Medication Reviews for Seniors: A Guide to Safer, More Effective Treatment
How regular medication reviews can reduce risks, eliminate unnecessary drugs, and improve your parent's health outcomes.
Medical Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with qualified healthcare providers for diagnosis and treatment decisions. Every individual's health situation is unique.
Key Takeaways
- ✓Regular medication reviews can identify unnecessary, harmful, or duplicative drugs
- ✓Medicare Part D covers medication therapy management for qualifying beneficiaries
- ✓Deprescribing can improve quality of life and reduce fall risk
- ✓Pharmacists are excellent resources for comprehensive medication reviews
- ✓Reviews should happen annually and after any hospitalization
As our parents age, their medication lists often grow. A blood pressure pill here, a cholesterol medication there, something for arthritis, something for sleep. Before long, they may be taking 10, 15, or even 20 different medications daily. Each was prescribed for a reason, but together they may be causing more harm than good.
A medication review is a systematic look at everything your parent takes to determine if each medication is still necessary, appropriate, safe, and being used correctly. Regular reviews can uncover dangerous interactions, eliminate unnecessary drugs, reduce side effects, and even save money—all while improving health outcomes.
What Is a Medication Review?
A medication review is a comprehensive evaluation of all medications a person takes—prescription drugs, over-the-counter medications, vitamins, supplements, and herbal products. The goal is to optimize medication therapy by ensuring:
- Appropriateness: Each medication is right for the patient's current conditions
- Effectiveness: Medications are actually working as intended
- Safety: No dangerous interactions or inappropriate drugs for seniors
- Adherence: Patient can and does take medications as prescribed
- Cost-effectiveness: Less expensive alternatives may work equally well
Types of Medication Reviews
Prescription Review
Basic check of prescription medications for interactions and duplications, typically done by pharmacist when filling prescriptions.
Comprehensive Medication Review (CMR)
In-depth review of all medications including OTC and supplements, with patient interview and personalized recommendations.
Targeted Medication Review
Focused review triggered by specific concerns like new side effects, recent hospitalization, or specific drug classes.
Medication Therapy Management (MTM)
Medicare-covered program including CMR plus ongoing monitoring, medication action plans, and follow-up consultations.
Why Medication Reviews Matter for Seniors
The risks of polypharmacy—taking multiple medications—increase dramatically with age. Medication reviews address several critical issues:
The Polypharmacy Problem
- • 40% of seniors take 5 or more prescription medications
- • Taking 5+ medications increases adverse drug event risk by 88%
- • Drug-related problems cause 10-30% of hospital admissions in elderly
- • Up to 50% of medications prescribed may be unnecessary
Common Issues Uncovered in Reviews
Prescribing Cascade
A drug causes side effects mistaken for a new condition, leading to additional prescriptions. Example: Blood pressure medication causes dizziness, leading to a prescription for vertigo medication.
Therapeutic Duplication
Taking two medications that do the same thing, often prescribed by different doctors. Example: Two different acid reflux medications, or brand and generic of the same drug.
Drug-Disease Interactions
Medications that worsen other conditions the patient has. Example: NSAIDs worsening kidney disease or heart failure.
Inappropriate Medications
Drugs that are generally unsafe for elderly patients (per Beers Criteria). Example: Long-acting benzodiazepines, certain muscle relaxants, or first-generation antihistamines.
Changed Goals of Care
Medications that no longer align with patient's health goals or life expectancy. Example: Aggressive cholesterol treatment in someone with advanced dementia.
