Medication Reviews: When Seniors Should Stop or Deprescribe Medicines

More than half of Australians over 65 take five or more medications every day. Some of these pills might be doing more harm than good.

Why Stopping Medicines Can Be Healthier Than Taking Them

It’s easy to assume that more medicine equals better health-especially for seniors managing multiple conditions. But that’s not always true. In fact, taking too many drugs can lead to confusion, falls, dizziness, kidney problems, and even hospital stays. This isn’t about skipping treatment. It’s about deprescribing: the careful, planned process of stopping or reducing medicines that no longer serve the patient’s needs.

Deprescribing isn’t new. It was first proposed in 2003 by an Australian doctor, Michael Woodward, who saw older patients drowning in prescriptions. Today, it’s backed by decades of research. Studies show that when done right, deprescribing reduces adverse drug events by 17% to 30%, cuts hospital readmissions by up to 25%, and improves how people feel day-to-day-without making their chronic conditions worse.

The goal isn’t to eliminate all meds. It’s to keep only what matters. A 90-year-old with advanced dementia doesn’t need a statin to lower cholesterol if they’re not expected to live another year. A frail 82-year-old on blood thinners and multiple painkillers might be at higher risk of a bleed than benefit from those drugs. These aren’t edge cases-they’re common.

When It’s Time to Ask: Should This Medicine Stay?

There are clear moments when a medication review isn’t just a good idea-it’s essential. Here are the top situations when stopping a drug should be on the table:

• New symptoms appear. If your parent suddenly feels dizzy, confused, or has unexplained bruising, it could be a reaction to a drug-not just aging. Many older adults are misdiagnosed with dementia or depression when the real culprit is a medication side effect.
• Life expectancy has changed. If someone is in the late stages of heart failure, cancer, or dementia, preventive drugs like aspirin, cholesterol-lowering pills, or diabetes meds often offer no real benefit. The risks outweigh the rewards. Treatment should match life goals, not just lab numbers.
• They’re on high-risk combinations. Some drugs are dangerous together. For example, combining benzodiazepines (like diazepam) with opioids or antipsychotics increases fall risk dramatically. The Beers Criteria and STOPP guidelines list these risky pairings specifically for seniors.
• They’re taking drugs for prevention with no short-term benefit. Statins, blood pressure pills, or osteoporosis meds are often prescribed to prevent future problems. But if someone is 88, lives alone, and walks with a cane, the benefit of preventing a heart attack in 10 years is meaningless. The harm-dizziness, muscle pain, drug interactions-is happening now.

One real example: A 78-year-old woman in Perth was on eight medications, including a proton pump inhibitor (PPI) for heartburn she’d been taking for 12 years. She had no symptoms. Her doctor stopped the PPI. Within weeks, her energy improved. No rebound acid reflux. No problems. She went from eight pills to five-and felt better.

How Deprescribing Works: A Step-by-Step Approach

Deprescribing isn’t just turning off a switch. It’s a process. Here’s how it’s done safely:

1. Review the full list. Every pill, patch, or supplement should be listed-prescription, over-the-counter, vitamins, herbal remedies. Many seniors don’t tell their doctor about the aspirin they take daily or the melatonin they use for sleep.
2. Identify the goal. Is the goal to reduce falls? Improve appetite? Reduce confusion? The reason guides what gets cut first.
3. Choose one drug at a time. Never stop multiple meds at once. If symptoms change after stopping one, you won’t know which drug caused it. Start with the least necessary or most risky.
4. Plan the taper. Some drugs, like antidepressants or steroids, can’t be stopped cold turkey. A slow reduction over weeks or months is needed to avoid withdrawal.
5. Monitor closely. Keep a journal: sleep, mood, energy, pain, balance. Note any changes. Family members or caregivers should help track this.
6. Revisit in 4-8 weeks. Did stopping the drug make things better? Worse? No change? That’s the data you need to decide what to do next.

Pharmacists play a huge role here. In Australia, clinical pharmacists can do home-based medication reviews under Medicare. These aren’t just quick chats-they’re full assessments that take 45-60 minutes. They check for duplicates, interactions, and drugs that shouldn’t be used in seniors.

