Deprescribing: a growing trend in elderly care

Recent studies examine when discontinuing antihypertensives, statins, and other medications may reduce risks for elderly, frail, or polymedicated patients

Samuel Antenor

An older patient pouring tablets from a bottle into her open left palm over a tabletop

The view that clinical care should include not only the initiation of medications but also their appropriate and timely discontinuation—particularly among elderly patients who are frail, multimorbid, or polymedicated—has gained growing prominence in recent research and clinical discussions, as highlighted in a 2024 article in Science Arena.

Research published between 2025 and 2026 has further advanced the discussion, with particular attention given to the discontinuation of cardiovascular drugs, antihypertensive therapies, and preventive medications, as well as multidisciplinary approaches to deprescribing.

Recent systematic reviews and meta-analyses published in BMC Geriatrics—a leading international journal in aging research—have explored evidence that could help guide the safe discontinuation of medications in clinical practice.

In Deprescribing antihypertensive medications in older people: a systematic review and a meta-analysis, researchers analyzed clinical trials and observational studies involving adults aged 65 years and older to assess the effects of discontinuing antihypertensive therapy.

Outcomes assessed included mortality, myocardial infarction, stroke, and major cardiovascular events, with the study underscoring the need for individualized decision-making, particularly in frail and multimorbid populations.

Deprescribing may be indicated for certain patient groups, particularly those who are frail, have limited life expectancy, or experience orthostatic hypotension—a sudden drop in blood pressure upon standing that is relatively common among older adults.

According to the authors, the review provides a foundation for future research to address gaps and guide safer deprescribing practices in older adults in routine clinical practice.

Aligning care with patient goals

Another recent paper published in the same journal examines the discontinuation of preventive medications among older adults with advanced frailty, dementia, or limited life expectancy.

The study reviews evidence on the effects of discontinuing antihypertensives, statins, anticoagulants, and antidiabetic therapies, comparing outcomes with continued treatment across clinical, physiological, safety, and patient-centered measures.

The authors note that while polypharmacy and long-term use of preventive medications are common among older adults with these conditions—despite uncertain benefits and potential risks—discontinuing these therapies was not associated with poorer outcomes.

The article also explores the concept of goal-concordant care, an approach that seeks to align prescription decisions with patients’ individual goals and preferences rather than relying solely on population-based guidelines.

Continuing chronic preventive therapies may provide only limited additional benefit while increasing the risk of drug interactions, adverse events, and hospitalization, potentially compromising overall quality of life.

The impact of deprescribing

A third study published in BMC Geriatrics highlights the role of clinical pharmacists in the deprescribing process, and evaluates the impact of these interventions among older adults across a range of care settings.

The study examined pharmacist-led medication review and deprescribing programs targeting potentially inappropriate medications, demonstrating reductions in overall medication burden and the risk of adverse events.

The researchers also reported improved medication adherence—a critical factor among frail older adults—as well as enhanced therapeutic safety for patients with polypharmacy.

Given clinical pharmacists’ expertise in pharmacotherapy and their ability to implement evidence-based deprescribing interventions that reduce both potentially inappropriate medications and overall medication burden, the authors highlight a growing international trend toward structured multidisciplinary deprescribing practices rather than isolated physician-led decisions.

More recent research points to an important conceptual shift: deprescribing is increasingly viewed not as an exception to standard care, but as an integral component of strategies designed to improve patient safety and achieve clinical goals.

Regulations in Brazil

Brazil does not yet have specific regulations governing deprescribing, nor official guidelines on collaboration between physicians and clinical pharmacists. However, the practice is supported by existing regulatory and ethical frameworks.

Deprescribing is considered a legitimate medical decision when grounded in scientific evidence, a careful risk-benefit assessment, and informed patient consent.

This approach is also consistent with Brazil’s National Patient Safety Program (PNSP), particularly as it applies to preventing adverse events, drug interactions, and medication-related errors associated with polypharmacy.

While Brazil’s National Health Surveillance Agency (ANVISA) does not directly regulate deprescribing protocols, it does play a role in risk-benefit profiling, pharmacovigilance activities, and therapeutic reclassification.

In practice, Anvisa’s regulatory framework already incorporates the central principle underlying deprescribing: medications should be prescribed only when their benefits outweigh their risks.

Although Brazil has yet to establish a dedicated legal framework for deprescribing, its existing regulatory, ethical, and healthcare protocols provide a foundation for gradual adoption in the interest of patient safety and evidence-based medication use.

* This article may be republished online under the CC-BY-NC-ND Creative Commons license.
The text must not be edited and the author(s) and source (Science Arena) must be credited.