Volume 52, Issue 4, April 2023

Deprescribing considerations for older people in general practice

Hui Wen Quek    Amy Page    Kathleen Potter    Christopher Etherton-Beer   
doi: 10.31128/AJGP-08-22-6547   |    Download article
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Deprescribing is an integral part of patient care. The term ‘deprescribing’ may be new to some, but the concept is not. Deprescribing refers to the planned withdrawal of medicines that are causing harm or not helping an individual.


This article collates the latest evidence on deprescribing to guide general practitioners (GPs) and nurse practitioners on how to deprescribe for their elderly patients.


Deprescribing is a safe and effective method of reducing polypharmacy and high-risk prescribing. The challenge for GPs in deprescribing medicines for older people is to avoid adverse drug withdrawal events. Strategies to deprescribe confidently in partnership with patients include incorporating a ‘stop slow, go low’ approach and careful consideration of the medicine withdrawal plan.


Medicine use is one of the most common interventions in healthcare. A general practitioner (GP) in Australia typically prescribes 85.5 medicines per every 100 consultations.1 Part of good prescribing practice is selecting the most appropriate medicine and dosage to meet an individual’s therapeutic needs for a suitable duration.2 Prescribing is a dynamic process that requires continuing reassessment and monitoring. The risk–benefit profile of medication is constantly shifting, especially in older people with multimorbidity. Deprescribing encompasses the concept of good prescribing practice and refers to the withdrawal of medicine that is no longer warranted.3,4

Why is inappropriate polypharmacy an issue for older people?

In 2020–21, over half (54%) the medicines dispensed under the Pharmaceutical Benefits Scheme and the Repatriation Schedule of Pharmaceutical Benefits were for people aged 65 years and above.5 In addition to old age and comorbidities, the individual prescriber is a major risk factor for polypharmacy, defined as the concurrent use of five or more medicines.6 Polypharmacy is considered inappropriate when the potential harm of taking multiple medicines outweighs the potential benefits. Inappropriate polypharmacy in older people has a negative impact on cognition, health-related quality of life and mortality.7–9 Although some medicines may be therapeutically indicated for an individual, polypharmacy paves the way for an increased risk of drug–drug interactions, medicine errors due to complex regimens and increased healthcare expenditure.10,11 Because of frailty, older people are most vulnerable to the negative consequences of polypharmacy.12 Polypharmacy increases the treatment burden for a patient and, paradoxically, may lead to the underprescribing of indicated medicines.7 Complex medication regimens are also associated with non-adherence, contributing to poor patient outcomes, and medicine wastage.13

High-risk prescribing for older patients

The use of potentially inappropriate medicines (PIMs) is common in polypharmacy, but also occurs in the absence of polypharmacy.14 PIMs are medicines with an unfavourable benefit–harm ratio or no clear evidence-based indication that are not cost-effective or are used instead of a safer and more effective alternative.15,16 For example, anticholinergic and sedative medicines are often considered PIMs in older people because they are associated with serious adverse outcomes in this group, including increased frailty, reduced appetite and impaired cognitive and physical function.17,18

Prescribing cascades occur when a drug-related adverse reaction is misinterpreted as a new medical condition and a second medicine is used to manage the symptoms.19 An example of this is the use of loop diuretics to manage ankle oedema arising from the use of calcium channel blockers.20 Prescribing cascades are preventable. GPs should always first consider a patient’s current medicines as the cause of any new or ongoing troublesome symptoms. The question to ask is, ‘Are any of these medicines contributing to the symptoms experienced by my patient?’

Why should GPs consider deprescribing?

Deprescribing is an intervention to reduce inappropriate polypharmacy and high-risk prescribing (including PIMs and prescribing cascades; Figure 1). The common goals of deprescribing in older people are to reduce pill burden, improve health outcomes and reduce the risk of specific geriatric syndromes, such as falls and cognitive impairment;23,24 the ultimate goal is to improve quality of life.


Figure 1. Snapshot of polypharmacy, suboptimal use of medicines and deprescribing interventions.

The decision to deprescribe encompasses the concept of patient-centred care by focusing on an individual’s treatment goals and preferences, all of which evolve as a person ages and their functional status changes. The process of deprescribing is important because it provides a prime opportunity to reassess an individual’s health status and reconcile their current medicines list.

