NEW DELHI: For many senior citizens, a typical day starts with taking a few pills to treat blood pressure, diabetes, cholesterol and heart disease. But a new global review suggests that for very frail older people, continuing all long-term medications may not always be necessary — and in many cases it may be safe to carefully stop some of them.The findings, published in the journal BMC Geriatrics, come from an analysis of patients with advanced frailty, dementia or limited life expectancy – who often take multiple medications, although the long-term benefits are unclear. Researchers found that in most cases, reducing or discontinuing such drugs did not lead to an increase in death or serious complications.Many of these medications are designed to prevent problems years later. But for frail or severely ill patients, these benefits may never be realized. Conversely, taking multiple medications increases the risk of dizziness, weakness, confusion, and falls, often resulting in hospitalization.Doctors say this pattern of “polypharmacy,” in which patients take multiple drugs at the same time, is increasingly common among the elderly in India. “They often see multiple specialists, and prescriptions are not always reviewed together. For frail older adults, overtreatment can do more harm than good—for example, aspirin should be avoided for primary prevention, overcontrol of blood pressure may lead to falls, and medications such as diuretics, insulin, or sulfonylureas may cause electrolyte imbalances or hypoglycemia. The focus should be on reducing drugs where the risks outweigh the benefits,” said Dr Preen Gupta, professor, Department of Medicine, Ram Manohar Lohia Hospital.“For frail older patients, it is generally safe to discontinue some preventive medications if caution is taken, but those who have had heart disease or stroke need to be cautious,” said Dr. Rommel Tickoo, chief of internal medicine at Sackett Max Hospital. Medications that are often overused include statins for primary prevention, tightly controlled diabetes medications such as insulin or sulfonylureas, multiple antihypertensives, sleeping pills, long-term acid suppressants and anticholinergics, he added.“Deprescribing should be planned based on goals of care, frailty and life expectancy, with careful dose reduction and monitoring,” he said, noting that reducing medication often results in fewer falls, improved cognition and higher energy levels.Families often assume that more medication means better care, but the opposite may be true. Each added drug increases the risk of an interaction. This review reflects a shift from proactive prevention to patient-centred care, where treatment is consistent with health and priorities. Experts caution that medications cannot be discontinued at will; reductions must be supervised and each medication reviewed as needed.
