Adults who are residing in long-term care (LTC) facilities tend to use several medicines every day, a condition referred to as polypharmacy. Concerning these medications, some are vital and others end up being dispensable or outright dangerous. This process has been referred to as potentially inappropriate prescribing (PIP) and has been a prevalent distress that jeopardizes the health of the seniors and strain the healthcare budgets. But a radical Canadian study recently published in JAMA Network Open in May 2025 presents a scalable and technology-enabled solution, electronic decision support tools to deprescribe.
The Problem: Long-Term Care Puts Elderly on Overmedication
The problem of polypharmacy is endemic in the LTC homes whose residents tend to have multiple, overlapping comorbidities. Most drugs could be superseded, redundant or be taken in order to control side effects of other drugs, which has the effect of a downward spiral that results in without exclusion unreasonable pill burden.
The presented study discovered:
A total of 67-88 percent LTC residents had one or more potentially inappropriate medications (PIMs).
Popular PIMs were proton pump inhibitors, sedatives, antipsychotics and opioids
PIMs are linked to augmented incidences of fallings, fractures, mental deteriorations, hospitalizations, and deaths.
Although frequently reviewed medication is necessary in most LTC facilities, there are no standardized forms of deprescribing that lead to the cessation of most of the unsafe medications.
The Innovation: the Polypharmacy App and MedSafer
In order to fill these gaps, the research team introduced MedSafer, which is an electronic decision support system manufactured in Canada in a secure interface known as the Polypharmacy App. The tool:
Incorporated with previous patient records on interRAI instrument.
Produced patient-specific deprescribing reports that indicated high risk medications or unnecessary medications.
Provided tapering instructions and patient education material links.
Was available online, or in printable reports to medical personnel
The purpose of this low-touch intervention was to prompt prescribers to deprescribe in the course of their normal medication reviews but not to interfere with their workload.
Study Design: Real-World Evidence in the context of COVID-19
Of the 725 residents in five LTC homes in New Brunswick his trial was done in August 2021 and October 2022. The cluster randomized comparisons employed a stepped-wedge built into the homes as each participated in the usual care and the intervention the intervention group after every three months.
Key stats:
Average age of residents: 84 years.
Median of drugs: 10.
Median PIMs count: 3.
Two-thirds of the respondents were females
Since the research work was conducted both during the COVID-19 pandemic, the researchers had to cope with delays in evaluations and staff shortage, and the intervention success was even more significant.
Findings A significant Increase in Deprescribing
The results were evident and effective:
The height of deprescribing within 36.4 percent of the residents was realized in the intervention group compared to 12.7 percent who were part of the control group.
This amounted to an absolute change of 23.7 percent of which the number needed to treat (NNT) was only 4 to effect one positive outcome.
The medications most often deprescribed included opioids, antipsychotics, and sedative hypnotics.
These findings are indicative of the fact that medication safety can be enhanced in a considerable way when digital decision support is incorporated into daily care.
The Difficulties and Alerts
Ironically, there was a slight increment in falls in the intervention group. This may be because of decreased sedation (an increase in mobility) or disruptions in care caused by the pandemic itself and not the deprescribing tool itself.
Delirium or rate restraint use was not found to increase statistically significantly, but highlights that close monitoring and tapering needs to be followed during the process of deprescribing.
Scalability and the Elder Care Implications
In contrast to resource-demanding interventions, this study was based on available digital health infrastructure and did not demand much training. The fact that it has so much success demonstrates that:
Deprescribing is able to be introduced into routine care.
Electronic devices lower the mental burden of the clinicians.
Medication review is capable of being improved and standardised.
With healthcare organizations providing cost-effective and patient-centered elder care, interventions such as the present one may become the new norm within LTC facilities globally.
Conclusion
MedSafer is noteworthy because the Canadian trial of the technology-assisted deprescribing suggests that it is not an idealistic experiment, but a workable, scalable approach to improving the health outcomes of vulnerable seniors. This practice has an insignificant intrusiveness and a measurable outcome that should be highly taken into account as a future best practice of medication management in nursing homes.
With an aging population we must reconsider polypharmacy. If we adopt technology that helps clinicians make safer, more personalized decisions, we can improve the quality of life of older adults and make more than just more, medicine.
References and Resources
McDonald EG, et al. Electronic Decision Support for Deprescribing in Older Adults Living in Long-Term Care. JAMA Network Open. 2025;8(5):e2512931. https://doi.org/10.1001/jamanetworkopen.2025.12931
Choosing Wisely Canada – https://choosingwiselycanada.org
Deprescribing.org – https://deprescribing.org