The evidence base
The evidence behind deprescribing in older adults rests on screening tools such as the Beers Criteria and STOPP/START, on randomized trials, and on systematic reviews. Every figure on this site names its source, its population and its criterion.
Everything the framework asserts should be traceable to something published, and where it is not, that should be said out loud. These pages set out the tools, the trials and the syntheses that the field rests on — including the places where the evidence is weaker than the confidence it is quoted with.
What tools and trials guide deprescribing in older adults?
The Beers Criteria
What the AGS list is, what it is not, and the misreading that turns a prompt into a prohibition.
STOPP/START
Two lists in one tool — what to stop, and the omissions that matter just as much.
Deprescribing and falls
The claim that gets made most often, and what the trials actually found.
Polypharmacy in long-term care
How much medication is really on the list, in which populations, by which definition.
What deprescribing trials measure
Why a field can be well studied and still not answer the question you are asking.
Antipsychotics and mortality in dementia
The boxed warning, the meta-analyses behind it, and the size of the risk.
Time to benefit
A preventive drug that takes five years to help, in someone with a two-year outlook.
How does DWARAA weigh deprescribing evidence?
- Every figure carries a source, or it is not published. A page with fewer numbers is better than a page with one wrong one.
- Every figure names its population and its criterion in the same sentence. “Polypharmacy affects half of older adults” is not a fact until you know which older adults and what counts as polypharmacy.
- Systematic reviews and meta-analyses outrank single trials, randomized evidence outranks observational, and where a claim rests on observation rather than randomization, the page says so.
- A guideline is cited as a guideline, not as evidence of effect.
- Where the evidence is thin, the page gets longer, not more skeptical. Naming the exclusion criteria of a trial is a verifiable fact about that trial, and it is usually the most useful thing a complex patient can learn about it.
Frequently asked questions
What are the Beers Criteria?
The Beers Criteria are the American Geriatrics Society (AGS) list used to flag medications in older adults. The list is a prompt to take a closer look at a drug, not a ban on it. The most common mistake is reading it as a prohibition, which is why our Beers Criteria page sets out what the list is and what it is not.
What is STOPP/START?
STOPP/START is one screening tool made of two lists. STOPP names medications to consider stopping in an older adult. START names treatments that are missing but should be there, because an omission can matter just as much as an extra drug. Used together, the two lists make a medication review look in both directions.
Does deprescribing reduce falls in older adults?
That has not been shown. Sedating medications impair gait, balance and reaction time, and that part is not in doubt. But the trials that tested deprescribing programs were small and short, and most measured a medication count rather than a fracture. Absence of evidence from underpowered trials is not evidence that the drugs do not cause falls.
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.