Patient handout

Deprescribing in older adults

PRODUCTION

1. Your condition

This handout is for deprescribing in older adults. Your care team identified this based on: >=5 chronic medications — polypharmacy / medication-optimization trigger (o'mahony age ageing 2023).

Other reasons your team may use this plan: beers-listed / stopp-flagged / high-anticholinergic medication on review (ags beers 2023); limited life expectancy / advanced frailty / goals-of-care shift — time-to-benefit reassessment (scott jama intern med 2015); suspected adverse drug event, prescribing cascade, or drug-related fall/delirium (reeve br j clin pharmacol 2014).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
best_possible_medication_history	—	—	—	Reconcile ALL prescribed + OTC + supplement + PRN + topical + inhaled drugs with dose/duration/prescriber/adherence and the active indication for each (Scott JAMA Intern Med 2015)
capture_otc_and_supplements	—	—	—	OTC NSAIDs, sedating antihistamines, PPIs, and herbals/vitamins are routinely omitted yet high-yield targets (Reeve Br J Clin Pharmacol 2014)

Plan: Deprescribing — Scott/Reeve 5-step (reconcile → identify PIM → benefit-risk-in-context → prioritize+SDM → class-specific taper → iterate)

3. When to call your provider

Contact your care team if any of the following happen:

Abrupt-withdrawal symptoms (benzodiazepine/opioid/beta-blocker/clonidine) → restart lowest effective dose, restart taper, escalate setting if unstable (AGS Beers 2023)
Disease destabilization after deprescribing → re-prescribe, reassess indication (Scott JAMA Intern Med 2015)
Drug-related delirium / fall with injury / severe hypoglycemia → urgent assessment, hold offending agents (AGS Beers 2023)

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

High-withdrawal-risk drug (benzodiazepine, opioid, beta-blocker, clonidine, corticosteroid, SSRI/SNRI, gabapentinoid, levodopa) stopped abruptly rather than tapered (Reeve Br J Clin Pharmacol 2014)(life-threatening)
Original disease destabilizes after a drug was stopped (e.g. HF decompensation after diuretic stop, angina after beta-blocker stop, hyperglycemic crisis after antihyperglycemic stop) (Scott JAMA Intern Med 2015)
Benzodiazepine withdrawal (tremor, autonomic instability, seizure) or opioid withdrawal (agitation, autonomic, GI) emerging during a taper (AGS Beers 2023)
Acute delirium or fall with injury attributable to anticholinergic / sedative / opioid / antihypertensive burden in an older adult (AGS Beers 2023)

5. Follow-up

Iterative re-review at every visit and care transition; update advance care planning / goals of care; palliative deprescribing at end of life; caregiver communication tools + updated medication list; schedule next structured medication review (NICE NG5 medicines optimisation)

6. Sources

Guideline: US Deprescribing Research Network / Scott JAMA Intern Med 2015 5-step + STOPP/START v3 (O'Mahony 2023) + AGS Beers 2023 + NICE medicines optimisation