Common Medicines That Often Need Stopping

Not all drugs are equal. Some are more likely to cause harm in older adults. Here are the usual suspects:

• Proton Pump Inhibitors (PPIs) - Like omeprazole or pantoprazole. Often prescribed for heartburn, but used long-term without review. Risk: bone fractures, kidney damage, infections.
• Benzodiazepines and sleep aids - Diazepam, lorazepam, zopiclone. High risk of falls, confusion, memory loss. Alternatives: sleep hygiene, CBT-I.
• Antipsychotics for dementia - Quetiapine, risperidone. Used for agitation, but increase stroke and death risk. Non-drug approaches work better.
• NSAIDs - Ibuprofen, naproxen. Can cause stomach bleeds, kidney failure, and high blood pressure. Acetaminophen is safer for pain, if used correctly.
• Statins in very frail seniors - Atorvastatin, rosuvastatin. Benefit is minimal if life expectancy is under 2-3 years. Muscle pain and fatigue are common side effects.
• Insulin or sulfonylureas in advanced dementia - Risk of dangerous low blood sugar. Often unnecessary if eating is irregular.

The Beers Criteria, updated in 2023 by the American Geriatrics Society, is the gold standard list of these risky drugs. It’s used by doctors and pharmacists worldwide.

Barriers to Stopping: Why It’s Hard to Say No to Pills

Even when the evidence is clear, stopping meds is tough. Why?

• Doctors don’t know how. Medical training focuses on starting treatments, not stopping them. Many GPs feel unprepared to lead a deprescribing conversation.
• Patients are scared. “What if I get sick again?” “My last doctor said this was important.” Fear of relapse is real.
• Family pressure. Adult children often think “more meds = better care.” They may push to keep prescriptions going.
• System inertia. Automatic refills, pharmacy scripts, and electronic reminders make it easy to keep taking something-even if it’s no longer needed.

The solution? Make deprescribing a normal part of care. When a new drug is prescribed, ask: “Is this a trial? How will we know if it’s working?” When a prescription is renewed, ask: “Do we still need this?”

What Happens When You Stop? Real Outcomes

Some people worry that stopping a drug will cause a rebound effect or make their condition worse. That’s possible with some meds-but not always. And when it does happen, it’s usually manageable.

Studies show:

• People who stopped PPIs had no increase in reflux symptoms after 12 months.
• Seniors who stopped antipsychotics showed improved alertness and communication.
• Patients who stopped multiple sedatives reported better sleep quality-not worse.
• Those who stopped unnecessary statins had no increase in heart events over two years.

One 84-year-old man in Adelaide was on eight medications, including three for blood pressure. His BP was 130/80-perfectly normal. He was dizzy, tired, and fell twice. His doctor cut two blood pressure pills. His BP stayed normal. His dizziness vanished. He started walking again.

Deprescribing doesn’t mean giving up. It means choosing quality of life over quantity of pills.

How to Start the Conversation

If you’re a caregiver, family member, or senior yourself, here’s how to begin:

• Bring a full list of all medicines to the appointment-including supplements and OTC drugs.
• Ask: “Which of these are still necessary? Are any of them doing more harm than good?”
• Ask: “If we stopped this, what would we watch for?”
• Ask: “Can we try stopping one for a few weeks and see how things go?”
• Request a referral to a clinical pharmacist for a Medication Management Review (MMR) under Medicare.

Don’t be afraid to push back. Your parent’s health isn’t defined by the number of pills they take. It’s defined by how they feel, how they move, and how they live.

Resources to Help

Deprescribing.org is a free, evidence-based resource developed by Australian and Canadian experts. It offers:

• Guidelines for stopping PPIs, benzodiazepines, antipsychotics, and more.
• Printable patient handouts.
• Apps for Android and iOS to help track meds and withdrawal symptoms.

In Australia, you can also access a Medication Management Review (MMR) through your GP. It’s free under Medicare and includes a pharmacist visiting your home to review all your meds.

Medication reviews aren’t about cutting corners. They’re about cutting clutter. For seniors, fewer pills often mean more life-more walks, clearer thoughts, fewer falls, and more time spent doing what matters.