More than half of Australians over 65 take five or more medications every day. Some of those pills might not be helping anymore - and could even be hurting. It’s not laziness or forgetfulness. It’s not that doctors aren’t paying attention. It’s that medicine often keeps getting added, but rarely gets taken away. That’s where deprescribing comes in - the intentional, careful process of stopping medicines that no longer serve the person’s goals or safety.
Why Stopping Medicines Can Be Healthier Than Keeping Them
We’re taught that taking medicine is always good. But for older adults, especially those with multiple health issues, each new pill adds risk. The more drugs someone takes, the higher the chance of side effects, falls, confusion, kidney damage, or dangerous interactions. In Australia, the number of seniors on five or more medications jumped from 33% to 36% between 2006 and 2017. In the U.S., it tripled over the same period. This isn’t progress - it’s a safety crisis. Deprescribing isn’t about cutting corners. It’s about precision. Think of it like cleaning out a cluttered garage. Just because something is there doesn’t mean it’s useful. A blood pressure pill from 10 years ago? A statin for someone with advanced dementia? A proton pump inhibitor (PPI) for heartburn that hasn’t bothered them in years? These aren’t necessarily helping anymore. They’re just taking up space - in the medicine cabinet, in the body, and in the daily routine.When It’s Time to Consider Stopping a Medication
There are clear signs that a medication may need to be reviewed - or stopped. You don’t need to wait for a crisis. Here’s when to act:- New symptoms appear - dizziness, confusion, fatigue, nausea, or muscle weakness. These aren’t just ‘getting older.’ They could be drug side effects. For example, benzodiazepines for sleep can cause falls in seniors. Anticholinergics for overactive bladder can fog thinking. Stopping them often reverses the problem.
- Life goals have changed - if someone has advanced dementia, is in hospice, or is no longer able to live independently, the goal shifts from long-term prevention to comfort and quality of life. Taking a cholesterol-lowering drug for 10 years to prevent a heart attack doesn’t make sense if they have less than a year to live. The risks still apply; the benefit disappears.
- High-risk drugs are being used - certain medications are known to be dangerous for older adults. The Beers Criteria, updated regularly by the American Geriatrics Society, lists drugs like long-term PPIs, sleeping pills like zolpidem, and certain antipsychotics that should be avoided unless absolutely necessary.
- Preventive drugs are no longer practical - statins, aspirin, or osteoporosis meds are meant to prevent future problems. But if someone’s life expectancy is short, or they can’t swallow pills, the benefit is theoretical. The daily burden? Very real.
How Deprescribing Works - Step by Step
Deprescribing isn’t a one-time decision. It’s a process. Here’s how it actually works in practice:- Review the full list - gather every pill, patch, inhaler, and supplement. Include over-the-counter drugs and herbal remedies. Many seniors don’t tell their doctor about aspirin they take daily or turmeric capsules they think are ‘harmless.’
- Identify the purpose of each - why was this prescribed? Is the original condition still present? Has it been treated? Is the medication still needed?
- Assess risks vs. benefits - does the drug still help? Or is it causing more harm? Use tools like STOPP (Screening Tool of Older Persons’ Potentially Inappropriate Prescriptions) or Beers Criteria to spot red flags.
- Start with one - never stop multiple drugs at once. If you stop two and the person feels worse, you won’t know which one caused the change. Pick the most likely culprit - often a sleep aid, acid reducer, or antihypertensive.
- Taper slowly - some drugs, like antidepressants or beta-blockers, can’t be stopped cold turkey. A gradual reduction over weeks or months is safer and more comfortable.
- Watch and listen - track how the person feels. Are they sleeping better? More alert? Less dizzy? Are old symptoms coming back? Report changes to the doctor right away.
- Reassess regularly - even if nothing changed, review the list every 6 to 12 months. Health changes. Goals change. So should the meds.
Who Should Lead the Conversation?
