For many older adults, taking several medications every day is simply part of treating chronic health conditions. One medicine may control blood pressure, another may ease pain, and a third may help with sleep. Over time, prescriptions accumulate, sometimes without a clear opportunity to reconsider whether every drug is still necessary.
That raises an important question for healthcare providers: Could some older adults benefit from taking fewer medications without losing essential treatment?
Deprescribing represents a structured process in which healthcare professionals review medicines and carefully reduce or discontinue those whose risks may exceed their benefits.
A Canadian clinical trial published in JAMA Network Open in 2025 found that electronic decision-support reports helped clinicians identify more opportunities to discontinue potentially inappropriate medicines in long-term care facilities.
An April 2026 systematic review subsequently provided a wider perspective. Across 38 studies, drug reviews and deprescribing interventions improved prescribing practices, but no clear evidence showed they reduced falls, hospitalizations, or deaths.
Together, the data show that better medication management is achievable, while reminding us that reducing prescriptions is not automatically the same as improving every patient outcome.
Why Taking Multiple Medications Can Become a Problem
The term polypharmacy commonly refers to using five or more medications, though definitions vary across studies.
Polypharmacy is especially common among older adults living in nursing homes and other long-term care facilities. Many residents live with several chronic conditions and require multiple treatments.
Importantly, taking numerous medicines is not necessarily inappropriate. A person with heart failure, diabetes, and other medical conditions may genuinely benefit from a combination of treatments.
Problems arise when a prescription continues after its original purpose has passed, the dose becomes unsuitable, or its risks begin to outweigh the benefits.
These situations may include:
- A sleeping medicine that causes daytime sedation or confusion.
- A medicine continued longer than its recommended treatment period.
- Two medications with overlapping effects.
- A drug that interacts with another essential treatment.
- A prescription that no longer matches a patient’s health goals or life expectancy.
Medications that warrant special review are sometimes described as potentially inappropriate medications, or PIMs.
The word potentially matters. A medicine identified as high-risk by a screening tool may still be appropriate for a particular patient.
A careful clinical review is therefore essential before changing any treatment.
What Exactly Is Deprescribing?
Deprescribing is a supervised medication-management process. It entails assessing whether a medicine is still necessary and, when appropriate, gradually reducing the dose or discontinuing it.
The objective is not to minimize medication numbers at any cost. It is to optimize treatment for the individual.
For example, an older resident taking a sedative may experience excessive daytime sleepiness. A clinician might review the original reason for treatment, assess whether the medication still helps, consider alternatives, and, if appropriate, plan a gradual reduction.
Some medicines call for careful tapering because abrupt withdrawal can cause rebound symptoms or other complications.
Whenever possible, deprescribing should involve the patient, along with caregivers, prescribers, and pharmacists.
The Canadian Study: Can Software Improve Drug Reviews?
In May 2025, researchers published a randomized study examining whether electronic decision support could help healthcare teams deprescribe potentially inappropriate medications.
The trial took place in five long-term care homes in New Brunswick, Canada, between August 2021 and October 2022.
It included 725 residents with at least one potentially inappropriate medication.
Participants had a median age of 84 years and took a median of 10 medications. The median number of potentially inappropriate medications was three.
Rather than replacing clinicians, the intervention provided individualized reports identifying possible deprescribing opportunities during existing quarterly medication assessments.
How the intervention worked
The researchers used a stepped-wedge, cluster-randomized design.
In this approach, participating care facilities initially followed their usual care processes. Groups of facilities then transitioned to the intervention at different times, randomly assigned.
This allowed researchers to compare periods when clinicians had access to the electronic reports with periods when they did not.
The reports highlighted medicines that deserved further assessment, helping clinicians prioritize medication-review decisions.
Healthcare professionals made the final decision.
What did the researchers find?
During the usual-care phase, 12.7% of eligible residents had at least one potentially inappropriate medication deprescribed.
During the electronic decision-support phase, that figure was 36.4%.
