Kamal Ghorui
NEW DELHI: For many elderly people, a typical day begins with a handful of pills – for blood pressure, diabetes, cholesterol and heart disease. But a new global review suggests that in very frail older adults, continuing all long-term medicines may not always be necessary – and in many cases, carefully stopping some of them may be safe.The findings, published in the journal ‘BMC Geriatrics’, come from an analysis of patients with advanced frailty, dementia or limited life expectancy – a group often prescribed multiple medicines despite unclear long-term benefit. Researchers found that reducing or discontinuing such drugs did not lead to a rise in deaths or major complications in most cases.Many of these medicines are meant to prevent problems years later. But for frail or seriously ill patients, those benefits may never be realised. Instead, taking multiple drugs can increase the risk of dizziness, weakness, confusion and falls, often leading to hospitalisation.Doctors say this pattern of “polypharmacy”, where patients take several medicines at once, is increasingly common among the elderly in India. “They often see multiple specialists and prescriptions are not always reviewed together. In frail older adults, over-treatment can do more harm than good – for instance, aspirin for primary prevention should be avoided, excessive blood pressure control can lead to falls, and drugs like diuretics, insulin or sulfonylureas can cause electrolyte imbalance or hypoglycaemia. The focus sho-uld be on reducing medicines where the risks outweigh the benefits,” said Dr Pulin Gupta, professor in the department of medicine at Ram Manohar Lohia Hospital.“In frail elderly patients, stopping some preventive medicines is generally safe if done carefully, though those with prior heart attack or stroke need caution,” said Dr Rommel Tickoo, director of internal medicine at Max Hospital, Saket. He added that commonly overused drugs include statins for primary prevention, tightly controlled diabetes medicines like insulin or sulfonylureas, multiple blood pressure drugs, sleeping pills, long-term acid suppressants and anticholinergics.“Deprescribing should be structured – based on goals of care, frailty and life expectancy – with careful tapering and monitoring,” he said, noting that reducing medicines often leads to fewer falls, better cognition and improved energy levels.Families often assume more medicines mean better care, but the opposite can be true. Each added drug raises the risk of interactions. The review reflects a shift from aggressive prevention to pati-ent-centred care, where treatment aligns with health and priorities. Experts caution that medicines should not be stopped casually; reduction must be supervised, with each drug reviewed for need.
