Deprescribing strategies in older adults with multimorbidity and polypharmacy

Polypharmacy is common in older adults, especially among patients with multimorbidity, frailty, cognitive impairment, chronic kidney disease, cardiovascular disease, diabetes, chronic pain, and functional decline. Although many older adults appropriately require several medicines, medication regimens often become increasingly complex as conditions accumulate, guidelines are applied disease by disease, and medicines started for short-term indications are continued without review. This literature review examines deprescribing strategies in older adults with multimorbidity and polypharmacy, with attention to medication burden, frailty, adverse drug events, withdrawal frameworks, shared decision making, and clinical outcomes. PubMed-indexed literature was reviewed, including systematic reviews, randomized trials, prescribing criteria, consensus tools, deprescribing guidelines, and studies of patient attitudes. The evidence supports deprescribing as a planned and supervised clinical process rather than a simple reduction in medicine count. Effective deprescribing begins with medication reconciliation, confirmation of indications, assessment of benefit and harm, consideration of frailty and life expectancy, prioritisation of high-risk or low-benefit medicines, patient-centred discussion, gradual tapering where needed, and clear follow-up. Explicit tools such as the American Geriatrics Society Beers Criteria, STOPP/START criteria, and STOPPFrail can help identify potentially inappropriate medicines, but they do not replace clinical judgement. Randomized trials and systematic reviews show that deprescribing interventions can reduce potentially inappropriate medicines and medication burden. Evidence for effects on mortality, hospitalisation, falls, function, and quality of life is less consistent because studies differ in population, setting, intervention design, and follow-up. Deprescribing should be integrated into routine care for older adults with multimorbidity. It is not anti-treatment; it is a safety-focused method of aligning medicines with current clinical need, patient goals, frailty status, and likely time to benefit.