That is a 23.7-percentage-point difference.
After adjusting for factors including age, sex, number of potentially inappropriate medications, and study period, the researchers reported an adjusted odds ratio of 1.58 (95% CI, 1.07 to 2.34).
These findings show that electronic support improved the likelihood of deprescribing within the study setting.
However, the study does not demonstrate that every discontinued prescription was unnecessary, nor does it establish that residents who had a medicine stopped subsequently lived longer or experienced fewer serious health events.
Its clearest finding concerns improvement in the medication-review process.
Why the Study Matters Beyond Software
Healthcare professionals often recognize the importance of reviewing medication lists, but routine practice can make complete reviews difficult.
Nursing home inhabitants frequently have complex treatment plans. Clinicians must consider multiple diagnoses, medication interactions, changing symptoms, and individual treatment goals.
An electronic support system can organize relevant information and identify issues that deserve attention.
For example, a report might flag a long-term prescription for a medicine that is commonly recommended only for short-term use.
Instead of automatically instructing a clinician to stop treatment, it can prompt a better informed discussion.
This distinction is essential: software should support clinical decisions, not make them independently.
Canadian research suggests that including decision support into workflows healthcare professionals already use may be a practical way to make drug assessments more consistent.
But whether similar results would occur in other countries, different health systems, or facilities with fewer resources remains a question for further research.
What Changed in 2026? A Larger Review Offers a Clearer Picture
The 2025 trial examined a specific electronic intervention. A wider systematic review published in Age and Ageing in April 2026 evaluated drug reviews and deprescribing approaches more generally.
Researchers included 38 studies: 22 randomized controlled trials and 16 quasi-experimental studies.
The results showed improvements in prescribing appropriateness among older residents of long-term care facilities.
Across studies, interventions were associated with an average reduction of approximately 0.89 medications per person within 12 months and 1.60 medications per person at follow-up periods of at least 12 months.
The review also identified reductions in potentially inappropriate medications.
These outcomes are encouraging because they demonstrate that structured drug reviews can produce measurable changes in prescribing.
Did fewer medications lead to fewer falls or hospitalizations?
This is where the evidence becomes less certain.
The 2026 systematic review found no statistically significant improvements in falls, hospitalizations, or mortality.
That does not prove deprescribing offers no clinical benefits. The included studies differed in their methods, populations, interventions, and quality.
The reviewers also identified methodological weaknesses and substantial variation between studies.
What the evidence supports is more specific: deprescribing interventions can improve prescribing appropriateness, but their effects on major clinical outcomes remain uncertain.
This distinction matters for patients, caregivers, and healthcare providers.
Decreasing unnecessary medication exposure is a worthwhile clinical objective. Yet research must continue to show which approaches most improve symptoms, functioning, quality of life, and safety.
Are There Risks to Deprescribing?
Yes. Although deprescribing aims to reduce medication-related harm, stopping a medicine can sometimes cause problems.
The risks depend on the treatment, the patient’s medical condition, the duration of use, and how the medication is withdrawn.
Possible concerns comprise:
- Return of symptoms previously controlled by treatment.
- Withdrawal symptoms after abrupt discontinuation of certain medicines.
- Changes in blood pressure, blood glucose, mood, sleep, or pain.
- The need to restart treatment if its benefits become clear after withdrawal.
Some medicines can be stopped directly under professional guidance; others require a carefully monitored taper.
A medication identified as potentially inappropriate should never be discontinued solely because it appears on a computerized report or a general screening list.
The patient’s individual circumstances must determine what happens next.
What the 2026 Clinical Guidance Adds
A clinical practice guideline summary published in the Medical Journal of Australia in April 2026 reinforces the importance of structured deprescribing in older adults.
The broader approach stresses reviewing medication use in the context of the patient’s health needs, treatment goals, expected benefits, and potential harms.
A practical medication review may involve several questions.
Is the medicine still needed?
