Deprescribing medications for older people: practical guidance for primary care

Polypharmacy is increasingly prevalent in frail older adults and those approaching end of life, where multimorbidity and prescribing cascades heighten the risk of adverse drug events, hospitalisation and functional decline. Deprescribing, the planned and supervised withdrawal of medicines that are no longer beneficial or may cause harm, is now recognised as an essential element of safe prescribing and person-centred care. Evidence-based deprescribing frameworks, including STOPP/START, STOPPFrail, Medstopper, and national guidance were reviewed. Practical examples are drawn from common therapeutic areas such as antihypertensives, anticoagulants, anticholinergics, diabetes medicines, iron supplementation, opioids and hypnotics. Deprescribing is a clinical and ethical imperative in frail and end-of-life care. Embedding deprescribing into structured medication reviews, supported by validated tools and national frameworks, reduces avoidable harm, preserves function, and supports dignity at the end of life. This article provides practical guidance on identifying and managing inappropriate polypharmacy, with a focus on deprescribing strategies that optimise safety, reduce treatment burden, and align care with patient goals.