Deprescribing in the elderly: A systematic approach to rational polypharmacy

Polypharmacy is a growing concern in elderly populations due to rising multimorbidity and increased life expectancy. While medications are essential for managing chronic conditions, the cumulative burden of drugs can lead to adverse drug events, functional decline and poor quality of life. Deprescribing is the planned and supervised process of dose reduction or discontinuation of unnecessary or harmful medications offering a rational, patient-centred approach to optimise pharmacotherapy in older adults. This review explores the concept of deprescribing, its clinical rationale and various tools and frameworks such as screening tool of older persons’ potentially inappropriate prescriptions/screening tool to alert doctors to right treatment criteria, Beers Criteria, the Garfinkel algorithm and the Bruyère 5step model. Evidence from randomised controlled trials and meta-analyses demonstrates that deprescribing interventions can safely reduce medication burden without compromising clinical outcomes. Key challenges include clinician hesitation, patient resistance and systemic barriers such as lack of electronic health integration and standardised guidelines, especially in low and middle income countries like India. The review highlights the unique barriers and opportunities in the Indian context and emphasises the vital role of healthcare providers especially pharmacologists, pharmacists and physicians in promoting safe deprescribing practices. With the integration of digital tools, multidisciplinary collaboration and education reform, deprescribing can evolve from a theoretical concept to a practical standard of care in geriatric medicine.