Medication Review and Deprescribing in Healthy Ageing

Key Takeaways

Medication review examines whether each medicine still has an indication, produces sufficient benefit, creates avoidable harm or burden, and fits the person's current goals; deprescribing is the supervised reduction or withdrawal that may follow. [1] [2]
Randomized evidence shows that structured interventions can reduce medication counts and potentially inappropriate medication use in older adults. [3] [4] [5]
Improved prescribing is not the same as demonstrated improvement in health. Effects on hospitalization, falls, quality of life, mortality, and other clinical outcomes are mixed or uncertain. [3] [6] [7]
Stopping a medicine can itself cause withdrawal, symptom recurrence, or loss of preventive benefit; gradual tapering, monitoring, and the option to restart are therefore part of the intervention rather than afterthoughts. [1] [4]

Who This Is Useful For

This page is for readers assessing medication review as a healthy-ageing intervention. It distinguishes the direct outcomes of changing a prescription list from broader claims about function, hospitalization, survival, or biological ageing, which require different evidence. [3] [6]

What Medication Review and Deprescribing Mean

A medication review reconstructs what a person actually takes, including prescribed, over-the-counter, and as-needed products, and links each item to an indication. It then considers current benefit, adverse effects, interactions, treatment burden, time to benefit, and the person's priorities. Deprescribing is not simply stopping medicines or reaching a low medication count; it is a planned process for medicines whose expected harms or burdens now outweigh their expected benefits. [1] [2]

The same medicine may be appropriate for one older adult and inappropriate for another. Diagnosis, symptom control, frailty, renal or hepatic function, competing treatments, remaining time to benefit, and preferences can change the balance. Explicit criteria can identify candidates for review, but they do not replace individualized clinical judgement or detect important undertreatment. [1] [8]

Evidence at a Glance

Outcome	What the Evidence Shows	Interpretation	Main Limitation
Medication burden	Multisite randomized trials and meta-analyses generally find fewer medicines or potentially inappropriate medicines after deprescribing interventions. [3] [4] [5]	The intervention can change prescribing behaviour and medication exposure. [3]	A smaller list is a process outcome, not proof of better health. [9]
Adverse effects and withdrawal	Some syntheses report fewer adverse drug reactions, while targeted withdrawal can produce symptoms that require monitoring or reversal. [4] [7]	Benefits and harms can both occur during medication change. [4] [7]	Definitions, ascertainment, drug classes, and follow-up differ across studies. [7]
Falls, hospital use, and quality of life	Across reviews, effects are inconsistent and often small or imprecise. [3] [6] [7]	Reducing inappropriate prescribing does not automatically change every downstream outcome. [9]	Trials may be too short or underpowered, and interventions are heterogeneous. [3] [6]
Mortality and longevity	An updated review found no overall mortality reduction from deprescribing polypharmacy in randomized studies, although selected patient-specific subgroups showed signals of benefit. [6]	Deprescribing is not established as a lifespan-extending intervention. [6]	Subgroup findings need cautious interpretation and may not generalize. [6]

Why the Balance Can Change With Age

Medication decisions made years earlier may become less suitable as diagnoses, physiology, function, treatment goals, and the rest of the regimen change. Multiple medicines also create more opportunities for interactions, cumulative adverse effects, duplicated therapy, and prescribing cascades. These are reasons to reassess the regimen, not evidence that polypharmacy is inherently inappropriate. [1] [2]

Preventive treatments pose a particular timing question. Their benefit may accumulate over years, whereas dizziness, bleeding, hypoglycaemia, sedation, inconvenience, or monitoring burden may occur sooner. A review makes this time horizon explicit, but the resulting decision remains specific to the medicine, indication, baseline risk, and individual priorities. [1] [2]

What Randomized Trials Show

D-PRESCRIBE enrolled 489 community-dwelling adults aged 65 years or older who used one of four potentially inappropriate medication classes. At six months, 43% in the pharmacist-led education group versus 12% under usual care had discontinued the targeted prescription. Withdrawal symptoms were reported by 29 of 77 participants who attempted to taper sedative-hypnotics, illustrating why successful discontinuation and symptom-free discontinuation are not identical outcomes. [4]

OPTI-SCRIPT combined pharmacist academic detailing, general-practitioner medication review, treatment algorithms, and patient information. It reduced potentially inappropriate prescribing in primary care, particularly inappropriate proton-pump inhibitor use, but the study was designed around prescribing outcomes rather than longevity. [5]

OPERAM tested a structured doctor-and-pharmacist review supported by decision software in 2,008 hospitalized older adults with multimorbidity and polypharmacy. Recommendations were implemented for many participants and inappropriate prescribing declined, but the intervention did not reduce first drug-related hospital admission over twelve months; falls and mortality also did not differ clearly. [9]

The Deprescribing Process

A commonly described process begins by verifying all current medicines and their purposes, estimating overall risk of medication-related harm, comparing expected benefit and burden for each medicine, prioritizing candidates with an unfavourable balance, and then implementing and monitoring a withdrawal plan. The sequence matters because a medication list may be incomplete and because a symptom after withdrawal may represent recurrence, a withdrawal effect, or an unrelated event. [1]

