Polypharmacy is the thread running through falls, delirium, hospital admissions and functional decline in older people, and the single highest-yield habit is a deliberate, recurring medication review rather than a renew-everything repeat prescription.
At review, reconcile the full list against current goals, and look specifically for the usual culprits: anticholinergics, sedative-hypnotics, drugs that drop blood pressure or cause hypoglycaemia, and anything whose original indication has passed. A validated tool such as STOPP/START or the Beers criteria helps structure the search.
Deprescribe one agent at a time, with a taper and a monitoring plan where withdrawal effects are possible, and tell the patient why. In a frail older adult, stopping the wrong drug prevents more harm than starting a new one.
- Run a structured medication review at review visits, not a renew-everything repeat.
- Target anticholinergics, sedatives, blood-pressure-lowering and hypoglycaemic drugs, and lapsed indications.
- Use a validated tool such as STOPP/START or the Beers criteria to structure it.
- Deprescribe one drug at a time with a taper and monitoring, and explain why.
Why it matters
Polypharmacy drives falls, delirium and admissions in older people, and a deliberate medication review prevents more harm than most new prescriptions.
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