Deprescribing Frameworks: How to Safely Reduce Medications and Cut Side Effects

Every year, millions of older adults take more medications than they need. Some of these drugs were prescribed years ago for conditions that no longer exist. Others were meant to treat short-term problems but became long-term habits. And many are causing more harm than good-dizziness, confusion, falls, stomach bleeds, even hospital stays. The answer isn’t always to add another pill. Sometimes, it’s to stop one.

What Is Deprescribing, Really?

Deprescribing isn’t just quitting drugs. It’s a careful, step-by-step process of reviewing every medication a person takes and deciding which ones can be safely stopped. The goal? Reduce side effects, lower the risk of dangerous interactions, and improve quality of life-without sacrificing health.

This approach became a formal clinical strategy around 2010, led by researchers in Canada who saw how often older patients were drowning in pills. Today, it’s backed by solid evidence: deprescribing reduces medication burden without increasing hospitalizations or deaths. In fact, studies show patients often feel better after stopping unnecessary drugs.

It’s not about cutting corners. It’s about being smarter. Just like you wouldn’t start a drug without a reason, you shouldn’t keep taking one without checking if it still makes sense.

Why So Many People Are Taking Too Many Medications

Most people don’t end up on 10 or 12 pills by accident. It happens slowly. A patient gets a prescription for acid reflux. Then a sleep aid. Then a painkiller. Then a cholesterol drug. Each one makes sense on its own. But together? They pile up.

By age 65, nearly 40% of adults globally are taking five or more medications-a condition called polypharmacy. For those with chronic illnesses like diabetes, heart disease, or arthritis, it’s even higher. And here’s the problem: the more pills you take, the higher your chance of a bad reaction.

One major study found that inappropriate polypharmacy contributes to 30% of hospital admissions in people over 65. Many of those admissions could have been avoided if someone had looked back at the list and asked: “Do we still need this?”

Doctors aren’t ignoring the issue. They’re just overwhelmed. A typical primary care visit lasts 7 to 10 minutes. That’s not enough time to review 12 medications, check for interactions, talk to the patient about their goals, and decide what to stop.

The Five Key Medication Classes Targeted by Deprescribing

Not all drugs are equally risky. Deprescribing frameworks focus on five classes where the harm often outweighs the benefit, especially in older adults:

• Proton-pump inhibitors (PPIs) - Used for heartburn, but many take them for years without a clear reason. Long-term use raises risk of bone fractures, kidney damage, and infections.
• Benzodiazepines and sleep aids - These can cause drowsiness, memory loss, and falls. Many older adults take them for insomnia, but non-drug options like sleep hygiene work better and safer.
• Antipsychotics - Sometimes prescribed for agitation in dementia, even though they increase stroke risk and don’t fix the root problem.
• Antihyperglycemics - Blood sugar drugs like sulfonylureas can cause dangerous low blood sugar in older adults, especially if their diabetes is well-controlled or they’re not eating much.
• Opioid painkillers - Often continued long after acute pain has healed, leading to dependence, constipation, and confusion.

Each of these has a clear, evidence-based deprescribing pathway. For example, the PPI guideline says: check if the original reason still exists, try reducing the dose gradually over 4 to 8 weeks, and monitor for rebound symptoms. No sudden stops. No guesswork.

How Deprescribing Works: The Shed-MEDS Framework

One of the most proven methods is called Shed-MEDS. It’s a simple four-step system used in hospitals and clinics:

1. Best Possible Medication History - Get the full list from the patient, family, pharmacy records, and past charts. Don’t trust memory.
2. Evaluate - Use tools like STOPP/START criteria or the Beers Criteria to flag drugs that are risky or unnecessary.
3. Deprescribing Recommendations - Decide which meds can be stopped, tapered, or switched. Prioritize the highest-risk ones first.
4. Synthesis - Put it all together with the patient. Explain why you’re making these changes and what to watch for.

A 2023 clinical trial showed this method reduced the average number of medications per patient from 11.3 to 9.5 at discharge-and kept it low 90 days later. Crucially, there was no increase in bad outcomes. No more falls. No more ER visits. Just fewer pills and better function.

