Deprescribing — the growing movement to reduce unnecessary medications
This article is for educational purposes only and does not constitute medical, legal, or financial advice. Every family situation is different, and you should consult with appropriate professionals about your specific circumstances.
Watching your parent or spouse take a pill organizer stuffed with bottles can feel like you're supporting their health. In many cases, you are. But sometimes you wonder if all those medications are actually helping, or if they've simply accumulated over years of doctor visits, each specialist adding one more prescription to the mix. That uncertainty is what brings many families to ask a simple but transformative question: what if some of these medications could be stopped?
This question sits at the heart of deprescribing, a movement that's gaining traction among geriatric specialists, pharmacists, and thoughtful families everywhere. Deprescribing isn't about being reckless or ignoring medical advice. It's about being honest with yourself and your elder's doctor about what medications truly matter and which ones might be doing more harm than good.
Understanding What Deprescribing Really Means
Deprescribing means carefully and deliberately reducing or stopping medications that may no longer be necessary or helpful. A doctor supervises the process from start to finish, reviewing each medication and its purpose, then deciding which ones could potentially be withdrawn. Unlike abrupt medication changes that can cause serious problems, deprescribing follows a deliberate plan with close monitoring. It's medicine done thoughtfully, not rushed or reactive.
The concept sounds almost heretical in a healthcare system that's conditioned us to add medications but rarely subtract them. Yet the evidence is compelling. Studies show that older adults often take medications that aren't helping them and may be causing harm. Some medications were started years ago to prevent problems that either never materialized or have since been resolved. Others were prescribed to manage side effects from different medications. The longer your elder lives, and the more specialists they see, the more likely their medication list becomes a tangled mess where nobody quite remembers why each pill exists.
Many medications made perfect sense at the time they were prescribed. Your father was younger then. His kidneys worked better. His goals might have been different. A blood pressure medication that made sense when he was a working professional might feel entirely different when he's ninety and values quality of life above all else. Deprescribing asks whether assumptions we made years ago still hold true today.
Who Benefits Most From Deprescribing
The best candidates are older adults taking five or more medications, a condition called polypharmacy. But more importantly, look for signs that medications might be causing problems rather than solving them. If your elder is experiencing frequent falls, confusion, loss of appetite, or unexpected behavior changes, medications might be the culprit. Sometimes that confusion everyone blamed on age turns out to be a medication interaction. Sometimes the unsteadiness that seemed like inevitable aging was actually a side effect that stopped once the offending drug was removed.
People with declining kidney or liver function are especially good candidates because their bodies process drugs differently as they age. If your elder had kidney disease, heart failure, or liver problems, their body holds onto medications longer than it did when they were younger. A dose that worked perfectly at age sixty becomes too much at age eighty-five. Deprescribing can adjust for these biological changes.
Those approaching the end of life also benefit tremendously. If your elder has limited life expectancy, focusing on comfort rather than prevention makes far more sense. That medication preventing a possible stroke in three years won't matter if they're struggling with nausea and weakness today. Deprescribing at the end of life can restore good days, clarity, and connection with family.
Even people who feel fine sometimes benefit from deprescribing. Some medications are prescribed to prevent future problems rather than treat current ones. If your elder has taken an osteoporosis medication for ten years without any fractures, and they have balance and kidney problems that make the medication riskier, that medication might be a candidate for deprescribing. The goal is matching the medication to the person's current life, not their life five years ago.
How Deprescribing Actually Works
The process requires patience and partnership. Your elder's doctor won't simply stop medications overnight. Instead, they'll choose one medication to address first, usually one that's less critical for immediate health or one with known risks in older adults. Some medications can be stopped cold turkey, but others require tapering. Your elder might take a smaller dose for a week or two, then an even smaller dose, then finally none at all. This gradual approach allows the body to adjust and helps you all see whether stopping the medication actually causes problems.
Your doctor will likely prioritize medications that carry particular risks for older adults. There's actually a formal list called the Beers Criteria that identifies medications that geriatricians recommend avoiding or using cautiously in older people. Some of these medications might be on your elder's list. That's not a criticism of their doctor. It's just how medicine works sometimes. What was best practice twenty years ago gets refined as we learn more.
Throughout deprescribing, monitoring matters enormously. You'll likely schedule follow-up visits more frequently than usual. Blood pressure might need checking more often. Symptoms need documenting. If your elder starts feeling worse, the doctor can pause the deprescribing plan and reassess. If they feel no different or even better, you've successfully found a medication that wasn't pulling its weight.
