Polypharmacy drives falls, delirium, hospitalisation and drug interactions in older adults, and the medication list grows by accretion unless someone actively prunes it. Deprescribing is a core geriatric skill, not an afterthought.
Review the full list, including over-the-counter and herbal products, at every visit, and apply an explicit tool such as STOPP/START. Target the highest-risk drugs first: benzodiazepines and Z-drugs, strongly anticholinergic agents, long-term proton-pump inhibitors without indication, and NSAIDs, and tally the cumulative anticholinergic burden. Deprescribe one drug at a time, taper where withdrawal effects are expected, and monitor.
Anchor every decision to the patient's goals and prognosis: a drug for long-term prevention may no longer serve someone with limited life expectancy, while symptom relief stays a priority. Document the reason for each change so the next clinician does not simply restart it.
- Review the full medication list, including over-the-counter and herbal products, at every visit.
- Apply an explicit tool such as STOPP/START and tally the anticholinergic burden.
- Target benzodiazepines, Z-drugs, anticholinergics, long-term proton-pump inhibitors and NSAIDs first.
- Deprescribe one drug at a time, taper where needed, and align decisions with goals and prognosis.
Why it matters
Unchecked polypharmacy is a leading, modifiable cause of falls, delirium and hospitalisation in older adults.
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