Every medication an older adult takes should justify its place at each review, because the balance of benefit and harm shifts with age, falling renal function and competing priorities. Treat deprescribing as a routine step, not an afterthought reserved for a crisis.
Use an explicit tool — STOPP/START or the Beers criteria — to catch the usual culprits: anticholinergics and sedatives that worsen falls and cognition, proton-pump inhibitors continued without indication, and drugs duplicating one another's effect. De-escalate medicines whose acute indication has passed, and align what remains with the patient's own goals and realistic life expectancy.
This is established geriatric practice, and it is the habit that connects today's findings — the potent antiplatelet that can be eased, the steroid whose cumulative dose accrues harm — into one principle: keep reviewing whether each drug still earns its place.
- Review every older adult's full medication list for deprescribing at each visit, not only in crises.
- Apply STOPP/START or Beers criteria to flag anticholinergics, sedatives, unneeded proton-pump inhibitors and duplicates.
- De-escalate drugs whose acute indication has passed and stop those without a current goal-aligned reason.
- Match the remaining regimen to the patient's goals and realistic life expectancy.
Why it matters
The benefit–harm balance of most drugs shifts with age, so a regimen that was right once quietly becomes wrong without review.
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