Geriatrics
Implementing routine medication reviews in primary care to identify potentially inappropriate prescriptions for older adults.
Routine medication reviews in primary care improve safety for older adults by systematically evaluating each prescription for appropriateness, interactions, and overall benefit, reducing harm while supporting personalized care and patient participation.
Published by
Jessica Lewis
July 21, 2025 - 3 min Read
Routine medication reviews in primary care start with a structured plan that fits into existing clinical workflows. The clinician gathers a current list of all medicines, including over-the-counter drugs and supplements, and notes any recent changes in health status. The review then compares each medication against guidelines tailored to older adults, considering age-related physiology, polypharmacy risks, and cognitive or functional status. The goal is to identify potential inappropriate prescriptions or duplications, and to flag changes that might be unnecessary or even harmful. Effective reviews require clear communication with patients and caregivers about benefits, risks, and preferences. Documentation should specify actions and follow-up timelines.
A successful medication review goes beyond ticking boxes; it shapes ongoing care. Clinicians should set goals with patients, such as reducing side effects, simplifying regimens, or stopping drugs with limited benefit. By prioritizing medications most closely linked to adverse outcomes—like delirium, falls, or renal insufficiency—the team can allocate time and effort where it matters most. Decision support tools, when integrated into the electronic health record, help detect potentially inappropriate medicines and drug-drug interactions. Regularly updating patient histories ensures that new lab results, allergies, or hospitalizations are reflected, preventing reactive rather than proactive stewardship.
Collaboration fuels continuous improvement in prescribing practices.
The first step in a routine review is assembling a comprehensive medication list that extends beyond prescriptions to include vitamins, herbal products, and nonprescription analgesics. Patients should be encouraged to share beliefs about medications and any practical barriers to adherence. The clinician then notes existing medical conditions and functional goals, which influence which medications offer meaningful benefit. In this stage, attention to drug duplication is essential, as duplications can inflate risk without improving outcomes. Moreover, patient literacy and language considerations must be respected so that explanations about risks and alternatives are understandable and empowering.
The next phase centers on evaluating each drug’s current necessity. For older adults, even well-intentioned therapies can become burdensome or risky. Clinicians assess dose adequacy, frequency, renal or hepatic clearance requirements, and potential cognitive effects. They also consider deprescribing pathways for medications that no longer align with health goals or are superseded by safer alternatives. Engaging patients in shared decision-making is crucial; clinicians present evidence, discuss potential gains and harms, and listen to preferences. A well-documented plan should outline which drugs to discontinue, adjust, or substitute, along with a clear follow-up timetable.
Patient engagement improves acceptance and adherence to plans.
Interdisciplinary teams enrich medication reviews. Pharmacists bring expertise on pharmacodynamics, interactions, and safe tapering protocols, while nurses can monitor adherence and adverse effects in real time. Primary care physicians coordinate this collaborative approach, ensuring that decisions are aligned with chronic disease management plans. Engaging family members or caregivers when appropriate strengthens support at home and facilitates accurate reporting of symptoms. Regular team huddles after patient visits help capture nuanced concerns that might not be evident in isolated encounters. When teams share insights, the likelihood of identifying potentially inappropriate prescriptions increases and patient confidence grows.
Structured documentation is essential for continuity of care. Each medication change should be captured in a standardized format, including rationale, expected outcomes, and agreed follow-up actions. The chart should flag any drugs requiring slower tapering, monitoring for withdrawal phenomena, or dose adjustments. Alerts within the electronic health record can remind clinicians to reassess therapy at predefined intervals, such as every six to twelve months or after a hospitalization. Care plans must be accessible to all members of the care team, making it easier to maintain consistency across different settings and providers.
Real-world monitoring ensures safety after changes.
Before any alteration, clinicians should assess patient priorities and daily routines. A medication that complicates a schedule or causes disruptive side effects is more likely to be discontinued if alternatives exist. Practical considerations, such as pill burden, cost, and transportation to pharmacies, influence whether a plan is feasible. Clinicians can propose simplification strategies, like once-daily dosing or combining therapies when safely possible. Training patients on self-monitoring signs, such as dizziness or confusion, promotes early detection of adverse effects. The goal remains to maintain quality of life while minimizing potential harm from medications.
Education tailored to the patient’s literacy level makes information meaningful. Clinicians should explain not only what to take, but why, and what signs to report. Shared decision-making invites patients into the care process, turning prescriptions into collaborative choices rather than unilateral directives. Visual aids, plain-language handouts, and teach-back methods help verify understanding. When patients feel heard, they are more likely to report concerns promptly, allowing timely adjustments. Returning visits should revisit the medication list, confirm tolerability, and revise plans as health status evolves with aging.
Long-term goals center on safety, autonomy, and dignity.
After any deprescribing or dose adjustment, close monitoring is necessary to catch rebound symptoms or withdrawal effects. Clinicians should establish objective thresholds for success, such as reduced falls or fewer hospital visits, and track progress through patient-reported outcomes and routine measurements. Barriers to adherence, including cognitive impairment or visual difficulties, must be addressed with supportive tools or caregiver involvement. Telehealth check-ins can supplement in-person visits, offering a convenient way to verify that changes are working as intended and to adjust when needed. Timely communication among the care team sustains momentum and accountability.
Community and system-level factors influence long-term success. Health systems can standardize deprescribing protocols and provide ongoing education for clinicians about age-related pharmacology. National guidelines, locally adapted, should guide decisions while allowing room for patient preferences. Policies that encourage medication reconciliation at every care transition reduce the risk of omissions and duplications. When organizations invest in longitudinal stewardship programs, patient safety improves and clinicians feel supported in difficult conversations about risk and benefit.
A sustainable approach to medication reviews recognizes that aging is a dynamic process. Regular re-evaluation is not a one-off event but an ongoing cycle that adapts to changes in comorbidity, function, and goals of care. Clinicians must stay vigilant for emerging risks associated with polypharmacy, such as cognitive decline or frailty progression, and respond with proportionate interventions. The patient’s voice remains central; reviews should reflect evolving wishes about independence, comfort, and practical living arrangements. By maintaining a proactive stance, primary care teams can safeguard autonomy while minimizing drug-related harm across the lifespan.
In summary, routine medication reviews in primary care offer a practical path to safer aging. They require structured processes, collaborative expertise, patient-centered communication, and robust follow-up. When executed consistently, reviews help identify potentially inappropriate prescriptions and unnecessary polypharmacy, while preserving meaningful therapies. The ultimate reward is a care plan that aligns with each older adult’s values, health status, and daily living priorities. With commitment from clinicians, patients, families, and health systems, routine medication reviews become a cornerstone of high-quality geriatrics care, supporting safer, more autonomous aging for years to come.