Some medicines can be stopped directly, while others require tapering to reduce withdrawal or rebound. Monitoring creates a feedback loop: the plan can be paused, revised, or reversed if the original indication returns or harms emerge. Shared decision-making is therefore a mechanism of safe implementation, not merely a preference survey. [1] [2]

Evidence Quality and Interpretation

Confidence is strongest that deprescribing programmes can reduce medication counts and potentially inappropriate medication use. A 2025 review restricted to multisite randomized studies in community-dwelling older adults rated this evidence as moderate certainty. [3]

Confidence is lower for broad clinical outcomes. Reviews combine interventions that differ in setting, personnel, targeting, intensity, and follow-up, and they combine populations ranging from relatively healthy community residents to frail care-home residents and acutely hospitalized patients. A neutral average can therefore conceal both ineffective programmes and benefits in selected contexts. [6] [7] [10]

Medication-related outcomes are easier to detect than falls, disability, hospital admissions, or death. The latter have many causes and generally require larger samples and longer follow-up. Consequently, evidence that a programme improves prescribing appropriateness should not be reported as evidence that it slows biological ageing or extends life. [3] [6] [9]

What This Does Not Mean

It does not mean that taking many medicines is automatically inappropriate; indication and benefit-harm balance matter more than a numerical threshold. [1] [2]
It does not mean that every medicine identified by a screening criterion should be stopped; such tools initiate review rather than determine the final decision. [8]
It does not mean that medication withdrawal is risk-free; tapering, follow-up, and reinstatement may be necessary. [1] [4]
It does not establish deprescribing as a treatment for biological ageing or a method of extending lifespan. [6] [9]

Practical Interpretation Examples

If a study reports fewer potentially inappropriate medicines: this supports improved prescribing quality, but clinical benefit must be assessed using separate patient outcomes. [3] [9]
If a medicine was appropriate when started: later changes in health, goals, co-medication, or time to benefit can still justify reassessment. [1] [2]
If symptoms appear during a taper: they do not by themselves show that deprescribing is always harmful or that the medicine must always continue; they require clinical interpretation and adjustment of the plan. [1] [4]

References

Scott, I. A. et al. "Reducing inappropriate polypharmacy: the process of deprescribing." JAMA Internal Medicine (2015). https://pubmed.ncbi.nlm.nih.gov/25798731/
Hoel, R. W., Giddings Connolly, R. M. & Takahashi, P. Y. "Polypharmacy Management in Older Patients." Mayo Clinic Proceedings (2021). https://pubmed.ncbi.nlm.nih.gov/33413822/
Linsky, A. M. et al. "Deprescribing in Community-Dwelling Older Adults: A Systematic Review and Meta-Analysis." JAMA Network Open (2025). https://pubmed.ncbi.nlm.nih.gov/40338546/
Martin, P. et al. "Effect of a Pharmacist-Led Educational Intervention on Inappropriate Medication Prescriptions in Older Adults: The D-PRESCRIBE Randomized Clinical Trial." JAMA (2018). https://pubmed.ncbi.nlm.nih.gov/30422193/
Clyne, B. et al. "Effectiveness of a Multifaceted Intervention for Potentially Inappropriate Prescribing in Older Patients in Primary Care: A Cluster-Randomized Controlled Trial (OPTI-SCRIPT Study)." Annals of Family Medicine (2015). https://pubmed.ncbi.nlm.nih.gov/26553894/
Quek, H. W. et al. "The effect of deprescribing interventions on mortality and health outcomes in older people: An updated systematic review and meta-analysis." British Journal of Clinical Pharmacology (2024). https://pubmed.ncbi.nlm.nih.gov/39164070/
Zhou, D., Chen, Z. & Tian, F. "Deprescribing Interventions for Older Patients: A Systematic Review and Meta-Analysis." Journal of the American Medical Directors Association (2023). https://pubmed.ncbi.nlm.nih.gov/37582482/
O'Mahony, D. et al. "STOPP/START criteria for potentially inappropriate prescribing in older people: version 2." Age and Ageing (2015). https://pubmed.ncbi.nlm.nih.gov/25324330/
Blum, M. R. et al. "Optimizing Therapy to Prevent Avoidable Hospital Admissions in Multimorbid Older Adults (OPERAM): cluster randomised controlled trial." BMJ (2021). https://pubmed.ncbi.nlm.nih.gov/34257088/
Kua, C. H., Mak, V. S. L. & Huey Lee, S. W. "Health Outcomes of Deprescribing Interventions Among Older Residents in Nursing Homes: A Systematic Review and Meta-analysis." Journal of the American Medical Directors Association (2019). https://pubmed.ncbi.nlm.nih.gov/30655193/

Educational Disclaimer

This page summarizes population-level research and does not provide an individual medication review or medical advice. Medicines should not be stopped or reduced solely on the basis of this page. Appropriate decisions and tapering schedules depend on the medicine, indication, dose, duration, health history, treatment goals, and clinical monitoring.