Medication Reviews: When Seniors Should Stop or Deprescribe Medicines

Many older adults take multiple medications every day - sometimes a dozen or more. It’s easy to assume that if a doctor prescribed it, it’s still needed. But that’s not always true. In fact, as people age, their bodies change. What helped last year might now be doing more harm than good. This is where deprescribing comes in - not as a way to cut corners, but as a smart, safe way to simplify care and protect health.

What Is Deprescribing, Really?

Deprescribing isn’t just stopping pills. It’s a careful, step-by-step process of reviewing which medications are still helping - and which are just adding risk. The term was first used in Australia in 2003 by a clinician named Michael Woodward, and since then, it’s become a core part of geriatric care. The idea is simple: if a drug’s risks outweigh its benefits, it’s time to reconsider.

Think of it like this: when you start a new medicine, you don’t take it forever without checking in. You monitor how it works. You watch for side effects. You ask: is this still worth it? Deprescribing applies that same logic to every pill in the medicine cabinet. It’s not about reducing numbers for the sake of it. It’s about matching treatment to what matters most to the person - whether that’s staying independent, avoiding falls, or just feeling better day to day.

Why This Matters So Much Right Now

In Australia, over one in three adults over 65 takes five or more medications. In the U.S., that number jumped from 14% in 1994 to over 42% by 2014. More pills don’t mean better health - they mean more chances for bad reactions. Every extra drug increases the risk of confusion, dizziness, kidney problems, falls, and hospital visits.

One study found that up to 30% of hospital admissions in seniors are caused by medication side effects. Many of those could’ve been avoided. For example, a person on a proton pump inhibitor (PPI) for heartburn for five years might not need it anymore - especially if they’ve changed their diet or lost weight. Yet, doctors often just keep renewing the prescription because no one ever asked if it was still needed.

The financial cost is huge too. In the U.S. alone, over $30 billion a year is spent treating adverse drug events in older adults. That’s money spent on ER visits, hospital stays, and long-term care - all preventable with better medication reviews.

When It’s Time to Talk About Stopping a Medicine

There are clear moments when deprescribing should be on the table. Here are the top four situations where it’s not just okay - it’s essential:

• New symptoms appear - If your loved one started feeling dizzy, confused, or unusually tired after a new drug was added, that’s a red flag. Medications can cause side effects weeks or even months after starting. A medication review can help untangle what’s causing the problem.
• Life goals have changed - If someone has advanced dementia, severe heart failure, or is no longer able to live independently, the focus shifts from long-term prevention to comfort and quality of life. A statin to lower cholesterol might have made sense at 70, but at 88 with limited life expectancy, the benefit is gone. The risk of muscle pain, liver stress, or memory issues remains.
• High-risk drugs are involved - Some medications are especially dangerous for older adults. The Beers Criteria, used by doctors in the U.S. and Australia, lists these. Examples include benzodiazepines (like diazepam) for sleep, anticholinergics (like diphenhydramine in Benadryl) for allergies, and certain painkillers like meperidine. These drugs increase fall risk, confusion, and even dementia over time.
• Preventive meds have no clear short-term benefit - Taking a daily aspirin to prevent a heart attack? Maybe. But if the person hasn’t had one and is now 85 with frailty, the bleeding risk may be higher than the benefit. Same with bone-density drugs like bisphosphonates - after five years, most people don’t need them anymore. These aren’t one-time fixes. They’re ongoing treatments that need regular re-evaluation.

How a Medication Review Actually Works

A good medication review doesn’t happen in five minutes at a doctor’s visit. It takes time, teamwork, and sometimes multiple visits. Here’s how it typically unfolds:

1. List every medication - Include prescriptions, over-the-counter pills, vitamins, herbal supplements, and even topical creams. Many seniors forget to mention things like melatonin, calcium supplements, or ibuprofen they take for joint pain.
2. Check each drug’s purpose - Why was this started? Is the original condition still present? Has the goal changed? For example, a blood pressure pill started after a stroke might still be needed - but if the person’s blood pressure is now too low, it could be causing fainting spells.
3. Use evidence-based tools - Doctors and pharmacists use tools like the Beers Criteria or STOPP (Screening Tool of Older Persons’ Potentially Inappropriate Prescriptions) to spot risky combinations or outdated prescriptions.
4. Consider the person’s values - Does the patient want to avoid hospital trips? Stay at home? Reduce pill burden? Their goals matter just as much as clinical data.
5. Change one thing at a time - Never stop multiple drugs at once. If you stop two pills and the person feels worse, you won’t know which one caused the problem. Withdrawal should be slow, monitored, and documented.
6. Watch and wait - After stopping a drug, check in after two weeks, then four, then eight. Some side effects fade. Some symptoms come back. Both are useful data.

