A Pathway to Healthier Aging or an Illusion? A Narrative Review on Deprescribing Protocols for the Elderly

Polypharmacy is the concurrent use of many drugs increasingly prevalent in elderly populations worldwide, with over 50% of older adults taking more than five drugs. The rise in chronic conditions such as diabetes, hypertension, and dementia largely drives this trend. However, polypharmacy poses significant risks, including adverse drug events, falls, cognitive decline, and hospitalizations, particularly due to age-related physiological changes that alter drug metabolism and clearance. Vulnerable populations, especially those with comorbidities, face heightened risks of complications associated with polypharmacy, underscoring the need for effective management strategies. Despite extensive literature on polypharmacy, gaps remain in practical, evidence-based approaches to safely reduce medication burdens. Structured deprescribing protocols are emerging as a critical intervention for reducing inappropriate medication use, improving patient outcomes, and lowering healthcare costs. These protocols involve stepwise algorithms and tools for screening to find potentially inappropriate medications and clinical decision-making frameworks to prioritize deprescribing as it can reduce fall risk, hospitalizations, and healthcare costs while enhancing quality of life. This narrative review examines evidence from trials, cohort studies, and meta-analyses on deprescribing protocols, highlighting challenges like patient resistance and withdrawal effects. It emphasizes tailored approaches, patient engagement, and shared decision-making for safe, effective, patient-centered deprescribing across healthcare settings.