stop multiple drugs at once. You won’t know which change caused a reaction. Pick the most likely culprit-maybe a sleeping pill or an old antidepressant.
4. Plan the taper. Some drugs can be stopped cold. Others need to be lowered slowly to avoid withdrawal. For example, stopping a benzodiazepine too fast can cause seizures. A doctor or pharmacist will guide the pace.
5. Monitor closely. After stopping, watch for two things: return of original symptoms (which might mean the drug was still needed) or new symptoms (which might mean the drug was causing harm). Keep notes. Call the doctor if anything changes.
6. Reassess in 4-6 weeks. Did the person feel better? More alert? More steady on their feet? If yes, you’re on the right track. If not, you may need to reconsider.

Common Myths About Stopping Meds

Many families are afraid to stop meds because of old beliefs:

• Myth: "If it was prescribed, it must be necessary." Truth: Doctors prescribe based on the best info at the time. Conditions change. Guidelines update. A drug that helped ten years ago might now be doing more harm.
• Myth: "Stopping could make things worse." Truth: Sometimes it does-briefly. But often, the side effects were already making things worse. Withdrawal symptoms are usually short-lived and manageable with proper planning.
• Myth: "It’s easier to just keep taking them." Truth: More pills mean more trips to the pharmacy, more costs, more confusion, more risk of mistakes. Simplifying regimens saves time, money, and stress.

What’s Being Done to Help?

The system is slowly catching up. The U.S. Agency for Healthcare Research and Quality (AHRQ) has found that pharmacist-led interventions and electronic alerts in electronic health records reduce inappropriate prescribing. The Centers for Medicare & Medicaid Services now track deprescribing as part of quality care metrics.

Organizations like deprescribing.org offer free, evidence-based guides for common drugs-PPIs, sleep aids, antipsychotics, and more. Each guide includes a step-by-step plan, patient handouts, and even short videos to help families understand the process.

Some clinics now use AI tools to flag high-risk prescriptions during routine visits. These aren’t replacements for human judgment-they’re assistants that remind doctors: "This patient is 82, has dementia, and is on five sedatives. Are we still trying to prevent a heart attack 15 years from now?"

What You Can Do Today

You don’t need to wait for a formal review. Start now:

• Ask your doctor: "Is this medication still right for me-or for my loved one-given how things are now?"
• Bring the full list of meds to every appointment. Include vitamins and supplements.
• Ask: "What are we trying to prevent or treat with this drug? What happens if we stop it?"
• Don’t refill a prescription without reviewing it first. Many pharmacies auto-fill refills. Say no if you’re unsure.
• Use tools like deprescribing.org to look up guidelines for specific drugs.

It’s Not About Cutting-It’s About Caring

Deprescribing isn’t about taking away care. It’s about giving back control. For seniors, fewer pills often mean more energy, fewer falls, clearer thinking, and better sleep. It means living well-not just surviving with a long list of drugs.

The goal isn’t to be pill-free. It’s to be rightly medicated. Every drug should have a purpose. If it doesn’t, it’s time to talk about stopping.