Medication Reviews: When Seniors Should Stop or Deprescribe Medicines

More than 4 in 10 older adults in the U.S. are taking five or more prescription drugs daily. That’s not just common-it’s dangerous. Many of these medications were started years ago for conditions that no longer apply, or they’re now doing more harm than good. The truth is, deprescribing isn’t about cutting corners. It’s about cleaning up clutter that’s putting seniors at risk.

What Is Deprescribing, Really?

Deprescribing means stopping or lowering the dose of a medicine when the risks outweigh the benefits. It’s not quitting meds cold turkey. It’s not ignoring doctors. It’s a careful, planned process backed by science. The term was first used in 2003 by an Australian doctor who noticed how often older patients were drowning in pills they didn’t need. Today, it’s a recognized part of geriatric care.

Think of it like this: if you started taking a pill for high blood pressure ten years ago and your pressure is now normal, why keep taking it? What if that same pill is now causing dizziness, falls, or kidney problems? That’s when deprescribing kicks in. The goal isn’t to reduce the number of pills for the sake of it. It’s to match treatment to what matters now-your health, your safety, your quality of life.

When Should You Consider Stopping a Medication?

There are clear signs that it’s time to talk to a doctor about deprescribing:

• New symptoms show up after starting a drug. Did you start a new pill and then feel foggy, weak, or off-balance? That could be a side effect, not aging. Dizziness, confusion, nausea, or sudden fatigue are red flags.
• You’ve been diagnosed with advanced illness. If you have late-stage dementia, heart failure, or cancer that’s no longer treatable, some medications-like cholesterol drugs or diabetes pills-no longer make sense. They won’t extend your life, but they might make your days harder.
• You’re on high-risk drugs. Some medications are especially dangerous for older adults. Benzodiazepines (like Valium or Xanax) raise fall risk. Anticholinergics (found in some sleep aids and bladder meds) can cause memory loss. Long-term proton pump inhibitors (PPIs) for heartburn can weaken bones and cause infections. These are top candidates for review.
• You’re taking preventive meds with no short-term benefit. Statins for cholesterol, aspirin for heart protection, or vaccines like pneumonia shots? Great when you’re healthy. But if you’re 85, frail, and living at home, the long-term benefit of a statin might be years away-while the side effects are happening now.

The American Geriatrics Society and the American Academy of Family Physicians both say: Review every medication at every visit. Don’t assume a pill is still needed just because it’s been on your list for years.

How Do Doctors Decide What to Stop?

There’s no one-size-fits-all list. But experts use tools to guide decisions:

• Beers Criteria - Updated regularly by the American Geriatrics Society, this list identifies drugs that are risky for seniors, like certain antihistamines, muscle relaxants, and sleep aids.
• STOPP Criteria - Focuses on inappropriate prescribing, like giving multiple drugs that do the same thing or combining meds that increase side effects.
• Pharmacist reviews - Clinical pharmacists are trained to spot drug interactions, duplicate therapies, and outdated prescriptions. Studies show they reduce inappropriate meds by up to 40% in older adults.

These tools aren’t rules-they’re starting points. A doctor will look at your overall health, how long you’ve lived with a condition, your life expectancy, and what matters most to you. If you want to stay active and independent, a drug that makes you sleepy or dizzy might not be worth keeping.

Why Is Polypharmacy So Common?

It’s not just about poor care. It’s systemic. Here’s how it happens:

• Specialists don’t talk to each other. Your cardiologist prescribes a beta-blocker. Your rheumatologist adds a painkiller. Your primary care doctor doesn’t know both are happening. Each adds a med. No one steps back to see the whole picture.
• Refills become automatic. Most prescriptions are renewed without review. A pill gets refilled for years because no one ever said to stop.
• Doctors aren’t trained to stop. Medical schools teach how to prescribe. Few teach how to stop. A 2019 study found that 90% of guidelines explain how to start a drug-but only 1 in 5 explain how to stop it.
• Patient fear plays a role. Many seniors worry that stopping a drug will make their condition worse. They don’t know it’s safe to try.

Between 1994 and 2014, the percentage of U.S. seniors on five or more medications tripled. That’s not progress. That’s a public health problem.

What Happens When You Stop a Drug?

Some people think stopping meds will cause a rebound effect-like blood pressure shooting up or pain returning. Sometimes it does. That’s why deprescribing is done slowly, one drug at a time.

For example:

• Stopping a PPI (like omeprazole) might cause temporary heartburn-but that usually fades in 2-4 weeks. Many people find they don’t need it anymore.
• Reducing a sleep aid like zolpidem can lead to insomnia at first, but most seniors adjust within a month and sleep better without the drug.
• Stopping a statin in a frail 80-year-old doesn’t increase heart attack risk-it just removes dizziness, muscle pain, and liver stress.

Studies show that when deprescribing is done right, adverse drug events drop by 17-30%. Hospital readmissions fall by 12-25%. And seniors report feeling clearer-headed, stronger, and more in control.

How to Start the Conversation

You don’t need to wait for a crisis. Here’s how to bring it up:

1. Make a list of every pill, supplement, and over-the-counter drug you take-including doses and why you take them.
2. Ask: “Which of these are still helping me? Which might be causing problems?”
3. Request a full medication review during your next visit. Say: “I’d like to go over my list and see what we can safely stop.”
4. Ask if a pharmacist can help. Many clinics now offer free medication reviews.
5. Don’t stop anything on your own. Work with your doctor to taper safely.

Bring a family member. Write down answers. If the doctor says “it’s fine,” ask: “What would happen if I stopped this?” If they don’t know, that’s a sign it’s time to get a second opinion.

What About Chronic Conditions?

You might be thinking: “But I have diabetes. What if I stop my meds?”

Good question. Deprescribing doesn’t mean abandoning treatment. It means tailoring it. For example:

• If your A1C is stable at 7.2% and you’re 82, your doctor might switch from insulin to a less risky oral drug-or even stop it entirely if your risk of low blood sugar outweighs the benefit.
• If you have mild hypertension and no history of stroke, your target blood pressure might change from 120/80 to 140/90. That could mean dropping one pill.

Life expectancy matters. If you’re 90 with limited mobility and no desire for aggressive treatment, the goal shifts from preventing a heart attack in 10 years to feeling well today.

What’s Changing in 2026?

Technology is catching up. Electronic health records now have built-in alerts for risky drug combinations. Apps like Deprescribing.org offer free, evidence-based guides for stopping PPIs, benzodiazepines, and antipsychotics-with printable checklists and videos.

Some clinics now assign a “medication coach”-often a pharmacist-who follows up after a deprescribing attempt. They call you two weeks later to see how you’re feeling. That kind of support makes a huge difference.

The World Health Organization now lists deprescribing as a global patient safety priority. Medicare is starting to track how often seniors have medication reviews. That means more doctors will be encouraged-and eventually required-to do them.

What’s the Biggest Mistake People Make?

Thinking deprescribing means giving up. It doesn’t. It means choosing better care. It means saying: “I don’t want to live on a pile of pills that make me feel worse.”

One woman, 86, was on eight medications. She felt tired all the time and had fallen twice. After a pharmacist review, three drugs were stopped: a sleep aid, a stomach acid reducer, and a cholesterol pill. Within a month, she was sleeping better, walking without a cane, and eating meals with her grandchildren again.

That’s not a miracle. That’s smart medicine.

Final Thought: Your Meds Are Not Permanent

Every prescription is a trial. Every refill is a chance to ask: “Is this still helping?”

Seniors aren’t just patients. They’re people who want to live well, not just live longer. The best care isn’t about adding more drugs. It’s about removing the ones that don’t belong.