What tools are available to help with deprescribing?

GPs are very familiar with the concept of discontinuing ineffective medicines or those causing adverse effects worse than the condition being treated. However, with multiple competing priorities, many prescribers will not feel as confident with a shared decision-making process that involves a comprehensive assessment and medicines reconciliation with a focus on identifying suitable targets for cessation. Hence, several tools have been developed to facilitate decision making in this type of deprescribing (Table 1). For example, the CEASE (Current medicines, Elevated risk, Assess, Sort, Eliminate) algorithm (Figure 2) and ERASE (Evaluate, Resolved conditions, Ageing normally, Select targets, Eliminate) approach (Figure 3) are clinical mnemonics developed to aid deprescribing. Table 2 lists the resources available for the specific medicines prescribers may consider targeting first.

Table 1. Tools to aid deprescribing
Tool Purpose Example of applicability Reference Open access?
MATCH-D criteria (Medication Appropriateness Tool for Comorbid Health conditions during Dementia) To optimise medicine use in people with dementia For people with early stage dementia, consider stopping antiplatelet, anticoagulant and antithrombotic agents used for preventative measures Page et al25 Yes, with the tool freely available at
Validated prescribing appropriateness criteria for older Australians Australian prescribing indicators to help identify common medicine-related problems in older people Patient taking a PPI is NOT taking a medication that may cause dyspepsia unless prescribed for gastroprotection Basger et al26 Yes
Beers Criteria® Explicit list of potentially inappropriate medicines in older people Avoid using antipsychotics for behavioural problems of dementia American Geriatrics Society Beers Criteria® Update Expert Panel27 No
STOPP (Screening Tool for Older Peoples Prescriptions) Explicit rules for ceasing certain medicines Cease calcium channel blockers with chronic constipation O’Mahony et al28 Yes
Deprescribing algorithm modified from the Good Palliative – Geriatric Practice (GPGP) algorithm Decision tree diagram for deprescribing
  • Inappropriate prescription
  • Adverse effects or interaction
  • Drug taken for symptom relief
  • Drug intended to prevent serious future events
Page et al29 No
CEASE algorithm (Figure 2) Guide the deprescribing process during a doctor–patient encounter Current medicines, Elevated risk, Assess, Sort, Eliminate Scott and Le Couteur30 Tool provided in this article
ERASE approach (Figure 3) Review diagnoses and associated medicines
Evaluate diagnoses through the consideration of Resolved conditions, Ageing normally, Selecting appropriate targets to Eliminate unnecessary diagnoses and medicines Page and Etherton-Beer6 Tool provided in this article
Prescribing and deprescribing in CKD Optimising medicine use in people with CKD List of commonly prescribed medications that may require dose reduction or cessation in people with CKD (eg diabetes medications) Manski-Nankervis et al31
CCB, calcium channel blocker; CKD, chronic kidney disease; PPI, proton pump inhibitor.
Table 2. Deprescribing guidelines for specific medicines/drug classes  
Medicine/drug class Risk for use in older people Relevant deprescribing guidelines
Allopurinol Worsening renal dysfunction and serious skin toxicity A
Anticholinergics Cognitive impairment and urinary retention B
Antihyperglycaemics Hypoglycaemia and related morbidity A, C
Antihypertensive agents Falls A
Antipsychotics Parkinsonism or extrapyramidal symptoms, falls A, B, C
Aspirin GI bleeding A
Benzodiazepines and/or Z-drugs Sedation, falls, confusion, dependence A, C
Bisphosphonates Hypocalcaemia A
Cholinesterase inhibitors and memantine GI upset, urinary incontinence, bradycardia A, C
Gabapentinoids Sedation, ataxia, falls D
Glaucoma eye drops Mostly well tolerated but may no longer be indicated if life expectancy is limited A
NSAIDs GI bleeding, renal failure, exacerbation of cardiovascular diseases A
Opioids Sedation, falls, fractures, dependence A, B, E
Proton pump inhibitors Long-term use increases the risk of fractures, altered absorption of nutrients and some medicines A, B, C, Turner et al32
Sedating antihistamines Falls, fractures, confusion, drowsiness B
SSRIs and SNRIs Falls B
Statins Myopathy, rhabdomyolysis and fatigue A
Tricyclic antidepressants Falls, sedation, anticholinergic adverse effects B
Vitamin D and calcium Falls, hypercalcaemia A