Who Should Lead Deprescribing? Pharmacists Are Key

Doctors can’t do it alone. The most successful deprescribing programs involve pharmacists-specifically those trained in medication therapy management (MTM). These pharmacists spend hours reviewing charts, talking to patients, and coordinating with prescribers.

Studies show deprescribing success rates jump 35% to 40% when pharmacists are involved. Why? They have the time. They’re trained to spot hidden risks. They know how to taper safely.

But here’s the catch: only 28% of U.S. primary care practices have formal deprescribing protocols. In Canada, where a national program called DIGE has been running since 2018, the number is 63%. The difference? System support.

Successful programs don’t rely on one overworked doctor. They build teams: pharmacists, nurses, physicians, and patients working together. They use electronic health record alerts that flag high-risk meds. They train staff to ask: “When was this last reviewed?”

What Patients Say About Stopping Medications

Many patients are scared to stop pills they’ve taken for decades. “This is what my doctor told me to take,” they say. “What if I get sick without it?”

A 2022 study found that 65% of older adults felt relieved after reducing their medications. They slept better, had less stomach upset, and felt less confused. But 22% felt anxious-especially about stopping sleep aids or heart meds.

The key? Communication. Don’t just hand someone a list of drugs to quit. Sit down. Explain why. Show them the evidence. Let them ask questions. Reassure them that stopping doesn’t mean giving up care-it means getting smarter care.

One pharmacist in Ohio reported tapering 18 out of 22 patients off benzodiazepines over six months. Only two had mild withdrawal symptoms-and those were managed quickly. “They thanked me afterward,” she said. “They said they finally felt like themselves again.”

Barriers to Getting It Done

Even with strong evidence, deprescribing is still rare in many clinics. Why?

• Time - Most visits are too short for deep medication reviews.
• Tools - Only 32% of clinicians feel their EHR systems help them identify deprescribing opportunities.
• Guidelines - Out of 3,569 recommendations in major clinical guidelines, only 7% mention deprescribing. Most still focus on adding drugs, not removing them.
• Training - Medical schools barely teach deprescribing. Most doctors learned to prescribe, not to stop.

There’s also fear. Some worry stopping a drug will cause harm. But the data says otherwise. In the same trial that showed medication reductions, the rate of adverse events was nearly identical between those who deprescribed and those who didn’t.

Dr. Amy Gravely put it best: “Deprescribing is not simply stopping medications-it’s a structured clinical process that requires the same rigor as initiating therapy.”

What’s Changing in 2025 and Beyond

The tide is turning. In June 2024, the American Medical Association issued its first policy urging physicians to routinely review all medications. Starting in 2026, Medicare will start measuring deprescribing as part of provider performance ratings.

The FDA has funded over $8 million in deprescribing research since 2020. The European Union now lists it as a top priority. And researchers are working on AI tools that scan EHRs and flag drugs that should be reconsidered.

By 2030, experts predict deprescribing assessments will be as routine as checking blood pressure. The goal? A 40% drop in medication-related hospitalizations among older adults.

But there’s still a gap. Of the 500+ common medication combinations used in older adults, less than half have clear deprescribing guidance. That’s where the next wave of research is headed.

Where to Start: Free Tools for Clinicians and Patients

You don’t need fancy software to begin deprescribing. These free, evidence-based resources are ready to use today:

• deprescribing.org - Offers step-by-step algorithms for PPIs, benzodiazepines, antipsychotics, and more. Downloadable, printable, and easy to follow.
• STOPP/START Criteria (Version 3, 2021) - A checklist to identify potentially inappropriate prescriptions and missed opportunities for needed drugs.
• Beers Criteria (2023 Update) - Lists 34 medications to avoid or use with caution in older adults. Updated every two years by the American Geriatrics Society.

These aren’t just guidelines. They’re safety nets. Use them to start conversations-not to dictate decisions, but to guide them.

Final Thought: Less Is Sometimes More

Medicine has gotten really good at adding treatments. Now it’s time to get good at removing them. Deprescribing isn’t about cutting corners. It’s about cutting clutter.

For older adults, fewer pills often mean more energy, fewer falls, clearer thinking, and better days. It’s not about living longer. It’s about living better.

Ask yourself: Is this medication still helping? Or is it just another thing to manage? Sometimes, the most powerful prescription is the one you don’t take.