Medicine
Pharmacists' Role in Deprescribing in Frail Older Adults
Quick fact
In frail older adults, deprescribing programmes can reduce medication burden and potentially inappropriate medicines, but evidence for consistent reductions in falls, hospital admissions or mortality remains limited. Each change must be individualised and monitored.
Why this is interesting
An older person can accumulate prescriptions from years of treatment until the medicines themselves become a source of burden. Which drugs still help, and how can the rest be reduced safely?
Read the full explanation
Understanding Pharmacists' Role in Deprescribing in Frail Older Adults
Deprescribing is a planned, supervised process, not simply throwing medicines away. A pharmacist first helps build an accurate list of everything the person uses, including non-prescription products, and checks the indication, dose, duration, interactions and likely benefit of each item. Frailty, kidney or liver function, symptoms, life expectancy and the person's own goals can change the balance between benefit and harm. The pharmacist can flag duplication, medicines without a current indication, high-risk combinations and treatments whose time to benefit no longer fits the care goal. Decisions are then made with the patient or representative and the prescriber. Some medicines can be stopped directly; others require tapering to reduce withdrawal or rebound effects. The team agrees what to monitor and when to review. A medicine may be restarted if symptoms return or the expected benefit was underestimated. The pharmacist's value lies in systematic medication expertise and follow-up within a shared clinical decision, not in independently stopping every medicine that appears on a checklist.
A deeper explanation
A structured deprescribing review combines evidence with the circumstances of one patient. Medication reconciliation establishes what is actually being taken. For each medicine, the team asks whether there is a current indication, whether it is achieving a meaningful goal, how large and how soon the expected benefit is, and what harms arise from the drug itself or from interactions. Frail people may be more sensitive to sedation, low blood pressure, bleeding, anticholinergic effects and changes in drug clearance, but a useful medicine should not be removed merely because the list is long. Pharmacists can apply explicit tools for potentially inappropriate prescribing, examine renal dosing and interactions, and identify medicines needing a taper. They also help explain options in plain language and create a monitoring plan with the patient, carers and prescriber. Changes are commonly prioritised one at a time so that new symptoms can be interpreted. Evidence reviews in older adults living with frailty suggest that deprescribing is feasible and can reduce medicine counts or potentially inappropriate medicines without a clear increase in hospitalisation or mortality in the limited studies available. However, the evidence base is small and heterogeneous, and improvements in falls, function or other major outcomes are not guaranteed. Safe deprescribing is therefore an iterative clinical process: agree goals, change cautiously, monitor, and revise the plan.