Deprescribing: A Patient-First Approach to Safer, Simpler Medication Use
Many older adults take multiple medicines — sometimes so many that the pills themselves start to cause problems. Deprescribing is the careful process of reviewing and reducing or stopping medicines that may no longer be needed or that may cause harm. It's a team effort between clinicians, patients, and families, and it can improve safety, clarity, and quality of life.
What deprescribing means and why it matters
- Deprescribing is a structured review of every medicine a person takes to decide whether to continue, reduce, or stop it.
- It's especially important for older adults and people in assisted living because taking many medicines (polypharmacy) raises the risk of side effects, dizziness, confusion, falls, and harmful drug interactions.
- The goal is to make sure each medicine still helps and does not cause more harm than benefit.
How we do deprescribing at our clinic
- Complete medication review — we list prescriptions, over-the-counter drugs, vitamins, and supplements.
- Identify candidates to stop or reduce — medicines with unclear benefit, high risk, or those started for short-term reasons that were never reassessed.
- Shared decision-making — we discuss risks, benefits, and alternatives with the patient and family.
- Taper when needed — some medicines (for example, certain antidepressants) must be reduced slowly to avoid withdrawal symptoms.
- Follow up and monitor — we check how the patient is doing and adjust the plan if needed.
Real-life example from our assisted-living visits
The situation
A new resident arrived at an assisted-living facility taking 22 medications. Over time, medicines had been added after hospital stays, specialist visits, or for short-term problems that were never reassessed. The family noticed increased drowsiness, poor appetite, and unsteadiness when walking.
What we did together
We reviewed every item on the medication list with the resident and their family. After careful discussion and clinical judgment, we made several changes aimed at safety and simplicity:
- Stopped amlodipine because the resident's blood pressure readings were consistently low; continuing it could increase dizziness and fall risk.
- Stopped fish oil because the resident had no history of stroke or heart disease that would justify ongoing use; it added pill burden without clear benefit.
- Stopped turmeric supplement because there was no proven benefit for the resident's conditions and it contributed to unnecessary complexity.
- Weaned Lexapro (escitalopram) over four weeks rather than stopping abruptly, to reduce the chance of withdrawal symptoms such as dizziness, sleep disturbance, or mood changes.
We documented the plan, explained what to watch for, and scheduled follow-up to monitor the resident's response and adjust treatment as needed.
Practical tips for families
- Deprescribing is individualized. What's right for one person may not be right for another.
- Never stop medicines on your own. Some drugs need tapering or monitoring. Always talk with the prescribing clinician first.
- Bring a complete list of everything taken: prescriptions, OTC drugs, vitamins, and supplements. Small items like herbal products matter.
- Ask about goals. As health changes, priorities may shift from long-term prevention to comfort, safety, and independence.
Questions to ask the care team
- Which medicines are still helping?
- Could any of these be causing side effects we're seeing?
- If we stop a medicine, what should we watch for and when should we call you?