When to Have a Medication Review
Routine Reviews
- Annually: All seniors taking regular medications should have at least yearly reviews
- Quarterly: For those taking 10+ medications or with complex conditions
- Medicare Annual Wellness Visit: Good opportunity for medication review
Triggered Reviews
Request a review whenever:
Review Triggers
- ✓ After any hospitalization or ER visit
- ✓ When a new medication is prescribed
- ✓ If new symptoms or side effects appear
- ✓ After a fall or near-fall
- ✓ When cognitive changes are noticed
- ✓ If health status significantly changes
- ✓ When seeing a new doctor
- ✓ If there are concerns about adherence
- ✓ When transitioning to hospice or palliative care
How to Get a Medication Review
Medicare Medication Therapy Management (MTM)
Medicare Part D plans must offer MTM to beneficiaries who meet certain criteria:
- Have multiple chronic conditions (varies by plan, typically 2-3)
- Take multiple Part D medications (typically 2-8)
- Have annual Part D drug costs above threshold (around $5,000 in 2024)
MTM Services Include
- • Comprehensive medication review with pharmacist
- • Written summary of medications and action plan
- • Quarterly targeted reviews
- • All at no cost to qualifying beneficiaries
Other Review Options
Primary Care Doctor
- • Request dedicated appointment for medication review
- • Bring all medications to the visit ("brown bag" review)
- • May be covered as part of wellness visit
Pharmacist Consultation
- • Many pharmacies offer free medication reviews
- • Pharmacists have expertise in drug interactions
- • Can coordinate with doctors on recommendations
Geriatrician
- • Specialists in elderly care including medications
- • Expertise in Beers Criteria and deprescribing
- • Ideal for complex medication regimens
Consultant Pharmacist
- • Clinical pharmacists specializing in medication management
- • May do home visits
- • Often available through geriatric care programs
Preparing for a Medication Review
Gather All Medications
Collect everything your parent takes:
- All prescription medications (including eye drops, patches, inhalers, creams)
- Over-the-counter medications (even occasional use)
- Vitamins and minerals
- Herbal supplements and natural products
- Probiotics or specialty supplements
- Medical marijuana or CBD products if used
Information to Bring
About Medications
- ☐ Name (brand and generic)
- ☐ Strength/dosage
- ☐ How often taken
- ☐ What it's prescribed for
- ☐ When it was started
- ☐ Which doctor prescribed it
Other Information
- ☐ Known drug allergies
- ☐ Side effects experienced
- ☐ Medications stopped recently (and why)
- ☐ Problems taking medications (swallowing, cost)
- ☐ List of all medical conditions
- ☐ Recent lab work results
Questions to Prepare
- Is each medication still necessary?
- Are there any medications that could be stopped or reduced?
- Are there dangerous interactions?
- Could any symptoms be medication side effects?
- Are there less expensive alternatives?
- Can any medications be combined or simplified?
- Is the timing of doses optimal?
Understanding Deprescribing
Deprescribing is the planned, supervised process of reducing or stopping medications that may no longer be beneficial or may be causing harm. It's not about denying needed treatment—it's about optimizing care.
When Deprescribing May Be Appropriate
- Medication was prescribed for a condition that's resolved
- Side effects outweigh benefits
- Drug is on the Beers List of potentially inappropriate medications for seniors
- Goals of care have changed (e.g., transition to comfort care)
- Life expectancy makes long-term preventive medications less relevant
- Multiple drugs are doing the same thing
- Medication is contributing to falls or cognitive issues
Common Deprescribing Candidates
- Proton pump inhibitors (PPIs): Often continued longer than needed
- Benzodiazepines: Significant fall and cognitive risks in elderly
- Anticholinergic medications: Associated with cognitive decline
- Long-term preventive medications: May not benefit those with limited life expectancy
- Sleep medications: Better managed with non-drug approaches
- Diabetes medications: May need reduction as appetite/activity decreases
Safe Deprescribing Process
- Identify candidates: Work with doctor to determine which medications to evaluate
- Prioritize: Focus on highest-risk medications first
- Plan: Determine if medication should be stopped abruptly or tapered
- Monitor: Watch for withdrawal effects or return of symptoms
- Follow up: Schedule appointment to assess results
Important Warning
Never stop medications without medical guidance. Some drugs (like blood pressure medications, antidepressants, and seizure medications) can be dangerous to stop suddenly and require careful tapering.
After the Medication Review
Getting Results
After a comprehensive medication review, you should receive:
- Updated medication list with any changes
- Explanation of any medications recommended for change
- Action plan with specific steps and timeline
- Information about potential withdrawal effects to watch for
- Follow-up appointment schedule
Implementing Changes
Communicate with all providers
Ensure all doctors know about medication changes, especially if one specialist's prescription is being modified.
Update pharmacy records
Inform your pharmacy about discontinued medications so they don't continue auto-refilling.
Dispose of discontinued medications
Properly dispose of stopped medications to prevent confusion or accidental use.
Update medication list
Revise the master medication list and share updated copies with family and providers.
Monitor carefully
Watch for both improvement and any concerning symptoms during the transition period.
Frequently Asked Questions
Related Articles
Drug Interactions Guide
Understanding dangerous medication interactions in seniors.
Medication Management
Systems for organizing and tracking daily medications.
Doctor Appointment Preparation
How to get the most from medical visits.
Medicare Part D Guide
Understanding prescription drug coverage and MTM benefits.