The timeline for deprescribing varies depending on how many medications you're addressing. You might reduce one medication per month. You might address several over the course of a year. There's no race here. Slow and steady wins. Your elder's doctor might decide that some medications truly are essential and shouldn't be touched, and that's completely appropriate. Deprescribing isn't about hitting a target number of pills. It's about making deliberate choices.
What Makes Deprescribing Challenging
Many families worry that deprescribing means abandoning necessary care. The opposite is true. Deprescribing is rigorous care that questions assumptions instead of accepting them. It means asking whether a blood pressure medication started ten years ago still makes sense for someone whose priorities have shifted toward quality of life. It means wondering if an expensive medication preventing a theoretically possible heart attack is worth the nausea and weakness your elder experiences daily.
Some of your elder's doctors might worry that deprescribing means you don't trust their medical judgment. They may have worked hard to optimize your elder's medications, and the idea of unwinding that feels like criticism. A good conversation with their primary care doctor can help frame this positively. You're not saying their earlier decisions were wrong. You're recognizing that circumstances have changed and revisiting those decisions makes sense.
Your elder themselves might feel frightened about stopping any medication. They might believe that more medication means more safety. They might worry that their doctor worked hard to get their conditions under control and stopping medications undoes that work. These fears are completely understandable. You might carry the same doubts. The way forward is to approach their doctor with genuine curiosity rather than demands.
Building the Conversation With Your Doctor
"Are there any medications we could consider reducing or stopping?" is a question that invites thoughtful conversation. It shows you're thinking about their overall wellbeing, not just checking a box. Bring your elder's complete medication list to the appointment. Include over-the-counter medications, supplements, and herbal products too. Write down any side effects you've noticed. Be specific. Instead of "he's been feeling worse," try "he's had two falls this month and he's more confused at night."
Some doctors embrace deprescribing readily. Others seem more committed to the status quo, even when the status quo isn't working well. If your elder's primary care doctor seems dismissive, consider asking for a referral to a geriatrician or clinical pharmacist who specializes in medication review. Many insurance plans cover medication therapy management services where a pharmacist reviews all medications and makes recommendations. These professionals often have the time and expertise to question what your elder's regular doctors might not have questioned.
The Financial and Health Benefits
The financial aspect deserves mention too. Medications cost money, sometimes a lot of it. When you stop medications your elder doesn't need, you free up resources for those they do. You also reduce the risk of medication interactions and side effects, which can lead to expensive emergency room visits or hospitalizations. In this sense, deprescribing can improve both health and finances simultaneously.
Beyond finances, deprescribing often improves how your elder actually feels. Fewer medications means fewer side effects. Your elder might regain appetite that a medication had suppressed. They might become steadier on their feet without a medication affecting balance. They might think more clearly. They might have more energy. These aren't small things. These are the things that make life worth living.
Your Role in Making Deprescribing Work
You play a important role in making deprescribing work. You know your elder better than any doctor does. You see them every day or frequently enough to notice subtle changes in mood, appetite, memory, or physical function. You can report back on whether stopping a medication changed anything. You can advocate for your elder if they're too shy or cognitively impaired to speak up themselves. You can help them understand that less medication sometimes means better health.
As you move forward, keep a close record of baseline symptoms, important signs, and functional abilities before deprescribing begins. This gives you concrete information for comparing before and after. If your elder experienced depression, confusion, or frequent falls, write those down. If they were managing stairs independently or keeping up with hobbies, note that. When you stop a medication, you'll have real data about whether anything changed, rather than relying on feelings or guesses.
Why This Movement Matters
The movement toward deprescribing represents a fundamental shift in how we think about health in later life. It acknowledges that more healthcare isn't always better healthcare. It trusts that older adults and their families can make informed decisions about medications. It recognizes that quality of life matters as much as quantity. Your willingness to ask whether each medication still serves your elder's actual needs puts you squarely on the side of truly thoughtful care.
Deprescribing isn't about taking risks or ignoring serious medical conditions. It's about being smart and intentional. It's about making sure the medications your elder takes are genuinely helping them live the life they want to live. That kind of thoughtfulness, combined with medical expertise and close monitoring, is what good healthcare looks like in the later years.
How To Help Your Elders is an educational resource. We do not provide medical, legal, or financial advice. The information in this article is general in nature and may not apply to your specific situation. Always discuss medication changes with your elder's healthcare providers before making any decisions.