A, Primary Health Tasmania (;
B, New South Wales Therapeutic Advisory Group (;
C, Bruyère Research Institute (;
D, Canadian Medication Appropriateness and Deprescribing Network (;
E, Victorian Department of Health (
GI, gastrointestinal; NSAIDs, non-steroidal anti-inflammatory drugs; SNRIs, serotonin noradrenaline reuptake inhibitors; SSRIs, selective serotonin reuptake inhibitors; Z-drugs, zopiclone, eszopiclone, zaleplon and zolpidem.
Figure 2. The CEASE (Current medicines, Elevated risk, Assess, Sort, Eliminate) algorithm.

Figure 2. The CEASE (Current medicines, Elevated risk, Assess, Sort, Eliminate) algorithm.

Figure 3. The ERASE (Evaluate, Resolved conditions, Ageing normally, Select targets, Eliminate) approach for undiagnosing in older people.

Approaches to successful and safe deprescribing

Deprescribing interventions appear to cause few adverse outcomes (Table 3).22,33–35 Physicians should consider tapering medicines more likely to cause withdrawal symptoms and those that cause rebound syndromes if ceased abruptly. Such medicines include central nervous system-active medicines, proton pump inhibitors, beta-blockers and non-steroidal anti-inflammatory drugs.36 In most cases, adverse drug withdrawal events are not severe and, if necessary, the withdrawn medicine (or an alternative) can be restarted. When there is more than one medicine to deprescribe, GPs should first prioritise the medicine with the highest risk of harm and the lowest anticipated benefit from continued use. The prioritisation matrix (Figure 4) is unique to each individual, and GPs are familiar with using risk stratification strategies in their day-to-day practice.

Table 3. Potential pitfalls of a deprescribing intervention
Potential consequences Examples Suggestions
Return of original disease symptoms Symptoms of reflux on discontinuation of a proton pump inhibitor
Rebound insomnia on discontinuation of temazepam
‘Stop slow, go low’ approach:
  • short-term pharmacological substitution or management
  • taper the medicine
  • psychological support (if applicable)
  • periodic monitoring of the original disease
Adverse drug withdrawal events Sleep disturbance, tremor, irritability, anxiety, and palpitation on discontinuation of a benzodiazepine ‘Stop slow, go low’ approach:
  • stop one medicine at a time (refer to Figure 4)
  • taper the medicine
  • close monitoring
Unmasking drug interactions For patients on warfarin, altered INR on discontinuation of amiodarone Thorough medication review before deprescribing to identify any potential pharmacokinetic interactions
Damaging patient–doctor relationship Patients may interpret deprescribing as ‘giving up’ Shared decision making and patient collaboration:
  • engage patients (and their caregivers) in every step of the intervention
  • clear explanation of expected risks and benefits
  • provide written patient information
  • psychological support where needed
Deprescribing-related complications An occurrence of myocardial infarction being attributed to discontinuing a statin
  • Careful consideration of the benefit–harm ratio of a preventative medicine is key, taking into account an individual’s life expectancy
  • Consider other options for risk management (eg lifestyle changes)
  • Document all reasonable grounds for stopping a medicine
INR, international normalised ratio.

Figure 4. Prioritisation matrix for deprescribing.

Outcomes of deprescribing

A 2016 systematic review of deprescribing polypharmacy found that the intervention did not alter mortality in randomised controlled trials (odds ratio [OR] 0.82; 95% confidence interval [CI]: 0.61, 1.11), but did reduce mortality in non-randomised studies (OR 0.32; 95% CI: 0.17, 0.60).22 Although the benefits of deprescribing on health outcomes are uncertain, recent evidence suggests it is safe and feasible,22,37–39 with the caution that many deprescribing studies are of low quality with small participant numbers and short follow-up periods.40

What do patients think of deprescribing?

