Deprescribing Research: What Happens When You Reduce Medications in Older Adults

Why Reducing Medications Isn’t Just Stopping Pills

Most people assume taking more pills means better care. But for older adults on five, ten, or even fifteen medications, that belief can be dangerous. Deprescribing isn’t about cutting corners-it’s about removing drugs that no longer help, or worse, are hurting. This isn’t a new idea. It’s a growing movement backed by clinical trials, patient stories, and real-world data from clinics across North America. The goal? To help people live better, not just longer.

What Exactly Is Deprescribing?

Deprescribing means carefully stopping or lowering the dose of a medication when the risks outweigh the benefits. It’s not random. It’s a planned, step-by-step process. According to the American Geriatrics Society, it’s about identifying drugs that might be causing harm-like dizziness from blood pressure pills, confusion from sleeping aids, or stomach bleeding from daily aspirin-and deciding if they’re still needed. This isn’t for everyone. It’s targeted: older adults with multiple chronic conditions, those nearing end-of-life, or people taking drugs that were meant for prevention but no longer make sense given their current health.

Think of it like this: You took a statin at 65 to lower your cholesterol and prevent a heart attack. Now you’re 82, have advanced dementia, and can’t remember to eat. That statin isn’t helping you live longer-it’s adding to your pill burden, increasing your risk of muscle pain or liver issues, and maybe even making you feel worse. Deprescribing asks: Is this drug still doing what it was meant to do? If not, why keep it?

The Five Steps Behind Every Successful Deprescribing Plan

Good deprescribing doesn’t happen by accident. It follows a clear structure:

1. Identify potentially inappropriate medications. This means looking at each drug on the list and asking: Is this still needed? Does it interact with others? Is it on the Beers Criteria list of drugs to avoid in older adults?
2. Determine if it can be reduced or stopped. Not all drugs can be cut cold turkey. Some need slow tapering-like antidepressants or benzodiazepines-to avoid withdrawal symptoms.
3. Plan the taper. How fast? What’s the schedule? Will the patient need extra support? This step is personalized. One person might stop a sleeping pill over two weeks. Another might need three months to come off a blood pressure drug.
4. Monitor closely. After stopping, symptoms are watched for three to six weeks. Did the patient’s balance improve? Did their confusion clear up? Did pain return? These signals tell doctors if the decision was right.
5. Document everything. What was stopped? When? What happened? This info goes into the medical record so future providers don’t just add it back in.

This process mirrors how doctors start medications-except now they’re stopping them. And it requires the same level of care, attention, and follow-up.

What Does the Research Say About Outcomes?

Studies show deprescribing works-but not always in the way people expect.

A major 2023 review in JAMA Network Open looked at over 100 trials involving older adults on multiple medications. On average, patients were taking nearly 10 drugs. After deprescribing, they dropped to about 8. That’s one fewer pill per person. Sounds small? It’s not. For a doctor with 2,000 patients, that adds up to 140 fewer medications prescribed each year. That’s 140 fewer chances for side effects, drug interactions, or hospital visits.

But here’s the real win: Patients didn’t get sicker. In fact, many felt better. Falls decreased. Mental clarity improved. Hospital stays dropped. One study found patients who stopped antipsychotics for dementia had fewer infections and better mobility. Another showed that cutting proton pump inhibitors (PPIs) in older adults reduced the risk of bone fractures and kidney damage.

Still, some early studies didn’t find big changes in mortality or hospitalizations. Why? Because most were too short. You can’t measure the benefit of stopping a drug that causes slow, cumulative harm in a 30-day trial. That’s why experts like Dr. Dan Gnjidic say we need longer studies-ones that track falls, fractures, cognitive decline, and death over years, not weeks.

Why Don’t More Doctors Do This?

It’s not that they don’t want to. It’s that they’re stuck in a system designed for adding drugs, not removing them.

Most electronic health records don’t have a ‘stop medication’ button. They’re built to prescribe. Insurance forms don’t ask, ‘Is this still necessary?’ They ask, ‘What’s the diagnosis?’ Patients rarely bring up reducing meds-they’re afraid of being seen as noncompliant. And many doctors worry: What if I stop something and something bad happens?

That fear is real. But the bigger fear? Continuing a drug that causes more harm than good. The American Academy of Family Physicians found that patients actually want to take fewer pills-if their doctor brings it up. In one survey, 80% of older adults said they’d be open to stopping a medication if their doctor explained why.

That’s the key: It’s not about taking away. It’s about choosing what matters. One woman, 86, stopped her daily aspirin after her doctor explained she had no history of heart disease and was at higher risk for bleeding. She stopped feeling nauseous. Her energy improved. She didn’t need to take a stomach pill anymore. That’s not losing treatment. That’s gaining life.

Who Benefits Most From Deprescribing?

Not everyone needs it. But these groups see the biggest gains:

• Older adults with five or more medications. About 40% of seniors fall into this group. The more pills, the higher the risk.
• People with dementia or advanced frailty. Preventive drugs like statins or osteoporosis meds rarely help here. The goal shifts from prevention to comfort.
• Those on high-risk drugs. Benzodiazepines, antipsychotics, NSAIDs, and long-term PPIs are top candidates for review.
• Patients with multiple prescribers. Someone might get a sleeping pill from a neurologist, a blood thinner from a cardiologist, and an antidepressant from a psychiatrist. No one’s looking at the whole list.

And here’s something surprising: Deprescribing isn’t just for the elderly. Younger people on long-term pain meds, acid reflux drugs, or antidepressants without clear benefit are also starting to be evaluated. The principle is the same: Is this still helping?

How Patients and Families Can Start the Conversation

If you or a loved one is on multiple medications, here’s how to begin:

1. Make a full list. Write down every pill, patch, inhaler, and supplement. Include doses and why you take them.
2. Ask your doctor: ‘Is everything here still necessary?’ Don’t say ‘Can I stop this?’ Say ‘I’d like to understand if any of these can be safely reduced.’
3. Bring up symptoms. ‘I’ve been feeling dizzy since I started this new pill.’ ‘I’m always tired.’ These are clues.
4. Ask about alternatives. ‘Is there a non-drug way to manage this?’
5. Request a follow-up. ‘If we stop this, when should we check back?’

Resources like deprescribing.org offer printable medication lists and question guides for patients. Over 500,000 people have downloaded them since 2015. That’s not a niche tool-it’s a movement.

The Future of Deprescribing

What’s next? Better tools. Researchers are building AI-powered alerts in electronic health records that flag drugs likely to cause harm in older adults. One pilot program in family clinics reduced inappropriate prescriptions by 15% just by adding a simple pop-up during appointments.

There’s also work on personalized deprescribing. Some studies are looking at genetic testing to see how a person metabolizes certain drugs. Someone who processes benzodiazepines slowly might need a slower taper. Someone with a gene variant linked to stomach bleeding might be told to stop aspirin for good.

And as the population ages-with 20% of Americans expected to be over 65 by 2030-deprescribing won’t be optional. It’ll be standard. The question isn’t whether to do it. It’s how fast we can make it part of everyday care.

Final Thought: Less Isn’t Less Care

Reducing medications doesn’t mean giving up. It means choosing wisely. It means recognizing that more drugs don’t always mean better outcomes. Sometimes, the most powerful thing a doctor can do is say, ‘You don’t need this anymore.’

For older adults, that can mean more energy, fewer falls, clearer thinking, and more time doing what matters-talking with family, walking in the garden, enjoying a meal without worrying about pill interactions. That’s not a loss. That’s a win.