For families of residents
Specific questions work better than general concern. “Is she on too much?” invites reassurance. “What is this one for, and is that still happening?” invites an answer.
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 four core questions
These are the same four questions a careful prescriber asks about each medicine. You are entitled to ask them, and a good clinician will be glad you did.
- “What is this one for — and is that still happening?” Not what class of drug it is. What problem, in this person, now. A surprising number of long-term prescriptions treat something that resolved, or something never confirmed.
- “Could this one be treating a side effect of another one?” This is the question that finds a prescribing cascade, and it is almost never asked from outside.
- “How long does this take to help, and is that realistic for her?” Fair to ask about preventive medicines. Not relevant to anything treating a symptom now — a medicine relieving pain works today.
- “Is anything on this list sedating — and could what looks like decline be a medication?” The most important question on the page.
Four more that get useful answers
- “Has anyone looked at the whole list at once, in the order things were started?” Reading a list chronologically reveals things an alphabetical list hides.
- “What is this psychiatric medicine for, specifically — which behavior?” If nobody wrote down the target symptom when it was started, nobody can tell later whether it worked. That is a fair thing to ask about, gently.
- “When was her blood pressure last checked standing up as well as sitting?” A drop on standing causes dizziness and falls, takes three minutes to measure, and is skipped constantly.
- “If something is reduced, what should I watch for, and who do I tell?” This one turns you into part of the monitoring, which is where you are most useful.
What a good answer sounds like
| A good answer | An answer worth following up |
|---|---|
| “It is for reflux. She had symptoms in 2021; we have not retested. It is worth reviewing.” | “That is standard for someone her age.” |
| “That one is sedating. Let us reduce it slowly and see whether she is brighter in three weeks.” | “She needs it to settle at night.” |
| “We started it for agitation in March. Looking back, I cannot see that it helped. Let us try coming off it.” | “She has been on it a long time.” |
| “I would rather not change that one, and here is why.” | “We cannot change anything the hospital started.” |
What to bring
- Dates. “She has been sleepier since about the third week of March” is clinical information. “She has not been herself” is a starting point but harder to act on.
- What changed, and what changed around it. A move, an infection, a hospital stay, a new medicine.
- What she was like before. You may be the only person who can supply the baseline that makes a change detectable.
- What has worked before. Families know things no assessment tool recovers, and the guidance explicitly asks for family input on past triggers and what has helped.
Asking works
This is not a hopeful assertion. In a randomized trial, 303 people aged 65 to 95 who had been taking a sedative for a long time were simply mailed a booklet explaining the risks and describing a gradual reduction plan. 62% of them started a conversation about stopping with their doctor or pharmacist, and at six months 27% had come off entirely, against 5% of those who got nothing. Nobody was told what to do. They were given information and they asked.
A second trial made the same point differently: the family got a brochure and the doctor got a written clinical opinion, at the same time. 43% of that group were no longer taking the inappropriate medicine six months later, against 12% of the comparison group.
Two things to expect
A reduction may be uncomfortable at first. In one trial, 38% of people reducing a sedative reported withdrawal symptoms — while no one required hospital admission. That is a reason for follow-up and a slower reduction, not a reason to abandon the attempt.
Sometimes the answer is to put it back. If a reduction turns out to have been wrong, restarting is a normal, planned part of the process. It tells everyone the medicine was doing something, which was not knowable in advance.
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.
References
- Tannenbaum C, Martin P, Tamblyn R, Benedetti A, Ahmed S. Reduction of inappropriate benzodiazepine prescriptions among older adults through direct patient education: the EMPOWER cluster randomized trial. JAMA Internal Medicine. 2014;174(6):890–898. PMID 24733354 · DOI 10.1001/jamainternmed.2014.949.
- Martin P, Tamblyn R, Benedetti A, Ahmed S, Tannenbaum C. Effect of a Pharmacist-Led Educational Intervention on Inappropriate Medication Prescriptions in Older Adults: The D-PRESCRIBE Randomized Clinical Trial. JAMA. 2018;320(18):1889–1898. PMID 30422193 · DOI 10.1001/jama.2018.16131.
- Kim JL, Lewallen KM, Hollingsworth EK, Shah AS, Simmons SF, Vasilevskis EE. Patient-Reported Barriers and Enablers to Deprescribing Recommendations During a Clinical Trial (Shed-MEDS). The Gerontologist. 2023;63(3):523–533. PMID 35881109 · DOI 10.1093/geront/gnac100.
- Kales HC, Gitlin LN, Lyketsos CG; Detroit Expert Panel. Management of neuropsychiatric symptoms of dementia in clinical settings: recommendations from a multidisciplinary expert panel. Journal of the American Geriatrics Society. 2014;62(4):762–769. PMID 24635665 · DOI 10.1111/jgs.12730.
- By the 2023 American Geriatrics Society Beers Criteria Update Expert Panel. American Geriatrics Society 2023 updated AGS Beers Criteria for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society. 2023;71(7):2052–2081. PMID 37139824 · DOI 10.1111/jgs.18372.
Bibliographic records on this page were retrieved from PubMed. Every reference links to its DOI or PubMed record.
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.