Recent studies of patient attitudes towards deprescribing found that 84–90% were willing to withdraw one or more of their medicines when suggested by the prescriber.41,42 Although individual cases vary, most people accept their GP’s opinion and advice. One of the critical attributes of deprescribing is ‘patient-centred care’.43 Partnering with the patient is an important part of patient-centred care, which encompasses the concept of individualised care by assessing a person’s needs that define the overall goals of care in the patient context.44

Barriers and enablers to deprescribing intervention

Many factors impede implementation of deprescribing as part of routine clinical care,40 including:

  • clinician-related barriers: lack of time or resources, competing priorities, inadequate communication between different healthcare professionals about medical history or the medicine withdrawal plan, possible lack of knowledge and skills
  • patient-related barriers: inadequate knowledge about deprescribing or medication review, perceived or potential reliance on certain medicines, personal beliefs and attitudes
  • system-related barriers: gaps in transitional care between different healthcare settings, insufficient health campaign on deprescribing, poor design of GP prescribing software that warns of significant drug interactions, limited availability of effective non-pharmacological treatment options.
Interprofessional collaboration between GPs, pharmacists and nurses can address some of these barriers, in particular GPs’ lack of time and resources to perform a detailed medication review (Box 1).45 Pharmacist-led medication reviews identify medicines suitable for deprescribing, and nurses can undertake the monitoring and patient support components.46,47 Patients favour the involvement of pharmacists in the process,48 and pharmacists can address important patient-related barriers, such as inadequate knowledge about medicine cessation. Collaborative deprescribing also empowers patients to be more proactive and involved in their own care.
Box 1. Case study

Tom (age 80 years) sees you today for a repeat prescription on all of his usual medicines for his chronic conditions. Tom’s medical conditions include hypercholesterolaemia, hypertension, gout, chronic constipation, and insomnia, for which he takes a daily dose of rosuvastatin 10 mg, ramipril 5 mg, hydrochlorothiazide 25 mg, allopurinol 150 mg, amitriptyline 10 mg and docusate sodium/senna 50 mg/8 mg. During the consultation, you ask Tom how he feels about all the medicines he is currently taking, with a focus on his medication adherence, possible side effects, his personal views towards each medicine and cost. Tom expresses his concern to you over side effects and increased treatment burden. You then ask Tom if he would prefer stopping or reducing some of his medicines. Tom agrees to give it a try, and asks for your recommendations. You decide to use the CEASE algorithm to help with your decision making:

  1. You reconcile Tom’s current medicines (or provide a referral to an accredited pharmacist for a Home Medicines Review).
  2. You are aware of the different tools available to help you identify medicines that may be more harmful to Tom. By referring to the Beers and STOPP criteria, you identify:
    • amitriptyline, which is highly anticholinergic and sedating, may cause orthostatic hypotension, worsen constipation and could be a prescribing cascade with docusate sodium/senna
    • hydrochlorothiazide, because it may exacerbate gout and could be a prescribing cascade with allopurinol.
  3. You assess the benefit–harm trade-offs of these medicines in the context of Tom’s age, concurrent medicines, overall physical health, possible pill burden, personal preferences, treatment goals, and social and financial support. Based on this, you further identify the following as potential deprescribing targets:
    • rosuvastatin for primary prevention
    • ramipril, considering the blood pressure targets for Tom’s age
    • docusate sodium/senna, due to the evidence of inefficacy
    • allopurinol, which may be ceased if Tom has been asymptomatic for the past 12 months and diuretic has been ceased or if Tom’s dietary and alcohol intake have improved.
  4. By using the prioritisation matrix and taking into account Tom’s preferences, you decide to prioritise ceasing amitriptyline over the other medicines because it has a comparatively higher risk of harm from continued use.
  5. You propose a medication withdrawal plan using the relevant drug-specific deprescribing guideline to gradually taper the dose of amitriptyline. Finally, you inform Tom of what to expect and reassure him that you will monitor his progress closely for improvement in outcomes or the onset of adverse events. You also provide Tom with a leaflet on managing insomnia through lifestyle modifications.
On future visits, if Tom is responding well and no longer has constipation, you could then suggest the next plan is to deprescribe his other medicines.


Deprescribing should be a core component of the clinical care provided to older people by GPs because this intervention is a key antidote to the harms caused by inappropriate polypharmacy. GPs can make deprescribing a routine part of their day-to-day clinical practice by using evidence-based practical deprescribing tools and engaging in collaborations with pharmacist and nurse colleagues.

