The new guideline explains when and how to stop medications in older people and includes drugs that might fly under the radar of GPs.
A new guideline aims to help clinicians reduce or stop prescribing medications in older people when the risks and harms start to outweigh the benefits.
The RACGP-endorsed guideline includes 35 medicine classes with the latest evidence and guidance on when and how to deprescribe and how to monitor patients amid the complexity of polypharmacy and multimorbidity.
GPs can search for drugs including those most commonly prescribed to people aged 65 and over, as well as drugs where there is evidence to inform deprescribing in older people.
The authors say the new guideline aims to reduce the harms and hospitalisations of overprescribed medications in older people, who are at higher risk of drug-related harm from inappropriate medicine use and drug interactions.
According to the Australian Commission on Safety and Quality in Healthcare, almost 40% of Australians aged 75 and over take five or more medicines.
And according to one review, 20% of geriatric admissions to an emergency department are medication related. In just under 50% of cases, that was due to multiple medicines, and 87% of those were considered preventable.
Existing clinical practice guidelines focus on single diseases and don’t reflect the complex reality of multimorbidity, said the authors of the project, led by researchers at the University of Western Australia.
“Medicine use in older people is a fine balance of managing the underlying symptoms or risks in accord with the older person’s preferences, while at the same time minimising drug-related problems through monitoring, reducing pill burden, and avoiding unnecessary medicine use,” the authors said.
Contributing author and Chair of RACGP Specific Interests Aged Care, Dr Anthony Marinucci, said this was the first RACGP-endorsed, centralised repository of drug information for clinicians.
The guideline includes the current evidence base for continuing or deprescribing high-risk medications, as well as those that might be overlooked, he told The Medical Republic.
“There are extremely high-risk medications that we all know about as clinicians, like benzodiazepines, or a lot of the psychotropic medications that we know come with a significant falls risk and side effects.
“But one of the other things that this guideline does is that it highlights medications that perhaps went under the radar.
“For instance, something like a cardiac medication like digoxin, which wouldn’t typically have been under the radar of a lot of doctors, does come with potential side effects and there is a role for deprescribing in certain patients, depending on their current care needs.
“The non-typical ones are probably just as important as those typical ones … that we know come with a significant burden of potential morbidity.”
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Dr Marinucci said older patients in the community faced barriers to accessing primary care.
Once medications were started, “they’re often not reviewed for deprescribing as often as they should”, he said.
“There’s always the goal to deprescribe, but it often can become quite challenging when there are certain impediments in the way to achieve it, and the number one step is getting that patient to see their doctor in the community in the first place.”
Dr Marinucci said patients and their families sometimes resisted the idea of deprescribing, and the guideline would help GPs communicate the risks and benefits, making those complex discussions easier.
“I’ve always found that having good evidence-based guidelines as an assistance in conversations to be very, very helpful.
“Often I have discussions with people of advanced age that we know there is no data, no evidence to suggest that statins or cholesterol-lowering drugs are helpful in that age group.
“But often people think there is, and that could just be historical context.
“Maybe that medication was started 20 years ago in their mother or father or themselves, and they believe that continuing that will confer the same amount of benefit now as it did 20 years ago.
“Having the guideline really helps with good, solid, evidence-based discussions to achieve that deprescribing.”
Helping patients and their families make the informed choice of whether the small risks of stopping a medication outweighed the benefits of continuing was a “difficult discussion to have”, he said.
“It is particularly more difficult when we don’t have the recent evidence base right at our fingertips.
“That’s the beauty of these guidelines. You type in a medication and it gives you the recent evidence base at your fingertips to say, ‘this is what we’ve studied in the real world, this is what we know. Let’s come together to make a shared and informed decision about whether we continue this medication for you or not’.”
For example, as patients get older, the risks of taking anticoagulants for atrial fibrillation begin to outweigh the benefits, Dr Marinucci said.
“Perhaps if they’re falling a lot, they’re hitting their head a lot, we need to have that discussion. To say, ‘in an ideal world, this medication is good for you, it reduces your risk of stroke, but in your particular context I feel that you continuing this medication is actually doing you more harm’.”
Deprescribing in older people: a clinical practice guideline, 2025
