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

Every year, millions of older adults take medications that no longer help them-and may be hurting them. It’s not laziness or neglect. It’s the quiet buildup of prescriptions over decades: a pill for acid reflux, another for sleep, one for blood pressure, a painkiller, an antidepressant, maybe even an antipsychotic for agitation. Over time, these add up. Five, seven, ten pills a day. And with each new medication, the risk of side effects, falls, confusion, and hospital stays grows. This isn’t normal aging. It’s polypharmacy-and it’s a silent crisis in older healthcare.

What Is Deprescribing? It’s Not Just Stopping Pills

Deprescribing isn’t about cutting drugs randomly. It’s a careful, step-by-step process to stop or lower doses of medicines that are no longer doing more good than harm. Think of it like cleaning out a medicine cabinet you haven’t looked at in 10 years. Some things are still useful. Some are expired. Some never should’ve been there in the first place.

The idea took shape in the early 2010s, led by researchers in Canada like Barbara Farrell and Cara Tannenbaum. Today, deprescribing.org is the go-to hub for evidence-based guidelines. These aren’t opinions. They’re built from clinical trials, expert reviews, and real patient outcomes. The goal? Reduce side effects, improve quality of life, and avoid hospital trips caused by drug reactions.

Who Benefits Most From Deprescribing?

It’s not just for people in nursing homes. It’s for anyone over 65 taking five or more medications-especially if they’ve got multiple chronic conditions like diabetes, heart disease, arthritis, or dementia. About 40% of older adults globally are on too many drugs, according to the World Health Organization. And in the U.S., one in three hospital admissions for seniors is linked to medication problems.

Some groups are at higher risk:

• People who see multiple doctors (each prescribing their own meds)
• Those with memory issues or who struggle to manage pill schedules
• Patients on long-term proton-pump inhibitors (PPIs) for heartburn
• Older adults taking benzodiazepines for sleep or anxiety
• Those on opioids for chronic pain without clear benefit

The American Geriatrics Society’s 2023 Beers Criteria lists 34 medications that are often inappropriate for older adults. But here’s the catch: only 12 of those have clear, step-by-step deprescribing plans. That leaves a lot of uncertainty for doctors.

The Five Best-Understood Medication Classes for Deprescribing

Not all drugs are equal when it comes to safely reducing them. Five classes have solid, tested frameworks:

1. Proton-pump inhibitors (PPIs) - Like omeprazole or pantoprazole. Many take these for years for heartburn, but most don’t need them long-term. The guideline: check if you still have symptoms. If not, try cutting the dose by half, then stop over 4-8 weeks. Watch for rebound acid, but it’s usually mild and short-lived.
2. Benzodiazepines and sleep aids - Drugs like lorazepam, diazepam, or zolpidem. These increase fall risk and confusion. The plan: slowly reduce by 10-25% every 1-2 weeks. Replace with sleep hygiene, not another pill. Studies show most patients adjust well.
3. Antipsychotics - Often prescribed for dementia-related agitation. But they raise stroke risk and can cause stiffness or tremors. Guidelines say: try non-drug approaches first-music therapy, routines, calming environments. If meds are still needed, reduce to the lowest possible dose.
4. Antihyperglycemics - Blood sugar pills like sulfonylureas (glyburide) or insulin. In older adults with limited life expectancy, tight blood sugar control can cause dangerous lows. The fix: aim for less strict targets. Switch to safer drugs like metformin if possible.
5. Opioid painkillers - For chronic pain without clear benefit. These can cause dizziness, constipation, and addiction. Taper slowly: reduce by 10% every 1-4 weeks. Combine with physical therapy or acupuncture. Many patients report feeling clearer-headed after stopping.

These aren’t guesses. They’re based on trials like the 2023 JAMA Internal Medicine study that tested the Shed-MEDS framework. Patients on this plan lost an average of 1.8 medications-without more falls, confusion, or ER visits.