Key points

  • Deprescribing is an intervention to reduce polypharmacy and high-risk prescribing.
  • The ultimate goal of deprescribing is to improve patient outcomes.
  • GPs can deprescribe medicines safely by ensuring slow dose tapering and patient engagement.
  • Deprescribing is acceptable to patients.
  • Deprescribing requires an individualised approach and can be supported by a multidisciplinary team.
Competing interests: KP is employed by Ryman Healthcare aged-care provider, outside of the submitted work, is Co-chair of the Medication Advisory Committee of Ryman Health Care and is a Community Representative of Health of Older People Service Level Alliance. The remaining authors have no competing interests to disclose.
Provenance and peer review: Commissioned, externally peer reviewed.
Funding: HWQ is supported by an Australian Government Research Training Program (RTP) Scholarship at The University of Western Australia. Provenance and peer review: Commissioned, externally peer reviewed.
Correspondence to:
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  1. Britt H, Miller G, Henderson J, et al. A decade of Australian general practice activity 2004–05 to 2013–14. General Practice Series 37. Sydney: Sydney University Press, 2014. Search PubMed
  2. De Vries TPGM, Henning RH, Hogerzeil HV, Fresle DA. Guide to good prescribing: A practical manual. WHO/DAP/94.11. Geneva: World Health Organization, 1994. Search PubMed
  3. Farrell B, Mangin D. Deprescribing is an essential part of good prescribing. Am Fam Physician 2019;99(1):7–9. Search PubMed
  4. Reeve E, Gnjidic D, Long J, Hilmer S. A systematic review of the emerging definition of ‘deprescribing’ with network analysis: Implications for future research and clinical practice. Br J Clin Pharmacol 2015;80(6):1254–68. doi: 10.1111/bcp.12732. Search PubMed
  5. Australian Institute of Health and Welfare (AIHW). Medicines in the health system. Canberra, ACT: AIHW, 2022. Available at [Accessed 22 August 2022]. Search PubMed
  6. Page A, Etherton-Beer C. Undiagnosing to prevent overprescribing. Maturitas 2019;123:67–72. doi: 10.1016/j.maturitas.2019.02.010. Search PubMed
  7. Lee GB, Etherton-Beer C, Hosking SM, Pasco JA, Page AT. The patterns and implications of potentially suboptimal medicine regimens among older adults: A narrative review. Ther Adv Drug Saf 2022;13:20420986221100117. doi: 10.1177/20420986221100117. Search PubMed
  8. Aljeaidi MS, Tan EC. The association between polypharmacy and cognitive ability in older adults: A national cohort study. Res Social Adm Pharm 2022;18(3):2505–09. doi: 10.1016/j.sapharm.2021.04.018. Search PubMed
  9. Aljeaidi MS, Haaksma ML, Tan ECK. Polypharmacy and trajectories of health-related quality of life in older adults: An Australian cohort study. Qual Life Res 2022;31(9):2663–71. doi: 10.1007/s11136-022-03136-9. Search PubMed
  10. Rodrigues MC, Oliveira Cd. Drug–drug interactions and adverse drug reactions in polypharmacy among older adults: An integrative review. Rev Lat Am Enfermagem 2016;24:e2800. doi: 10.1590/1518-8345.1316.2800. Search PubMed
  11. Kwak MJ, Chang M, Chiadika S, et al. Healthcare expenditure associated with polypharmacy in older adults with cardiovascular diseases. Am J Cardiol 2022;169:156–58. doi: 10.1016/j.amjcard.2022.01.012. Search PubMed
  12. McLachlan AJ, Bath S, Naganathan V, et al. Clinical pharmacology of analgesic medicines in older people: Impact of frailty and cognitive impairment. Br J Clin Pharmacol 2011;71(3):351–64. doi: 10.1111/j.1365-2125.2010.03847.x. Search PubMed
  13. Wimmer BC, Cross AJ, Jokanovic N, et al. Clinical outcomes associated with medication regimen complexity in older people: A systematic review. J Am Geriatr Soc 2017;65(4):747–53. doi: 10.1111/jgs.14682. Search PubMed
