Polypharmacy and deprescribing
How to run a medication review in an older person, the 2025 Australian deprescribing guideline, a worked review of a falls patient's list, drug-class rules for stopping, the trial evidence, and HMR, RMMR and on-site pharmacists.
Tier 1Medical sciences concept
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Polypharmacy is 5 or more regular medicines; hyperpolypharmacy is 10 or more. In Australia about 250,000 hospital admissions a year are medication-related, half of them potentially preventable (PSA, Medicine Safety: Take Care, 2019).
- Some polypharmacy is appropriate: a person with HFrEF, AF and diabetes can need eight drugs. The problem is drugs whose harm now outweighs their benefit.
- Deprescribing is the supervised withdrawal of a medicine whose benefit no longer justifies the harm, aiming at the person's goals. It's part of prescribing, not a separate act.
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Sources
- Deprescribing in older people: a clinical practice guideline summary (Quek HW et al. Med J Aust 2026;224(4):e70174)AU/NZMedical Journal of Australia, 2026
- Clinical practice guidelines for deprescribing in older peopleAU/NZUniversity of Western Australia (Australian Deprescribing Network and partners), September 2025
- Therapeutic Guidelines: Prescribing in special populations (older people)AU/NZTherapeutic Guidelines Ltd, topic version not verified
- Medicine Safety - Take CareAU/NZPharmaceutical Society of Australia, 2019
- Aged Care On-site Pharmacist Measure - pharmacist and residential aged care home guideAU/NZAustralian Government Department of Health, Disability and Ageing, 2025
- American Geriatrics Society 2023 updated AGS Beers Criteria for potentially inappropriate medication use in older adultsJournal of the American Geriatrics Society 2023;71:2052-81, 2023 (current edition at November 2026; companion alternatives list July 2025)
- STOPP/START criteria for potentially inappropriate prescribing in older people: version 3European Geriatric Medicine (O'Mahony D et al. 2023;14:625-32), 2023
- Effect of antihypertensive medication reduction vs usual care on short-term blood pressure control in patients with hypertension aged 80 years and older: the OPTIMISE randomized clinical trial (Sheppard JP et al. JAMA 2020;323:2039-51)JAMA, 2020
- Effect of a pharmacist-led educational intervention on inappropriate medication prescriptions in older adults: the D-PRESCRIBE randomized clinical trial (Martin P et al. JAMA 2018;320:1889-98)JAMA, 2018
- Reduction of inappropriate benzodiazepine prescriptions among older adults through direct patient education: the EMPOWER cluster randomized trial (Tannenbaum C et al. JAMA Intern Med 2014;174:890-8)JAMA Internal Medicine, 2014
- Optimising drug therapy in multimorbid older adults: the OPERAM cluster randomised trial (Blum MR et al. BMJ 2021;374:n1585)BMJ, 2021
- Safety and benefit of discontinuing statin therapy in the setting of advanced, life-limiting illness (Kutner JS et al. JAMA Intern Med 2015;175:691-700)JAMA Internal Medicine, 2015
- Antipsychotic deprescription for older adults in long-term care: the HALT study (Brodaty H et al. J Am Med Dir Assoc 2018;19:592-600)AU/NZJournal of the American Medical Directors Association, 2018
- Time to benefit of bisphosphonate therapy for the prevention of fractures among postmenopausal women with osteoporosis (Deardorff WJ et al. JAMA Intern Med 2022;182:33-41)JAMA Internal Medicine, 2022
- Last updated
- 14 November 2026
What changed
- 14 November 2026 Personal emails, About story and Australian-style copy