A prescription may have been appropriate when it began but may no longer match the patient’s current condition.
Are its benefits greater than its risks?
A treatment that helps one patient may be unsuitable for another, particularly when frailty, kidney function, other medications, or personal tastes differ.
What would happen if the dose were reduced?
Clinicians should consider possible withdrawal effects, symptom recurrence, and how to monitor the response.
Does the patient understand and agree with the plan?
Medication decisions should not be made solely to satisfy a prescribing target. Patient preferences and quality of life matter.
What Families Can Ask During a Medication Review
Families and caregivers can play an important role by making sure medication concerns are discussed with the healthcare team.
Useful questions include:
- What is each medication currently treating?
- Are any medicines no longer necessary?
- Could any medicines contribute to dizziness, confusion, falls, or daytime sleepiness?
- Are there potentially harmful interactions between prescriptions?
- If a medication is reduced, what symptoms should we monitor?
- When should we review the treatment plan again?
These questions can support safer conversations without encouraging people to change prescriptions independently.
For residents with memory problems or difficulty communicating, caregivers may also provide useful information about changes in behavior, alertness, sleep, and daily functioning.
Limitations of the Research
The evidence is promising, but several limitations deserve attention.
First, the Canadian trial was conducted in only five long-term care facilities within one Canadian province. Its findings may not generalize to every healthcare setting.
Second, the trial took place during the COVID-19 pandemic, when staffing pressures and changes to routine care may have influenced implementation.
Third, increasing the rate of deprescribing does not by itself establish long-term clinical benefit.
Fourth, the 2026 systematic review included studies with considerable differences in design and methodological quality. This limits the certainty of some conclusions.
Finally, the Canadian study disclosed that some researchers had intellectual-property or commercial interests connected to MedSafer, the decision-support system involved. Such relationships do not invalidate the findings, but they are relevant when evaluating the evidence.
Independent studies across broader healthcare systems would help establish the effectiveness, safety, and financial effectiveness of electronic deprescribing interventions.
The Future of Digital Medication Safety
Electronic decision support could become an increasingly useful part of routine drug reviews.
Its value lies in helping clinicians identify prescriptions that warrant careful reconsideration, especially in complex treatment plans.
Subsequent research should look beyond how many medications are stopped.
Key outcomes include whether residents experience better daily functioning, fewer medication-related symptoms, improved quality of life, fewer serious adverse events, and continued, appropriate beneficial treatments.
Research must also establish how digital tools can be incorporated into clinical practice without creating unnecessary alerts or increasing workloads.
The objective should be better prescribing decisions, not simply fewer prescriptions.
Final Takeaway
Evidence through October 2026 points to a favorable yet measured conclusion.
A Canadian randomized trial showed that electronic decision support improved deprescribing rates in long-term care. A larger 2026 review confirmed that medication-review interventions can reduce potentially inappropriate prescribing.
However, the wider evidence has not shown clear reductions in falls, hospitalization, or mortality.
For older adults, the central lesson is that every medicine should have a continuing purpose, and treatment plans should be reviewed as health needs change.
The safest medication plan is not necessarily the one with the fewest drugs. It is the one in which each treatment has a justified role, clear benefits, manageable risks, and appropriate monitoring.
References
1. McDonald EG, et al. (2025). Electronic Decision Support for Deprescribing in Older Adults Living in Long-Term Care: A Stepped-Wedge Cluster Randomized Trial. JAMA Network Open, 8(5), e2512931.
https://doi.org/10.1001/jamanetworkopen.2025.12931
2. Carollo M, et al. (2026). Evaluating the impact of medication review and deprescribing on prescribing appropriateness and clinical outcomes in older people residing in long-term care facilities: a systematic review and meta-analysis. Age and Ageing, 55(4), afag084.
https://doi.org/10.1093/ageing/afag084
3. Quek HW, et al. (2026). Deprescribing in Older People: A Clinical Practice Guideline Summary. Medical Journal of Australia, 224(4), e70174.