  14. Coe A, Kaylor-Hughes C, Fletcher S, Murray E, Gunn J. Deprescribing intervention activities mapped to guiding principles for use in general practice: A scoping review. BMJ Open 2021;11(9):e052547. doi: 10.1136/bmjopen-2021-052547. Search PubMed
  15. O’Mahony D, Gallagher PF. Inappropriate prescribing in the older population: Need for new criteria. Age Ageing 2008;37(2):138–41. doi: 10.1093/ageing/afm189. Search PubMed
  16. Opondo D, Eslami S, Visscher S, et al. Inappropriateness of medication prescriptions to elderly patients in the primary care setting: A systematic review. PLoS One 2012;7(8):e43617. doi: 10.1371/journal.pone.0043617. Search PubMed
  17. Gnjidic D, Cumming RG, Le Couteur DG, et al. Drug burden index and physical function in older Australian men. Br J Clin Pharmacol 2009;68(1):97–105. doi: 10.1111/j.1365-2125.2009.03411.x. Search PubMed
  18. Lim R, Kalisch Ellett LM, Widagdo IS, Pratt NL, Roughead EE. Analysis of anticholinergic and sedative medicine effects on physical function, cognitive function, appetite and frailty: A cross-sectional study in Australia. BMJ Open 2019;9(9):e029221. doi: 10.1136/bmjopen-2019-029221. Search PubMed
  19. Rochon PA, Gurwitz JH. Optimising drug treatment for elderly people: The prescribing cascade. BMJ 1997;315(7115):1096–99. doi: 10.1136/bmj.315.7115.1096. Search PubMed
  20. Savage RD, Visentin JD, Bronskill SE, et al. Evaluation of a common prescribing cascade of calcium channel blockers and diuretics in older adults with hypertension. JAMA Intern Med 2020;180(5):643–51. doi: 10.1001/jamainternmed.2019.7087. Search PubMed
  21. Page AT, Falster MO, Litchfield M, Pearson SA, Etherton-Beer C. Polypharmacy among older Australians, 2006-2017: A population-based study. Med J Aust 2019;211(2):71–75. doi: 10.5694/mja2.50244. Search PubMed
  22. Page AT, Clifford RM, Potter K, Schwartz D, Etherton-Beer CD. The feasibility and effect of deprescribing in older adults on mortality and health: A systematic review and metaanalysis. Br J Clin Pharmacol 2016;82(3):583–623. doi: 10.1111/bcp.12975. Search PubMed
  23. Reeve E. Deprescribing tools: A review of the types of tools available to aid deprescribing in clinical practice. J Pharm Pract Res 2020;50(1):98–107. Search PubMed
  24. Steinman M, Reeve E. Deprescribing. Wellesley, MA: Uptodate, 2021. Available at [Accessed 22 August 2022]. Search PubMed
  25. Page AT, Potter K, Clifford R, McLachlan AJ, Etherton-Beer C. Medication appropriateness tool for co-morbid health condiHons in demenHa: Consensus recommendations from a multidisciplinary expert panel. Intern Med J 2016;46(10):1189–97. Search PubMed
  26. Basger BJ, Chen TF, Moles RJ. Validation of prescribing appropriateness criteria for older Australians using the RAND/UCLA appropriateness method. BMJ Open 2012;2:e001431. Search PubMed
  27. American Geriatrics Society Beers Criteria® Update Expert Panel. American Geriatrics Society 2019 updated Beers Criteria® for potentially inappropriate medication use in older adults. J Am Geriatr Soc 2019;67(4):674–94. Search PubMed
  28. O’Mahony D, O’Sullivan D, Byrne S, O’Connor MN, Ryan C, Gallagher P. STOPP/START criteria for potentially inappropriate prescribing in older people: Version 2. Age Ageing 2015;44:213–18. Search PubMed
  29. Page AT, Etherton-Beer CD, Clifford RM, Burrows S, Eames M, Potter K. Deprescribing in frail older people – do doctors and pharmacists agree? Res Social Adm Pharm 2016;12(3):438–49. Search PubMed
  30. Scott IA, Le Couteur DG. Physicians need to take the lead in deprescribing. Intern Med J 2015;45(3):352–56. Search PubMed
