The Case for Taking Less: What Every Patient on Multiple Medications Should Know About Deprescribing

There is a particular kind of medical appointment that many older Americans know well. You arrive with a list of complaints. You leave with a new prescription. Over years, that process compounds—a blood pressure medication here, a sleep aid there, a proton pump inhibitor added to counteract the gastrointestinal effects of an anti-inflammatory—until you are managing five, eight, or twelve daily medications, each with its own schedule, its own side effects, and its own cost.

This phenomenon has a name: polypharmacy. And while the clinical definition typically refers to the concurrent use of five or more medications, the real concern is not the number itself. It is whether each of those medications still serves a clear, current, and justified purpose for the patient taking them.

Increasingly, the answer for many patients is: not entirely.

A Growing Problem With an Underutilized Solution

According to data from the Centers for Disease Control and Prevention, approximately 40 percent of adults aged 65 and older in the United States take five or more prescription medications. Among adults in long-term care settings, that figure climbs significantly higher. The consequences of this medication burden are not abstract. Polypharmacy is associated with increased fall risk, cognitive impairment, hospitalizations, drug-drug interactions, and diminished quality of life.

Yet the clinical response to polypharmacy has historically been reactive rather than preventive. A patient develops confusion—a new medication is added to address it. A fall occurs—another drug is prescribed for bone protection. The cascade continues.

Deprescribing interrupts that cascade. Defined by researchers as the planned and supervised process of dose reduction or discontinuation of medications that may no longer be beneficial or that carry risks exceeding their benefits, deprescribing is not the absence of medical care. It is a form of medical care—one that requires clinical judgment, patient collaboration, and a willingness to question prescriptions that were once entirely appropriate but may no longer be.

Which Medications Are Most Commonly Over-Prescribed?

Certain drug classes appear consistently in deprescribing literature as candidates for reassessment, particularly in older adults.

Proton pump inhibitors (PPIs) such as omeprazole and pantoprazole are among the most widely prescribed medications in the country. They are appropriately used for conditions like gastroesophageal reflux disease and peptic ulcer disease. However, research suggests that a substantial proportion of patients remain on PPIs long after the original indication has resolved—often because no one revisited the prescription. Long-term PPI use has been associated with magnesium deficiency, increased fracture risk, and elevated susceptibility to Clostridioides difficile infection.

Benzodiazepines and sedative-hypnotics, including drugs like zolpidem and lorazepam, are frequently initiated for sleep disturbances or anxiety during a period of acute stress and then continued indefinitely. In older adults, these medications significantly increase the risk of falls, fractures, and cognitive decline. The American Geriatrics Society's Beers Criteria explicitly identifies this drug class as potentially inappropriate for older adults.

Antihypertensives represent a nuanced case. Blood pressure targets that are clinically appropriate for a 55-year-old may be unnecessarily aggressive—and even harmful—in a frail 82-year-old whose systolic pressure has dropped naturally with age. Overtreatment of blood pressure in elderly patients can produce orthostatic hypotension and dangerous falls.

Statins in patients with limited life expectancy or in very advanced age are another area of active deprescribing research. The cardiovascular benefits of statins accrue over years. For patients with a shortened life horizon due to advanced illness, the burden of daily medication, potential side effects, and cost may outweigh any realistic benefit.

The Cultural Barrier: Why Stopping a Medication Feels Wrong

For many patients—and, frankly, for many physicians—the act of discontinuing a medication carries an implicit discomfort. American healthcare culture has long equated intervention with care. Doing something feels safer than doing nothing, even when the evidence suggests otherwise.

Patients who raise concerns about their medication burden sometimes encounter resistance, reassurance without explanation, or the suggestion that stopping a drug would be risky. And in some cases, that concern is valid. Certain medications—antidepressants, corticosteroids, antiepileptics, opioids—require careful, supervised tapering rather than abrupt discontinuation. Others can be stopped without a taper but should still be monitored.

The key distinction is between stopping a medication carelessly and stopping it thoughtfully. Deprescribing is not self-discontinuation. It is a collaborative clinical process.

How to Start the Conversation With Your Doctor

If you or a family member is managing a complex medication regimen, the following steps can help facilitate a productive deprescribing discussion.

Compile a complete medication list. Include all prescription drugs, over-the-counter medications, vitamins, and supplements. Many patients are surprised to discover that their physicians are unaware of everything they are taking.

Ask about each medication's purpose. For every drug on your list, you are entitled to understand what condition it treats, whether that condition is still active, and what the current evidence says about its continued use in your specific situation.

Inquire about alternatives. Some medications can be replaced with behavioral interventions, dietary changes, or lower-risk alternatives. Cognitive behavioral therapy for insomnia, for example, has demonstrated superior long-term outcomes compared to sedative-hypnotics—without the fall risk.

Request a comprehensive medication review. Many pharmacists offer medication therapy management (MTM) services, often covered by Medicare Part D, specifically designed to identify problematic drug combinations and unnecessary medications.

Proceed gradually and with monitoring. Any deprescribing plan should include follow-up to track symptoms, blood pressure, lab values, or other relevant markers as medications are reduced or discontinued.

Reframing What Good Care Looks Like

The goal of medicine is not to maximize the number of conditions treated or the number of drugs prescribed. It is to support the patient's health, function, and quality of life—using the least burden necessary to achieve that goal.

For some patients, that means adding a medication that has been overlooked. For others, it means carefully removing one that has outlived its usefulness. Both represent good medicine.

At OpaMeds, our commitment is to equip patients with the information they need to participate meaningfully in decisions about their own care. If your medication list has grown year over year without a structured review, deprescribing may not just be an option worth considering—it may be the most important conversation you have not yet had with your doctor.