How Deprescribing Works in Practice: The Shed-MEDS Steps

One of the most reliable frameworks is Shed-MEDS. It’s simple, practical, and used in hospitals and clinics across North America. Here’s how it works:

1. Best Possible Medication History - Get every pill, supplement, and OTC drug on paper. Ask the patient. Check pharmacy records. Don’t assume.
2. Evaluate - For each drug, ask: Is it still helping? Is the risk worth it? Is there a better alternative? Use tools like STOPP/START criteria or Beers Criteria to guide you.
3. Deprescribing Recommendations - Pick one or two meds to target first. Start with the highest risk or lowest benefit. Create a taper plan. Don’t rush.
4. Synthesis - Share the plan with the patient. Explain why. Get their input. Write it down. Schedule follow-up.

This isn’t a one-time visit. It’s a conversation that happens over weeks or months. And it works best when pharmacists are involved. Studies show deprescribing success rates jump 35-40% when a pharmacist leads the process.

Why Isn’t Everyone Doing This?

You’d think this would be standard. But here’s the reality:

• Most doctors have 7-10 minutes per patient. Deprescribing takes 30-45 minutes the first time.
• Electronic health records don’t help. They remind you to prescribe, not to stop.
• Patients are scared. ‘I’ve taken this for 15 years-what if I get worse?’
• Guidelines exist for five drug classes. There are over 500 combinations without clear rules.

A 2022 Canadian study found only 15% of primary care clinics had formal deprescribing protocols. In the U.S., just 28% of practices use them. In Canada, where the DIGE program is national, it’s 63%. The difference? Training, time, and support.

What Patients Really Think

When asked, most older adults welcome fewer pills. A 2022 study found 65% felt more in control and less overwhelmed. One woman said, ‘I used to spend my mornings counting pills. Now I just drink coffee.’

But 22% felt anxious. ‘What if my pain comes back?’ ‘What if I can’t sleep?’ That’s why education matters. Patients need to know: this isn’t abandonment. It’s a smarter way to care.

Pharmacists report success: ‘I tapered 18 out of 22 patients off benzodiazepines. Only two had mild withdrawal. They all slept better without the fog.’

What’s Changing in 2025?

Deprescribing is moving from a niche idea to mainstream care.

• The American Medical Association adopted its first deprescribing policy in June 2024, saying doctors should ‘routinely assess’ all medications.
• Medicare will start measuring deprescribing as part of physician pay in 2026.
• The FDA has funded over $8 million in research since 2020 to build new guidelines-for antidepressants, anticoagulants, and more.
• AI tools are being tested to scan EHRs and flag drugs that might be safe to stop.

By 2030, experts predict deprescribing checks will be as routine as checking blood pressure during annual wellness visits.

How to Start Deprescribing-Even If You’re Not a Doctor

You don’t need to be a clinician to help. Here’s what you can do:

• Ask your doctor or pharmacist: ‘Are all these meds still necessary?’
• Bring a full list of everything you take-including vitamins, herbs, and OTC drugs.
• Ask: ‘What’s the goal of this medicine? Has it helped lately?’
• Don’t stop anything cold turkey. Always ask for a taper plan.
• Use deprescribing.org’s free tools to see if your meds are on their list.

If you’re a caregiver, help track symptoms after a dose reduction. Did the patient sleep better? Walk steadier? Feel less foggy? Write it down. That’s the data doctors need.

The Big Picture: Safer, Simpler, Smarter Care

Deprescribing isn’t about saving money-though it does. A 2023 study found for every $1 spent on deprescribing programs, $3.20 was saved in reduced hospital stays and medication costs.

It’s about dignity. About not living in a fog of pills. About giving people back their energy, their balance, their peace of mind.

The science is clear: reducing unnecessary medications cuts side effects, prevents falls, and improves life quality-without increasing risk.

The challenge now? Making it normal. Making it easy. Making it part of every older adult’s care plan.

It’s not about taking pills away. It’s about giving people back their health.