  31. Manski-Nankervis J, McMorrow R, Nelson C, Jesudason S, Sluggett JK. Prescribing and deprescribing in chronic kidney disease. Aust J Gen Pract 2021;50(4):183–87. Search PubMed
  32. Turner JP, Thompson W, Reeve E, Bell JS. Deprescribing proton pump inhibitors. Aust J Gen Pract 2022;51(11):845–48. Search PubMed
  33. Iyer S, Naganathan V, McLachlan AJ, Le Couteur DG. Medication withdrawal trials in people aged 65 years and older: A systematic review. Drugs Aging 2008;25(12):1021–31. doi: 10.2165/0002512-200825120-00004. Search PubMed
  34. Garfinkel D, Mangin D. Feasibility study of a systematic approach for discontinuation of multiple medications in older adults: Addressing polypharmacy. Arch Intern Med 2010;170(18):1648–54. doi: 10.1001/ archinternmed.2010.355. Search PubMed
  35. Le Couteur D, Gnjidic D, McLachlan A. Deprescribing. Aust Prescr 2011;34:182–85. Search PubMed
  36. Best Practice Advocacy Centre New Zealand. A practical guide to stopping medicines in older people. Dunedin: BPAC NZ Limited, 2010. Available at [Accessed 22 August 2022]. Search PubMed
  37. Kua CH, Mak VSL, Huey Lee SW. Health outcomes of deprescribing interventions among older residents in nursing homes: A systematic review and meta-analysis. J Am Med Dir Assoc 2019;20(3):362–72.e11. doi: 10.1016/j.jamda.2018.10.026. Search PubMed
  38. Wu H, Kouladjian O’Donnell L, Fujita K, Masnoon N, Hilmer SN. Deprescribing in the older patient: A narrative review of challenges and solutions. Int J Gen Med 2021;14:3793–807. doi: 10.2147/IJGM.S253177. Search PubMed
  39. Bloomfield HE, Greer N, Linsky AM, et al. Deprescribing for community-dwelling older adults: A systematic review and meta-analysis. J Gen Intern Med 2020;35(11):3323–32. doi: 10.1007/s11606-020-06089-2. Search PubMed
  40. Scott IA, Reeve E, Hilmer SN. Establishing the worth of deprescribing inappropriate medications: Are we there yet? Med J Aust 2022;217(6):283–86. doi: 10.5694/mja2.51686. Search PubMed
  41. Weir KR, Ailabouni NJ, Schneider CR, Hilmer SN, Reeve E. Consumer attitudes towards deprescribing: A systematic review and meta-analysis. J Gerontol A Biol Sci Med Sci 2022;77(5):1020–34. doi: 10.1093/gerona/glab222. Search PubMed
  42. Reeve E, Wolff JL, Skehan M, Bayliss EA, Hilmer SN, Boyd CM. Assessment of attitudes toward deprescribing in older Medicare beneficiaries in the United States. JAMA Intern Med 2018;178(12):1673–80. doi: 10.1001/jamainternmed.2018.4720. Search PubMed
  43. Page A, Clifford R, Potter K, Etherton-Beer C. A concept analysis of deprescribing medications in older people. J Pharm Pract Res 2018;48:132–48. doi: 10.1002/jppr.1361. Search PubMed
  44. Le Bosquet K, Barnett N, Minshull J. Deprescribing: Practical ways to support person-centred, evidence-based deprescribing. Pharmacy (Basel) 2019;7(3):129. doi: 10.3390/pharmacy7030129. Search PubMed
  45. Duncan P, Duerden M, Payne RA. Deprescribing: A primary care perspective. Eur J Hosp Pharm 2017;24(1):37–42. doi: 10.1136/ejhpharm-2016-000967. Search PubMed
  46. Trenaman SC, Kennie-Kaulbach N, d’Entremont-MacVicar E, et al. Implementation of pharmacist-led deprescribing in collaborative primary care seongs. Int J Clin Pharm 2022;44(5):1216–21. doi: 10.1007/s11096-022-01449-w. Search PubMed
  47. Wright DJ, Scott S, Buck J, Bhattacharya D. Role of nurses in supporting proactive deprescribing. Nurs Stand 2019;34(3):44–50. doi: 10.7748/ns.2019.e11249. Search PubMed
  48. Bužancic I, Dragovic P, Pejakovic TI, Markulin L, Ortner-Hadžiabdic M. Exploring patients’ attitudes toward deprescribing and their perception of pharmacist involvement in a European country: A cross-sectional study. Patient Prefer Adherence 2021;15:2197–208. doi: 10.2147/PPA.S323846. Search PubMed


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