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

Every year, millions of older adults take more medications than they need. Some were prescribed years ago for conditions that have changed or disappeared. Others were added one at a time by different doctors, with no one stepping back to ask: Do I still need this? That’s where deprescribing comes in-not as a side note, but as a deliberate, evidence-backed process to stop drugs that no longer help, or worse, harm.

What Exactly Is Deprescribing?

Deprescribing isn’t just quitting pills. It’s a structured, step-by-step review of every medication a person is taking, with one goal: improve quality of life by removing what’s unnecessary or risky. The American Geriatrics Society defines it as the planned and supervised process of reducing or stopping medications that might be causing harm or offering no real benefit. This isn’t about cutting corners-it’s about treating medication use with the same care as prescribing it.

Think of it this way: when a doctor starts a new drug, they check your symptoms, your other meds, your kidney function, your goals. Deprescribing does the same thing-but in reverse. You ask: What was this for? Does it still make sense? What happens if we stop it?

Who Benefits Most from Deprescribing?

Not everyone needs to cut back. But certain groups see the biggest gains:

• Older adults taking five or more medications daily (about 40% of seniors in the U.S.)
• People with frailty, dementia, or advanced illness
• Those experiencing new symptoms like dizziness, confusion, or falls that could be drug side effects
• Patients on preventive drugs like statins or blood pressure meds when life expectancy is short
• Anyone on high-risk combinations-like benzodiazepines with opioids, or multiple drugs that slow the brain

One study found that nearly 20% of older adults take ten or more pills every day. That’s not just inconvenient-it’s dangerous. Each extra pill increases the chance of a bad reaction, hospital visit, or even death.

The Five Steps of Safe Deprescribing

Deprescribing doesn’t happen by accident. It follows a clear clinical roadmap:

1. Identify potentially inappropriate medications. Use tools like the Beers Criteria, updated in 2023, to flag drugs that are risky for older adults-like long-term benzodiazepines, anticholinergics, or NSAIDs.
2. Decide if stopping is possible. Ask: Is this drug still helping? Is the risk greater than the benefit? For example, a statin for primary prevention in someone with 18 months to live may not be worth the side effects.
3. Plan how to taper. Never stop cold turkey. Some drugs, like antidepressants or steroids, need slow reduction over weeks or months to avoid withdrawal symptoms.
4. Monitor closely. Watch for changes in mood, sleep, pain, or function. Some symptoms return quickly. Others take time. Document everything.
5. Record the outcome. Did the patient feel better? Worse? No change? This data helps future decisions-not just for them, but for others too.

Key point: Only stop one drug at a time. If you cut three pills and the patient feels worse, you won’t know which one caused the problem.

What Does the Research Say About Outcomes?

Early studies focused on one thing: How many pills can we remove? The answer? A lot. A 2023 review in JAMA Network Open found that deprescribing interventions reduced the average number of medications from 9.74 to about 8.7 per person. That might sound small-but scale it up. A primary care doctor with 2,000 patients, half of them on multiple meds, could safely remove over 140 unnecessary prescriptions in a year.

But the real question isn’t how many pills disappear-it’s what happens to the person. Here’s what the data shows:

• Fewer falls: Stopping sedatives, antipsychotics, or blood pressure meds linked to dizziness cuts fall risk by up to 30% in some trials.
• Better mental clarity: Patients on multiple anticholinergics (common in allergies, bladder meds, and sleep aids) often report improved memory and focus after stopping.
• Lower hospital admissions: One study showed a 17% drop in ER visits after a structured deprescribing program in nursing homes.
• No increase in death rates: Despite fears, no major study has found that deprescribing increases mortality-even in frail elderly patients.

But here’s the catch: most studies only lasted 6 to 12 months. We still don’t know the full long-term impact. That’s why researchers like Dr. Dan Gnjidic call for larger, longer trials that track actual outcomes-like mobility, cognition, and survival-not just pill counts.

Why Don’t More Doctors Do This?

It’s not that they don’t want to. It’s that the system doesn’t make it easy.

• No time: A 15-minute visit doesn’t leave room to review 12 medications.
• No tools: Most electronic health records don’t flag potentially inappropriate drugs or suggest alternatives.
• No reimbursement: Insurance doesn’t pay for medication reviews unless they’re tied to a new diagnosis.
• Patient pressure: Many patients think more meds = better care. They’re scared to stop anything.

One study found that patients want to take fewer pills-but only if their doctor brings it up. Left to their own devices, most won’t ask. They assume their meds are all necessary.

What’s Changing Now?

The tide is turning. Here’s what’s new in 2025:

• Electronic health record alerts: Some clinics are testing tools that flag high-risk drug combinations and suggest deprescribing options during chart reviews. Pilot programs saw a 15% drop in inappropriate prescriptions.
• Pharmacist-led programs: In hospitals and community pharmacies, pharmacists are now trained to initiate deprescribing conversations-especially after discharge.
• Shared decision-making tools: Websites like deprescribing.org offer printable guides patients can bring to appointments. Over 500,000 have been downloaded since 2015.
• Genetic testing integration: Early research is exploring how drug metabolism genes (like CYP2D6 or CYP2C19) can help predict who’s more likely to have side effects from certain drugs, making deprescribing more personalized.

And it’s not just about cutting pills-it’s about shifting the mindset. Instead of asking, What drug should we add? the new question is: What drug can we safely remove?

What Patients Should Know

If you or a loved one is on multiple medications:

• Ask your doctor: “Is this still necessary?” Don’t wait for them to bring it up.
• Bring a full list of everything you take-including vitamins, supplements, and over-the-counter drugs.
• Ask: “What happens if I stop this?” and “What signs should I watch for?”
• Don’t stop anything on your own. Even “harmless” drugs like melatonin or ibuprofen can cause problems when stopped abruptly.
• Remember: A pill that helped five years ago might not help now. Your body, your health, and your goals have changed.

One woman in her late 70s stopped her daily blood pressure pill after her doctor explained her numbers were fine and the drug was making her dizzy. Within two weeks, she stopped falling. She didn’t need the pill anymore-but she’d been too afraid to ask.

The Bigger Picture

By 2030, one in five Americans will be over 65. That means more people on more meds. Without action, we’ll see more hospitalizations, more falls, more confusion-all tied to drugs meant to help.

Deprescribing isn’t about taking away care. It’s about restoring balance. It’s about giving people back their energy, their clarity, and their safety. It’s about treating medication like a tool-not a default.

The science is clear: stopping the wrong drugs can be just as important as starting the right ones. The challenge now is making it standard-not optional.

What Comes Next?

The future of deprescribing lies in making it routine-not rare. Health systems are starting to build it into care workflows: automated alerts in EHRs, pharmacist-led medication reviews, and patient education tools. The goal is simple: stop treating pills like a checklist, and start treating them like a conversation.

Medications aren’t harmless. They’re powerful tools-with risks. And sometimes, the most powerful thing you can do is not take one at all.