Higher-riskArticle link

Deprescribing Unnecessary Medications: A Step-by-Step Guide for Dementia Caregivers

Deprescribing is the careful, doctor-supervised process of reducing or stopping medications that may no longer be needed or may be causing harm. For people with dementia, fewer pills often means fewer side effects like falls, confusion, and sedation, and a better quality of life. This guide gives you concrete steps to start the conversation with your loved one’s healthcare team, what to watch for during the process, and how to handle resistance or fear. You are not alone in this, and small changes can make a big difference.

Key points

  • Deprescribing is a supervised process, not a cold-turkey stop. Always work with the doctor or pharmacist.
  • Fewer medications often mean fewer side effects like falls, confusion, and sedation, leading to better quality of life.
  • Start by gathering a complete list of all medications and asking the doctor to review them for necessity.
  • Use non-drug approaches first for behavioral issues; medications should be a last resort.
  • Keep a daily log during any taper to track changes and share with the doctor.
  • You have the right to question any medication, especially if it was prescribed years ago or seems to be causing harm.

What Is Deprescribing and Why Does It Matter?

Deprescribing is the supervised tapering or withdrawal of medications that are no longer necessary or appropriate for a patient. It is never about stopping medications cold turkey, but rather having a frank discussion with the doctor about whether every pill on the list is still needed. For older adults, especially those with dementia, having more prescriptions increases the risk of drug interactions, falls, cognitive impairment, constipation, and other side effects. The goal is to reframe the approach from just adding more medications to methodically looking for opportunities to remove those that are no longer beneficial.

Why Medications Get Prescribed and Never Stopped

Many people are started on medications in their 50s for conditions like high blood pressure or diabetes, and they remain on those same drugs into their 80s or 90s even though their health needs have changed. In dementia, the body’s metabolism and organ function change, so a drug that was once helpful may now cause more harm than good. Additionally, when a person with dementia develops new symptoms like agitation or sleep problems, doctors may add another medication without reviewing the existing list. This can lead to a cascade of side effects that look like worsening dementia but are actually drug-induced.

The Risks of Keeping Unnecessary Medications

Common side effects from unnecessary medications include increased confusion, falls, sedation, weight loss, stomach upset, and difficulty speaking or communicating. Some medications can even make sundowning or agitation worse. In nursing homes, overmedication can act as a chemical restraint, leaving the person too drowsy to engage in meaningful activities or relationships. On the other hand, deprescribing can restore quality of life: one patient went from 36 medications down to 8 and was able to remember where she was, recognize her grandchildren, and leave the house instead of sleeping all day.

General caregiving information, not medical advice. Check medications and major care changes with your clinician.

What not to do

  • Never stop any medication abruptly or without consulting the prescriber.

  • Do not assume that a medication prescribed years ago is still needed.

  • Do not attribute new symptoms like confusion or falls solely to dementia without reviewing the medication list.

Practical tools

  • Beers Criteria for Potentially Inappropriate Medication Use in Older Adults

    A freely available evidence-based list (published by the American Geriatrics Society) identifying medications that are often unnecessary or harmful for older adults, including those with dementia.

  • STOPP/START Criteria

    A validated tool for screening medications in older patients; helps identify drugs that should be stopped (STOPP) and those that should be started (START) based on current clinical need.

  • Medication Review Worksheet

    A simple template—paper or digital—that lists each medication, dose, reason prescribed, start date, and potential side effects, used to structure the deprescribing conversation with the doctor.

Discuss with your clinician

Ask the doctor: 'Is it safe to stop this blood pressure medication if my loved one’s blood pressure is now normal?'

Ask the doctor: 'Can we taper the antipsychotic slowly to see if the behavior returns? What signs should I watch for?'

Ask the doctor: 'Is this dementia medication still helpful at this stage, or is it time to stop?'

Ask the doctor: 'Could any of these medications be causing the falls or increased confusion we are seeing?'

Ask the doctor: 'What is the safest way to reduce or stop this medication, and how long should the taper take?'

Ask the doctor: 'If my loved one refuses medication, what is the best way to respond? Is there a truthful, simple explanation I can use that fits this specific drug?'

Related guides

Sources