What is deprescribing?

Deprescribing is the process of supervised reduction of medications, or stopping them altogether, when they are no longer of benefit to the patient or even doing more harm than good. This is often the case with elderly patients as their needs change over time and they become frail or develop cognitive issues. Elderly patients tend to be the heaviest users of medications, and in such instances it is important for health care teams to consider health priorities and whether potential side effects outweigh the benefits.

Over 90% of people aged 65 and over take at least one prescription medicine, and nearly 50% use five or more drugs. The higher a medication load, the more likely there is to be an occurrence of an adverse effect due to interactions between medications. There is growing evidence that reducing the amount of medication taken by older patients reduces the risk of falls and decreased cognition.

There are also financial benefits to deprescribing. Even in countries such as Australia where prescription medicines are heavily subsidised, consumers still experience some out of pocket expenses. Consumers themselves are often the reason for unnecessary medications to be continued. Patients feel benefits from medication which may initially be intended for short-term use to address symptoms and want to continue receiving those benefits. It is particularly difficult to encourage patients to reduce or cease taking a medication if they believe the drugs are providing pain-relief, improving function or prolonging life.
Many different types of prescription medicines spilled onto a table

In extreme cases patients can become addicted and require specialised healthcare treatment to be weaned, often through referral to a drug and alcohol service. Deprescribing is more likely to be successful if patients are cooperative. Patients and / or their carers also need to understand the importance of being monitored by their doctor during any reduction or cessation trial in order for effects to be observed and measured.
GPs are encouraged to review the medications their patients are taking regularly to ensure all are still necessary. Some patients do not attend the same medical centre or see the same doctor each visit and consequently new medications may have been described which are not in the patient’s history. Additionally patients are often discharged from hospital with a range of short-term medications and these should be reviewed by their regular family doctor.

Prescribers, such as GPs and specialists, can sometimes be confused by the process as some medicines can be stopped abruptly without implications whereas others require slowly tapering. Treatment guidelines are often based on trials in younger people and may not apply to elderly patients or those with multiple health conditions. Information is available from various sources including on how to recognise when medications can be ceased and how to undertake the process of deprescribing safely.