Polypharmacy and Deprescribing in Older Adults: A Care Staff Guide

It's not unusual for an older resident in a care home to be taking eight, ten, or even more regular medicines at once. Some of that is entirely appropriate — multiple long-term conditions often genuinely need multiple treatments. But medicines lists built up gradually over years, across different prescribers, can also accumulate drugs that are no longer needed, no longer helping, or actively causing harm. Recognising the difference, and knowing when a medicines review is overdue, is a skill care staff can support even without prescribing responsibility themselves.

Polypharmacy isn't automatically a problem

Polypharmacy simply means a person is using multiple medicines. The distinction that matters clinically is between appropriate and problematic polypharmacy. Appropriate polypharmacy is where multiple medicines are clinically indicated, properly optimised, and prescribed in line with current best evidence — for a resident managing several long-term conditions, this can genuinely extend life and improve quality of life. Problematic polypharmacy is where one or more medicines are no longer providing real benefit, where the risk of harm now outweighs the benefit, where combinations of drugs create meaningful interaction risk, or where the overall regimen has simply become too complex and burdensome for the person to manage or benefit from safely.

What STOPP/START criteria are

STOPP/START is one of the most widely used structured tools clinicians use to review older people's medicines. STOPP (Screening Tool of Older Persons' Prescriptions) flags medicines that are potentially inappropriate for a given resident's circumstances — for example, a drug that carries a disproportionate risk for someone with reduced kidney function, or one that duplicates the effect of another medicine they're already taking. START (Screening Tool to Alert doctors to Right Treatment) works in the opposite direction, flagging medicines that are evidence-based and appropriate but appear to be missing from a resident's current regimen. Used together, the tool supports a genuinely balanced medicines review — not simply cutting medicines to reduce numbers, but making sure the right treatments are in place and the wrong ones are removed.

What deprescribing actually means

Deprescribing is the planned, supervised process of tapering, stopping, or withdrawing medicines that are no longer appropriate, beneficial, or wanted by the person taking them. It's a clinical decision, not something care staff carry out themselves, but it should always involve shared decision-making with the resident and, where appropriate, their family — deprescribing done well is guided by what matters to the person, not just what a review tool flags. Stopping a long-standing medicine abruptly or without a proper plan can cause harm, which is why deprescribing is always a structured, supervised process rather than simply discontinuing something that looks unnecessary.

The role of care staff in medicines reviews

While STOPP/START reviews and deprescribing decisions sit with GPs and pharmacists, care staff play a genuinely important supporting role. Staff who see a resident daily are often best placed to notice things a periodic clinical review might miss: a medicine that seems to be causing drowsiness, confusion, or falls; a resident who consistently struggles to take a particular tablet; or simply a regimen that has become so complex it's hard to administer safely and accurately. Flagging these observations clearly, and requesting a medicines review when something doesn't seem right, is one of the most valuable contributions non-clinical staff can make to safer prescribing.

When a medicines review should be triggered

Good practice suggests a structured medicines review at least annually for residents on multiple regular medicines, and sooner whenever there's a significant change — a fall, a hospital admission, a new diagnosis, or a noticeable change in the resident's alertness or wellbeing. Reviews shouldn't only happen reactively after something goes wrong; building a routine review cycle into care planning, alongside medicines reconciliation at transition points, helps catch problematic polypharmacy before it causes harm rather than after.

Signs a resident's medicines regimen may need review

Certain patterns are worth flagging proactively rather than waiting for the next scheduled review. A resident newly experiencing dizziness, confusion, unsteady walking or a fall shortly after a medicine change deserves prompt attention, since these are classic signs of an inappropriate dose or interaction in older people. Similarly, a resident who has been prescribed a medicine to treat a side effect of another medicine — sometimes called a prescribing cascade — is a strong candidate for review, since treating a symptom rather than questioning its cause can quietly add medicines rather than resolving the underlying problem. Care staff don't need clinical training to notice these patterns; they need a clear, low-friction way to raise them with the team responsible for the resident's prescribing.

Frequently asked questions

Can care staff suggest a medicine should be stopped? Care staff shouldn't make that clinical judgement themselves, but raising a specific, well-documented observation with the GP or pharmacist is exactly the kind of input that supports a good deprescribing decision.

Is deprescribing the same as reducing a resident's care? No — deprescribing aims to remove medicines that are no longer helping, while ensuring genuinely beneficial treatment continues or is even added where START criteria identify a gap.

How often should medicines reviews happen for residents on many medicines? At least annually is common good practice, with earlier review triggered by falls, hospital admissions, or any significant change in the resident's condition.

Understanding the basic logic behind polypharmacy reviews helps care staff contribute meaningfully to safer prescribing, working alongside broader medication error prevention across the service.