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

Why Reducing Medications Isn’t Just Stopping Pills

Most people assume taking more pills means better health. But for older adults on five, ten, or even fifteen medications, that belief can be dangerous. Deprescribing isn’t about cutting corners-it’s about removing drugs that no longer help, or worse, hurt. It’s the opposite of prescribing: instead of adding something new, you carefully take something away. And research shows this isn’t just theoretical. Real people, in real clinics, are getting safer and feeling better when unnecessary meds are stopped.

The Problem: Too Many Pills, Too Little Benefit

In the U.S., about 40% of adults over 65 take five or more prescription drugs. One in five take ten or more. Many of these medications were started years ago-for high blood pressure, cholesterol, acid reflux, or sleep-and never re-evaluated. The problem? As people age, their bodies change. Kidneys slow down. Liver function drops. The brain becomes more sensitive to side effects. A drug that once helped now causes dizziness, confusion, or falls. And when you stack ten drugs together, the risks multiply.

One study found that older adults on polypharmacy are twice as likely to be hospitalized for adverse drug reactions. Some of these drugs are preventive-like statins or aspirin for heart disease-but if someone has advanced dementia or a life expectancy under two years, those benefits vanish. The risks, however, stay the same. That’s why deprescribing is no longer optional. It’s a necessary part of care.

How Deprescribing Actually Works

Deprescribing isn’t a one-time decision. It’s a five-step process, done slowly and carefully:

1. Identify potentially inappropriate medications. This means drugs with known risks in older adults, like benzodiazepines for sleep, proton pump inhibitors used long-term, or anticholinergics for overactive bladder.
2. Determine if the drug can be stopped or reduced. Not every pill can come off. But many can. For example, a patient on a low-dose statin with no history of heart disease and a life expectancy of less than five years may not need it anymore.
3. Plan a taper. Some drugs can’t be stopped cold turkey. Antidepressants, blood pressure meds, and steroids need gradual reduction to avoid withdrawal symptoms like rebound anxiety, high blood pressure, or adrenal crisis.
4. Monitor closely. After stopping a drug, patients are checked weekly for the first month. Did their pain get worse? Did they sleep better? Did they fall? Did their confusion clear up?
5. Document everything. What was stopped? Why? What happened? This becomes part of the medical record and helps future providers avoid restarting unnecessary meds.

This isn’t guesswork. It’s clinical protocol-same rigor as starting a new drug. And it requires teamwork: doctors, pharmacists, nurses, and patients all play a role.

What the Research Shows: Real Outcomes, Not Just Numbers

Early studies focused on how many pills were cut. That’s easy to measure. But the real question is: did patients feel better? Did they fall less? Did they live longer?

A 2023 review in JAMA Network Open analyzed 37 trials involving over 10,000 older adults. The results? On average, deprescribing reduced the number of medications by one per person. Sounds small? Consider this: a primary care doctor with 2,000 patients, half of whom are on multiple meds, could prevent 140 unnecessary prescriptions in a year. That’s not just a number-it’s 140 fewer chances for a dangerous interaction, a fall, or an ER visit.

And the benefits go beyond pills. Studies show deprescribing leads to:

• Reduced risk of falls (by up to 30% in some trials)
• Improved mental clarity and alertness
• Fewer hospital admissions
• Higher patient satisfaction

One study followed patients who stopped long-term proton pump inhibitors (PPIs) for heartburn. Within weeks, many reported less bloating, less nausea, and better digestion. Others stopped sleeping pills and found they slept more naturally-without the grogginess that made them stumble in the morning.

The Big Gap: We Still Don’t Know Enough

Here’s the problem: most deprescribing studies last only a few months. But the effects of stopping a drug can take longer to show-or to hide. What if stopping a blood pressure pill causes a stroke six months later? What if a patient’s depression returns after stopping an antidepressant? We don’t have long-term data.

Dr. Dan Gnjidic, a leading researcher in this field, says it plainly: “We’ve shown we can reduce medications. But we haven’t yet proven, with strong evidence, that this reduces deaths or major events like heart attacks.” That’s the next frontier. Researchers are now launching multi-year trials to track outcomes like hospitalization, mobility, cognitive decline, and survival-not just pill counts.

Another blind spot? Patients with multiple doctors. If someone sees a cardiologist, a neurologist, a rheumatologist, and a primary care provider, each might prescribe something without knowing what the others ordered. That’s why coordinated care is critical. Some health systems are now using digital alerts in electronic records to flag patients on high-risk drug combinations. Early pilot programs cut inappropriate prescriptions by 15%.

Patients Want This-But They Wait for the Doctor to Start the Conversation

Here’s something surprising: most older adults would gladly take fewer pills-if they felt safe doing it. But they rarely bring it up. Why? Because they’ve been taught to trust their doctor’s prescriptions. If a pill was given to them, it must be necessary. They don’t want to seem difficult or ungrateful.

One study found that 80% of patients over 70 had never been asked if they wanted to reduce their medications. Yet when doctors asked, 70% said yes. The key? How the question is asked. Saying, “We might be able to take some of these off and help you feel better,” works far better than, “Are you ready to stop your meds?”

Resources like deprescribing.org have helped. They offer simple handouts patients can read at home: “Medications that helped before might not help now.” That’s all it takes to start the conversation.

What’s Next? Personalized Deprescribing

The future of deprescribing isn’t one-size-fits-all. It’s becoming more precise. Researchers are exploring how genetics affect drug metabolism. For example, some people break down benzodiazepines slowly-making them more prone to confusion and falls. Genetic testing could one day help identify who’s at highest risk from certain drugs.

Another promising area: AI tools that scan a patient’s entire medication list and flag the most likely candidates for reduction. One pilot program at a large U.S. clinic used an algorithm to recommend deprescribing for 120 patients. Within six months, 68% of those recommendations were followed-and only 3% needed to restart the medication due to side effects.

As the population ages, this won’t be a niche practice. By 2030, 20% of Americans will be over 65. That’s 72 million people. Most will be on multiple medications. Without deprescribing, we’ll see more falls, more confusion, more hospital stays-and higher costs.

It’s Not About Cutting Costs. It’s About Cutting Harm.

Some think deprescribing is just a way to save money. It’s not. It’s about safety. About dignity. About letting people live well, not just live longer.

Stopping a drug isn’t failure. It’s good medicine. It’s saying, “We’ve done what we can. Now let’s make sure what’s left truly helps you.”