Polypharmacy is not clearly or consistently described in the literature. Polypharmacy can suggest that the medications a patient takes are excessive, unnecessary, or avoidable. Simply citing the number of medications a patient is taking provides limited actionable information, as these medications may be appropriately indicated and/or required as the number of comorbidities increases. Deprescribing medications is a stepwise process to reduce unnecessary or harmful medications based on patient and provider consideration of the patient’s current comorbidities, functional abilities, and wishes. Jansen et al (2) cites a shared medication deprescribing process, partnering patients and providers in collaborative decision making using four steps:

 Step #1. Discuss options, including medication discontinuation, with the patient, family, and providers.

 Step #2. Discuss benefits and harms of identified options.

 Step #3. Discuss and define patient preferences for the identified options.

 Step #4. Decide whether to deprescribe.

To identify medications that can be targeted for deprescribing, Page et al. (3) urge providers to engage in discussions across multiple visits. Considerations should include:

• Regularly identify and confirm medications the patient is actively taking (e.g. prescribed and over-the-counter (OTC) medications, supplements, and naturopathic regimens) and perform medication reconciliation.
• Identify the indication for each medication, whether a non-drug treatment alternative exists, if a different drug would be more appropriate or cost-effective, and if the medication is appropriate in older adults.
• Review medication side effects, interactions, combinations, and risk for addiction.
• Optimize the medication regimen to decrease unnecessary dosing, adjust to age-related physiological changes, and optimize the patient’s functional ability/care goals.
• Educate the patient and/family on the medications and their impact on function and cognition.

All medications used by patients > 65 years should be checked against the Beers Criteria, a consensus document that identifies high-risk medications for older adults. (4) When medications are identified as being used inappropriately, it is important to note if the medication can be stopped immediately or if a medication taper is needed prior to discontinuation. Certain medications, such as beta blockers, antidepressants, benzodiazepines, and opiates need to be weaned gradually to prevent withdrawal symptoms.