This isn’t something a senior should do alone. It’s a team effort. The best outcomes happen when:- Pharmacists - especially clinical pharmacists - review the full list. They spot interactions, duplicates, and outdated prescriptions. In Australia, community pharmacists are increasingly involved in medication reviews funded through the government’s Home Medicines Review program.
- Doctors - GPs or geriatricians must agree to stop or reduce a drug. They’re the ones who can write the new prescription or order the taper.
- The patient and family - the person taking the medicine must be part of the decision. They know how they feel. They know what matters to them. Do they want to avoid hospital trips? Sleep through the night? Eat without nausea? Their goals drive the plan.
What Happens When You Stop a Drug?
Fear of withdrawal or rebound symptoms keeps many people on unnecessary meds. But here’s the truth: most side effects disappear within days or weeks after stopping. And many symptoms thought to be ‘disease progression’ are actually drug-induced. For example:- Stopping a PPI (like omeprazole) for heartburn? Some people get temporary reflux - but it usually fades in 2-4 weeks. And many never needed it in the first place.
- Stopping a sleeping pill like zolpidem? Sleep may be worse for a few nights, but natural sleep often returns. And without the fall risk, it’s safer.
- Stopping an antipsychotic for agitation in dementia? Agitation may return - but often less than expected. And without the sedation and tremors, quality of life improves.
What’s Holding Deprescribing Back?
The science is clear. The tools exist. So why isn’t this happening more?- Doctors aren’t trained to stop things - medical education focuses on starting treatments, not stopping them. No one teaches you how to say, ‘Let’s try going off this.’
- Patients are scared - they worry stopping a pill will make them sicker. Or they think their doctor will think they’re ‘difficult’ if they ask.
- Systems don’t support it - electronic health records don’t flag outdated meds. Refill reminders keep coming. Insurance doesn’t pay for medication reviews unless they’re part of a formal program.
What You Can Do Right Now
You don’t need to wait for a perfect system. Here’s how to start today:- Bring your full medication list - including supplements - to your next doctor’s visit. Write it down. Don’t rely on memory.
- Ask: ‘Is this still needed? What’s the benefit now? What are the risks?’
- Ask: ‘If I stopped this, what would happen? Would I feel better?’
- Ask your pharmacist for a free medication review. Many offer this in-store.
- Don’t be afraid to say, ‘I’d like to try going off this.’
Is deprescribing the same as stopping all my meds?
No. Deprescribing means stopping only the medicines that no longer help - or that may be causing harm. It doesn’t mean stopping everything. Essential medications for heart disease, diabetes, or high blood pressure are usually kept unless there’s a clear reason to change them. The goal is to reduce unnecessary drugs, not essential ones.
Can I stop a medication on my own if I think it’s not helping?
No. Some medications, like blood pressure pills, antidepressants, or steroids, can cause serious withdrawal effects if stopped suddenly. Always talk to your doctor or pharmacist first. They can help you taper safely and monitor for side effects. Never stop a prescription without professional guidance.
What if my symptoms come back after stopping a drug?
That’s why deprescribing is done one drug at a time and with close monitoring. If symptoms return, it helps identify whether the drug was truly needed. Sometimes, the original problem comes back - but often, the symptoms were caused by the medication itself. Your doctor can then decide whether to restart it, try a different treatment, or accept that the symptom isn’t dangerous.
Are there free tools or resources to help with deprescribing?
Yes. Deprescribing.org offers free, evidence-based guides for common drugs like proton pump inhibitors, sleeping pills, and antipsychotics. Each includes a patient pamphlet, infographic, and video. In Australia, the Home Medicines Review program provides free pharmacist-led reviews for eligible seniors. Talk to your GP or pharmacist about accessing these.
How often should a senior have a medication review?
At least once a year - or anytime there’s a change in health, hospital stay, or living situation. If someone starts feeling more tired, confused, or unsteady, that’s a red flag to review all meds right away. Regular reviews aren’t optional - they’re part of safe aging.
