Drug-class library
Nine classes that account for most of what gets reviewed in an older adult. Each page sets out what the drug is for, what changes about it with age, what the evidence supports and where it is thinner than the confidence around it, and what a review of that class actually involves.
Before you read on
Never stop or change a prescribed medication without speaking to your own prescriber. Several of the classes described on this site rebound, or cause a withdrawal syndrome, when they are stopped abruptly, and some have to be reduced gradually over weeks or months under supervision. Nothing here is advice about your own medication, and nothing here is a reason to change anything on your own.
The classes
Opioids
Pain that is real, treatment that carries risk, and a tapering literature that has been widely misread.
Benzodiazepines
The class with the clearest harm signal in older adults and the best-tested discontinuation method.
Z-drugs
Marketed as the safer alternative to benzodiazepines. Largely the same receptor, largely the same risks.
Antipsychotics
A boxed warning, a mortality signal, and a set of situations where they are still the right answer.
Anticholinergics
A burden that is a property of the whole list, not of any one line in it.
Proton pump inhibitors
The gap between what observational studies suggested and what the randomized evidence found.
Statins in the very old
Time to benefit, the diabetes trade-off, and the age group the trials underenrolled.
Antihypertensives
The specific pathway from an over-tight dose to a broken hip, and why the target is not one number.
Gabapentinoids
Prescribing that grew as opioid prescribing fell, in a population that clears them slowly.
How to read these pages
Each page is written to be useful to a clinician and readable by a family. Where a figure appears, its population and the criterion used to produce it are named in the same sentence, because that is where these numbers most often go wrong. Where the evidence is mixed, both sides are given rather than the topic being hedged away — the trials in this field routinely exclude the frail, multimorbid, cognitively impaired patients who make up most of a long-term care population, and a clean result in a selected sample does not automatically transfer to the people who were screened out.
None of these pages is a taper schedule, and none of them tells anyone to stop anything. Tapering principles covers the method; the decision belongs to a prescriber who knows the person.
What the evidence does and does not show
Sedating medications impair gait, balance and reaction time, and their labels say so. That part is not in doubt. What has not been shown is that a deprescribing program reduces fall rates — the trials that tested it were small, short, and mostly measured a medication count rather than a fracture. Those are two different questions, and absence of evidence from underpowered trials is not evidence that the drugs do not cause falls. What the evidence actually shows about deprescribing and falls.
Written and medically reviewed by Dr. Gurpreet Singh Padda, MD, MBA, MHP, founder and medical director of DWARAA. Last reviewed . This page is educational. DWARAA does not prescribe, deprescribe, diagnose or treat.