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Deprescribing: what the trials show

GPs & clinicians Facility leadership Aged care staff 8 min read

By Dr Josh Hatch, FRACGP

Deprescribing means the planned, supervised stopping or reduction of medicines that are no longer helping or may be causing harm. Trials in residential care show that it reliably shortens medication lists and makes them more appropriate. Whether that leads to fewer deaths, hospital admissions or falls has not been shown 910.

Numbers in the text link to the 7 sources listed at the foot of this page.

How to read this page

Deprescribing trials usually test a process, such as a pharmacist review or a case conference, rather than stopping one drug. The interventions vary a great deal, which makes pooling the results difficult 9.

Most trials measure prescribing quality: the number of medicines and the number of potentially inappropriate ones. Fewer measure what residents and families care about most, and those that do are often too small to detect a difference 910.

The evidence

Structured medication review in residential care

Supported by trial evidence

Review programs reduce the number of medicines and improve how appropriate they are.

The evidence

A Cochrane review of 12 randomised trials, with 10,953 residents in 355 care homes in ten countries, found that interventions to optimise prescribing identified and resolved medication-related problems in seven studies and improved medication appropriateness in all five studies that measured it, with low-certainty evidence 9. A 2026 meta-analysis of 38 studies in long-term care, 22 of them randomised, found almost one fewer medicine per resident within 12 months (mean difference −0.89, 95% CI −1.46 to −0.32) and 1.6 fewer at 12 months or longer, with fewer potentially inappropriate medicines 10.

In practice

Most of the studies in the 2026 meta-analysis were at moderate or high risk of bias, and the interventions differed widely 10.

Medication review to reduce deaths, hospital admissions and falls

Uncertain / conflicting

The trials have not shown an effect on these outcomes. That reflects small and varied trials more than proof of no effect.

The evidence

In the Cochrane review, optimising prescribing may make little or no difference to adverse drug events (two studies) or mortality (six studies), with low-certainty evidence, and one study of eight found fewer days in hospital 9. The 2026 meta-analysis found no significant effect on falls, hospital admissions or mortality 10. For falls specifically, a 2025 Cochrane review was very uncertain of the effect of medication review and deprescribing as a single intervention (rate ratio 0.94, 95% CI 0.76 to 1.18; 12 trials) 13.

In practice

A meta-analysis across all settings found that deprescribing did not change mortality in randomised studies overall (odds ratio 0.82, 95% CI 0.61 to 1.11). In the subgroup where the intervention was specific to each patient, mortality was lower (0.62, 95% CI 0.43 to 0.88), while generic education programs had no effect (1.21, 95% CI 0.86 to 1.69) 11. Subgroup findings are weaker evidence than the main result.

Is it safe to stop?

The concern raised most often is that stopping a medicine will cause harm. The trial evidence, while limited, has not found that. In a Western Australian trial in four rural residential care homes, 95 residents with a mean age of 84 were randomised to planned deprescribing or usual care. Of 348 medicines targeted for stopping, 207 were stopped. After 12 months the intervention group took about two fewer regular medicines than the control group, and there were no significant differences in deaths (26% against 40%; hazard ratio 0.60, 95% CI 0.30 to 1.22), falls, fractures, hospital admissions, cognition, bowel function, sleep or quality of life 12.

The trial was small and open-label, so it could have missed a modest harm or benefit 12. The larger pooled analyses have not found an increase in deaths with deprescribing either 911.

Some medicines need to be reduced gradually, and for a few the original problem can return. In two antipsychotic withdrawal trials limited to residents who had responded well to treatment, symptoms were more likely to come back after stopping 16.

What seems to make review work

An analysis of 13 falls trials of medication review in residential care looked for the features that separated the three successful trials from the ten unsuccessful ones. The successful trials used a tool or list to guide decisions, involved at least one prescriber from the resident’s usual care team, and had clinicians review medicines together at least every six months. These features were present in all three successful trials and in two of the ten others 14. That is a hypothesis drawn from the trials, not a tested result.

It fits the pooled finding that interventions tailored to the individual patient did better than general education 11.

Related pages on this site

Sources cited on this page

  1. 9 Alldred DP, Kennedy MC, Hughes C, Chen TF, Miller P. Interventions to optimise prescribing for older people in care homes. Cochrane Database Syst Rev. 2016;(2):CD009095. (12 randomised trials, 10,953 residents.) View source
  2. 10 Carollo M, Cristini I, Crisafulli S, et al. Evaluating the impact of medication review and deprescribing on prescribing appropriateness and clinical outcomes in older people residing in long-term care facilities: a systematic review and meta-analysis. Age Ageing. 2026;55(4):afag084. (38 studies, 22 randomised; search to August 2024.) View source
  3. 11 Page AT, Clifford RM, Potter K, Schwartz D, Etherton-Beer CD. The feasibility and effect of deprescribing in older adults on mortality and health: a systematic review and meta-analysis. Br J Clin Pharmacol. 2016;82(3):583–623. (All settings; randomised and non-randomised studies.) View source
  4. 12 Potter K, Flicker L, Page A, Etherton-Beer C. Deprescribing in frail older people: a randomised controlled trial. PLoS One. 2016;11(3):e0149984. (95 residents, four rural Western Australian homes; open-label.) View source
  5. 13 Dyer SM, Kwok WS, Suen J, et al. Interventions for preventing falls in older people in care facilities. Cochrane Database Syst Rev. 2025;8:CD016064. (104 randomised trials.) View source
  6. 14 Suen J, Narayan S, Seppala LJ, et al. Features of successful medication review and deprescribing interventions for fall prevention in residential aged care facilities: an intervention component analysis of an updated systematic review. Age Ageing. 2025;54(8):afaf230. (13 trials; hypothesis-generating.) View source
  7. 16 Van Leeuwen E, Petrovic M, van Driel ML, et al. Withdrawal versus continuation of long-term antipsychotic drug use for behavioural and psychological symptoms in older people with dementia. Cochrane Database Syst Rev. 2018;3:CD007726. (10 randomised trials, 632 participants.) View source

See every source cited across the medicines and deprescribing section →

Written by Dr Josh Hatch, FRACGP. General information only, reflecting his reading of the published evidence as at October 2026. It is not individual medical advice, does not create a doctor–patient relationship, and must not be used to start, stop or change any treatment. Evidence and Australian regulatory, PBS and program arrangements change — always confirm current advice with the treating GP, pharmacist or specialist.

This is general education, not a clinical protocol. The doctors who practise with Umbrella Aged Care are independent general practitioners, and each makes their own clinical decisions with the resident and family. Your GP’s advice for an individual may differ from what is written here. If it does, please ask them to talk it through with you.

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