Clinical pharmacists are often the best people to lead this process. In Australia and Canada, pharmacists working in community clinics or hospitals now routinely run these reviews. They don’t just check for drug interactions - they ask questions like: “Do you still feel like you need this?” or “Have you noticed any changes since you started it?”

What Happens When You Stop a Medicine?

People worry about symptoms returning. That’s valid. But here’s the truth: not every symptom comes back. And if it does, you can always restart the medicine. The key is to do it slowly and with support.

For example:

• Stopping a PPI - Some people get rebound heartburn for a few days. That’s normal. It usually passes in under two weeks. A short course of antacids can help during this time.
• Stopping a statin - Cholesterol may rise slightly, but for someone over 80 with no history of heart disease, that small increase doesn’t raise risk enough to justify side effects like muscle pain or liver stress.
• Stopping a sleep aid - Insomnia might return, but often it’s because the drug was masking an underlying issue like pain or anxiety. Addressing the root cause - not just the symptom - is better long-term.

There’s strong evidence that when done right, deprescribing reduces hospital visits by 12-25% and lowers the chance of serious side effects by 17-30%. And in multiple studies, quality of life improved - people felt more alert, had fewer falls, and said they liked having fewer pills to manage.

What Families Can Do

If you’re caring for an older parent or relative, you can be the biggest advocate for a medication review. You’re often the one who notices changes: confusion after a new prescription, a fall, or a refusal to take pills because they’re too many.

Here’s what you can do:

• Bring a full list of all medications to the next doctor’s appointment - written down, not just remembered.
• Ask: “Is this still needed? What would happen if we stopped it?”
• Request a referral to a clinical pharmacist who specializes in geriatric medication reviews.
• Use free resources like deprescribing.org - they offer printable guides, videos, and checklists for common drugs like PPIs, sleep aids, and antipsychotics.
• Track changes after a medication is stopped. Write down how your loved one feels, sleeps, moves - even small improvements matter.

Common Myths About Stopping Medicines

• Myth: “If the doctor prescribed it, it must be necessary.”
  Truth: Prescriptions get renewed automatically. No one checks if they’re still needed.
• Myth: “Stopping meds will make things worse.”
  Truth: Many seniors feel better after reducing unnecessary drugs. Less confusion, more energy, fewer falls.
• Myth: “I need to take this forever.”
  Truth: Most preventive drugs - like statins, aspirin, or bone drugs - were never meant to be lifelong without review.
• Myth: “My doctor won’t listen.”
  Truth: Most doctors welcome the conversation. They’re trained to treat, not to question their own prescriptions. But with a clear list and thoughtful questions, you can lead the discussion.

What’s Next for Deprescribing?

Technology is helping. Electronic health records now include alerts when a senior is on five or more drugs. Some clinics use AI tools to flag high-risk combinations. In Sydney, pilot programs are testing AI that analyzes a patient’s history, lab results, and mobility to suggest which drugs might be safe to stop.

The World Health Organization now lists deprescribing as a global priority. Australia’s government has included it in its National Medication Safety Strategy. And more pharmacies are offering free medication reviews.

But the biggest change? It’s happening in living rooms, not hospitals. When families start asking, “Do we really need all these pills?” - that’s when real progress happens.

Final Thought: It’s Not About Taking Less - It’s About Taking What Matters

Deprescribing isn’t about cutting pills. It’s about making room for what truly improves life. A person with five unnecessary drugs might be one fall away from a hospital stay. But someone who’s stopped those drugs - and kept only what’s essential - might be walking the garden again, sleeping through the night, or remembering to take their morning tea.

Medication reviews aren’t a sign of giving up. They’re a sign of caring - smart, thoughtful, personalized care. And for seniors who’ve spent decades following doctors’ orders, it’s time to ask: which of these pills are still working for me? And which ones are just taking up space?”