Pharmacology & drugs
How to implement pharmacist-facilitated medication reviews focused on deprescribing and reducing inappropriate medication use in elders.
Pharmacist-led medication reviews offer a structured, elder-centered approach to deprescribing, minimizing risky drug therapies while preserving essential treatment, improving safety, quality of life, and independence for aging adults through collaborative, patient-aware processes.
Published by
Andrew Scott
July 18, 2025 - 3 min Read
Pharmacy teams bring a practical framework to deprescribing by combining evidence-based guidelines with real-world patient insights. When elder patients encounter polypharmacy, clinicians gain from systematic medication reviews that identify redundant, high-risk, or unnecessary drugs. Pharmacists can assess each prescription’s necessity, duration, and potential interactions within the patient’s current health status, kidney and liver function, and functional goals. Involving patients and families in these conversations helps set realistic expectations and aligns treatment with personal priorities. A well-organized review minimizes adverse events and costs, while preserving clinically valuable therapies. The result is a clearer, safer medication plan that supports sustained autonomy and functional capacity in daily life.
Implementing such reviews requires clear roles, standardized workflows, and patient-centered communication. Pharmacists collaborate with physicians, nurses, and caregivers to gather a complete medication history, including over‑the‑counter products and supplements. They document therapeutic intent, evidence strength, and the rationale for each deprescribing step. Shared decision-making fosters trust, as patients understand the rationale for stopping, dose adjustments, or switching to safer alternatives. Consistent follow-up helps detect withdrawal effects or recurrence of symptoms, enabling timely modifications. By building a culture of safety and transparency, teams reduce inappropriate medications, shorten hospital stays, and improve overall health trajectories for older adults.
Pharmacists coordinate with caregivers to support safe, gradual drug reductions.
A successful pharmacist-facilitated review begins with a comprehensive interview that explores daily routines, symptom burden, and medication goals. Pharmacists listen for barriers to adherence, such as complex dosing schedules, cognitive challenges, or transportation limits that hinder consistent use. They screen for potentially inappropriate medications using criteria tailored to older adults, including anticholinergic burden, sedative effects, and drug-disease interactions. The process emphasizes meaningful outcomes over rigid targets, ensuring that stop or start decisions align with the patient’s values. Documentation then translates into a personalized deprescribing plan, with milestones, safety nets, and milestones that reflect the patient’s life context and family support system.
After identifying riskier drugs, the team prioritizes deprescribing steps based on potential harm, reversibility, and withdrawal likelihood. Pharmacists assess alternative therapies that maintain symptom control while reducing risk, such as non-pharmacologic strategies or safer medication classes. They craft taper schedules with attention to gradual dose reductions that minimize withdrawal or symptom rebound, and they monitor for rebound effects. The plan includes clear communication to prescribing clinicians and caretakers, ensuring everyone understands timing, expected outcomes, and contingency measures. Ongoing evaluation captures changes in balance, cognition, falls risk, and overall functional independence, guiding iterative adjustments to the regimen.
Clear, consistent communication guides deprescribing across care settings.
Engaging caregivers is essential to sustain success beyond the clinic. Pharmacists provide practical education about each deprescribing step, what to expect, and red flags that require medical attention. They tailor conversations to the caregiver’s level of health literacy, using plain language and concrete examples. When feasible, home visits or telehealth check-ins reinforce adherence to taper plans and help detect early signs of adverse effects. This collaborative approach strengthens the home safety net, reduces emergency visits, and makes the care plan more resilient under daily stressors. The ultimate aim is a support system that maintains comfort, dignity, and independence for older adults.
System-wide, this approach benefits from integrated data, standardized tools, and continuous learning. Pharmacists rely on electronic health records to track medication histories, dosing changes, and laboratory results that reflect safety and efficacy. Decision-support tools help flag high-risk combinations and interactions, while deprescribing templates streamline documentation. Regular interdisciplinary meetings foster shared accountability for patient outcomes. Training programs emphasize communication skills, cultural sensitivity, and ethical considerations when adjusting lifelong therapies. By embedding deprescribing into routine care, health systems can sustain safer prescribing practices over time.
Ongoing monitoring ensures safety and patient-centered progress.
Transition points between hospital, primary care, and home care pose particular challenges and opportunities. Pharmacists can prepare discharge summaries that clearly outline which medications are stopped, how to resume if needed, and what follow-up is required. They ensure information transfers are accurate and timely, preventing duplication of therapy or missed doses. In the outpatient setting, pharmacists screen for persistent symptoms that signal under-treatment, while also reaffirming which drugs to discontinue. The goal is seamless continuity, so the patient’s daily routines remain stable and caregiver workload is manageable during the transition. Effective handoffs reduce confusion and support safer aging in place.
Monitoring is the watchdog of deprescribing success, guiding necessary refinements. Pharmacists create simple, actionable checklists for patients and caregivers to track mood, energy, sleep, appetite, and pain levels. They establish remote alert systems or periodic in-person visits to catch early warning signs of withdrawal or symptom relapse. Data gathered over time informs whether taper rates were appropriate or if adjustments are warranted. When adverse events occur, the team analyzes contributing factors, revises taper plans, and communicates revised expectations promptly. This vigilant approach sustains patient trust while improving clinical outcomes.
Respecting autonomy while guiding safer, wiser medication choices.
Medication reviews should incorporate environmental and social determinants that influence drug use. Pharmacists assess access to medications, affordability, and social support networks, recognizing that these factors shape adherence. They address barriers like transportation, pharmacy hours, and the complexity of multi-prescriber coordination. By aligning deprescribing plans with home capabilities and community resources, pharmacists help older adults maintain independence without compromising safety. Coordinated efforts with social workers and community organizations extend the reach of deprescribing benefits into everyday life, reinforcing a holistic approach to elder care.
Ethical guidelines and patient autonomy remain central throughout the process. Pharmacists respect patient choices, even when they diverge from clinical recommendations, and provide clear explanations about risks and benefits. They ensure consent is informed, documentation is transparent, and privacy protections are maintained. When patients lack capacity, clinicians engage legally authorized representatives to reflect the patient’s prior preferences and best interests. The deprescribing journey becomes a collaborative, rights-respecting partnership that honors the individual’s dignity and long-term goals.
Economic considerations influence deprescribing strategies as well. Reducing unnecessary medications can lower pharmacy costs, minimize adverse event-related expenses, and decrease hospital utilization. Yet, pharmacists must balance cost with clinical value, avoiding abrupt changes that could trigger symptom deterioration. Cost-awareness should not undermine patient preference; instead, it should inform shared decision-making. By documenting outcomes and demonstrating value to payers and care teams, deprescribing initiatives gain sustainable support. Transparent reporting helps expand successful models to other clinics serving older adults.
Ultimately, pharmacist-facilitated medication reviews create a proactive standard of care for elders. The approach centers on patient safety, functional ability, and a personalized plan that addresses the nuances of aging. Through collaboration, education, and careful monitoring, deprescribing becomes an integral part of routine management rather than an afterthought. This shift reduces inappropriate medication use and supports a healthier, more independent aging experience. By investing in these reviews, health systems cultivate resilience, improve outcomes, and empower patients to participate actively in their treatment journeys.
