Older patients are overprescribed — cutting back is safe, but results may fall short

© motortion - stock.adobe.com

Potentially inappropriate prescribing (PIP) is a common concern in primary care settings, especially for older adults managing multiple chronic conditions.

These prescriptions — often for medications with more risk than benefit or lacking a clear indication — can lead to adverse drug reactions, unnecessary hospital visits and reduced quality of life. Despite those risks, reducing medication burden can be tricky in day-to-day practice.

Now, a new analysis offers some reassurance: deprescribing interventions designed to identify and reduce PIP are both feasible and generally safe. But while they may lower medication counts, the broader impact on patient outcomes remains unclear.

Published June 27 in JAMA Network Open, the study reviewed 118 randomized clinical trials involving 417,000 older adults. The key finding: deprescribing efforts led to a modest but measurable reduction in prescriptions — about half a medication per person on average.

“These findings suggest that inappropriate prescribing interventions may be implemented to safely reduce the number of medications prescribed to older adults in the primary care setting,” wrote the study’s authors.

Why cutting back matters

Older adults often juggle multiple prescriptions, increasing the risk of drug interactions, side effects and unnecessary burdens.

Patients themselves are often open to change — some have said they’d even trade time or money to eliminate a daily pill. But deprescribing is easier said than done. Clinicians often cite practical barriers — time constraints, fragmented records, conflicting specialty guidance and discomfort altering another physician’s orders.

To help, a growing number of interventions — like pharmacist-led reviews or electronic prompts — aim to identify medications that may no longer be needed.

What the study found

Researchers broke the 118 trials into two categories: 68 tested broad, general medication reviews (“implicit” interventions), while 50 focused on avoiding specific high-risk drugs (“explicit” interventions).

Overall, interventions led to a decrease of roughly 0.5 medications per patient.

Beyond fewer pills, there were no consistent signs of clinical benefit:

• There was no clear reduction in minor drug side effects.
• The number of falls that caused injury stayed the same.
• Emergency department visits didn’t meaningfully change.
• Hospitalizations showed a very slight decline, but not enough to be considered significant.
• Death rates were similar between groups that received deprescribing interventions and those that did not.

There was a slight signal that explicit interventions might lower hospitalization risk, but the effect was small and driven largely by two large trials.

Still more to learn

The study confirms deprescribing is generally safe, but the lack of clear improvement on quality of life or serious events like hospital stays suggests there’s more to understand about when and how these efforts make the biggest difference.

The authors urged future research to use more standardized tools to measure outcomes and capture subtler benefits.

“There may be important benefits of reducing [potentially inappropriate medications] that were not directly assessed,” the authors wrote, “such as reducing the burden of taking medications and reducing adverse effects that do not require care or are misattributed to aging or comorbidity.”

For physicians navigating complex medication regimens with older patients, this study offers hope that deprescribing, when done carefully, can reduce pill counts without causing harm.

Still, it’s not a silver bullet. Reducing medications won’t necessarily reduce hospital visits or improve survival, but it might improve how patients feel, function and manage their health, especially when guided by shared decision-making and personalized goals.

“Taken together, our results suggest that PIP interventions can likely be used to safely reduce the number of medications an older adult is prescribed in primary care,” the authors concluded. “These findings may be reassuring to patients and to clinicians undertaking organized approaches to address PIP by deprescribing medications.”