Focused deprescribing of specific drugs appears safe but unclear clinical benefit in older adults

This umbrella systematic review examined whether a more targeted approach—focused deprescribing of specific drug classes—could be safer and more scalable. Researchers searched major medical databases through March 2025 and analysed 27 systematic reviews, which collectively covered thousands of older adults across clinical settings. Most studies focused on psychotropic drugs (especially benzodiazepines) and anticholinergic medications; fewer examined antidiabetics or fall-risk-increasing drugs. Deprescribing was most consistently successful for benzodiazepines and other psychotropics, particularly when interventions included psychotherapy or multiple components working together. However, clinical outcomes—mortality, falls, and cognitive function—were rarely measured and inconsistently improved across studies. Most included reviews were rated as critically low quality with low or very low certainty of evidence, limiting confidence in the findings.

The umbrella review found important drug-class differences. Benzodiazepine deprescribing showed the strongest evidence for medication reduction, especially when paired with psychotherapy or educational support. Antidiabetic deprescribing appeared feasible and safe in the studies reviewed, but anticholinergic and fall-risk medication deprescribing had limited evidence. A critical gap: most systematic reviews did not measure whether patients actually experienced fewer falls, better memory, or other concrete health improvements—they measured medication use instead. The authors noted that methodological quality was poor across most included reviews, meaning certainty about true benefit remains low. This suggests deprescribing is worth considering for specific drugs, but requires individualised assessment rather than blanket approaches.