Psychotropic Deprescribing in the Geriatric Population: A Review

Main Article Content

Sakshi Prasad Maanya Rajasree Katta, MBBS Ashish Sarangi, MD


Background: Potentially inappropriate medication (PIM) is defined as the usage of a medication for which the risks surpass the perceived benefits, particularly when more efficient alternatives exist. The focus has now shifted from prescribing to deprescribing, especially with one aging.

Methods: Based on the Scale for the Assessment of Narrative Review Articles (SANRA) criteria, we performed a search of articles published in Medline and google scholar databases between 2008 and 2022 using terms such as Deprescribing, Psychogeriatric patients, polypharmacy, psychotropic drugs, benzodiazepines, and potentially inappropriate medication (PIM). The initial search yielded 3058 articles. After review, 53 articles were included for discussion.

Discussion: Polypharmacy and multimorbidity are multifaceted interconnected concepts in geriatric care that call for timely intervention and interdisciplinary management across each healthcare and social setting. And although the literature and studies on the benefits are variable, deprescribing appears to be overall efficacious.

Conclusion: Further research on the efficacy of strategies and existing guidelines in lowering PIMs in geriatric psychiatry patients is warranted. The purpose of this review is to give an outline of the current evidence to inform effective methods for deprescribing PIMs for older persons, with an emphasis on strategies clinicians can use to address challenges to these approaches

Keywords: Deprescribing, Psychogeriatric patients, polypharmacy, psychotropic drugs, potentially inappropriate medication (PIM), Benzodiazepines

Article Details

How to Cite
PRASAD, Sakshi; KATTA, Maanya Rajasree; SARANGI, Ashish. Psychotropic Deprescribing in the Geriatric Population: A Review. Medical Research Archives, [S.l.], v. 11, n. 4, apr. 2023. ISSN 2375-1924. Available at: <>. Date accessed: 29 may 2023. doi:
Review Articles


1. Renom-Guiteras A, Meyer G, Thürmann PA. The EU(7)-PIM list: a list of potentially inappropriate medications for older people consented by experts from seven European countries. Eur J Clin Pharmacol. 2015;71(7):861-875. doi:10.1007/s00228-015-1860-9
2. Counter D, Millar JWT, McLay JS. Hospital readmissions, mortality and potentially inappropriate prescribing: a retrospective study of older adults discharged from hospital. Br J Clin Pharmacol. 2018;84(8):1757-1763. doi:10.1111/bcp.13607
3. Bao Y, Shao H, Bishop TF, Schackman BR, Bruce ML. Inappropriate medication in a national sample of US elderly patients receiving home health care. J Gen Intern Med. 2012;27(3):304-310. doi:10.1007/s11606-011-1905-4
4. Cahir C, Fahey T, Teeling M, Teljeur C, Feely J, Bennett K. Potentially inappropriate prescribing and cost outcomes for older people: a national population study. Br J Clin Pharmacol. 2010;69(5):543-552. doi:10.1111/j.1365-2125.2010.03628.x
5. Fiss T, Dreier A, Meinke C, van den Berg N, Ritter CA, Hoffmann W. Frequency of inappropriate drugs in primary care: analysis of a sample of immobile patients who received periodic home visits. Age Ageing. 2011;40(1):66-73. doi:10.1093/ageing/afq106
6. By the American Geriatrics Society 2015 Beers Criteria Update Expert Panel. American Geriatrics Society 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. J Am Geriatr Soc. 2015;63(11):2227-2246. doi:10.1111/jgs.13702
7. Mahony DO, Sullivan DO, Byrne S, Connor MNO, Ryan C, Gallagher P. Corrigendum: STOPP/START criteria for potentially inappropriate prescribing in older people: version 2. Age Ageing. 2018;47(3):489. doi:10.1093/ageing/afx178
8. Lee MS, Kisely S, Zolotarev B, Warren A, Henderson J, George M. Anticholinergic burden in older inpatients on psychotropic medication: do we care?. Australas Psychiatry. 2017;25(6):566-570. doi:10.1177/1039856217726687
9. Muhlack DC, Hoppe LK, Stock C, Haefeli WE, Brenner H, Schöttker B. The associations of geriatric syndromes and other patient characteristics with the current and future use of potentially inappropriate medications in a large cohort study. Eur J Clin Pharmacol. 2018;74(12):1633-1644. doi:10.1007/s00228-018-2534-1
10. Lim YJ, Kim HY, Choi J, et al. Potentially Inappropriate Medications by Beers Criteria in Older Outpatients: Prevalence and Risk Factors. Korean J Fam Med. 2016;37(6):329-333. doi:10.4082/kjfm.2016.37.6.329
11. Shade MY, Berger AM, Chaperon C, Haynatzki G, Sobeski L, Yates B. Factors Associated With Potentially Inappropriate Medication Use in Rural, Community-Dwelling Older Adults. J Gerontol Nurs. 2017;43(9):21-30. doi:10.3928/00989134-20170406-01
12. Alhmoud E, Khalifa S, Bahi AA. Prevalence and predictors of potentially inappropriate medications among home care elderly patients in Qatar. Int J Clin Pharm. 2015;37(5):815-821. doi:10.1007/s11096-015-0125-0
13. Zeenny R, Wakim S, Kuyumjian YM. Potentially inappropriate medications use in community-based aged patients: a cross-sectional study using 2012 Beers criteria. Clin Interv Aging. 2017;12:65-73. Published 2017 Jan 4. doi:10.2147/CIA.S87564
14. Harrison SL, Cations M, Jessop T, Hilmer SN, Sawan M, Brodaty H. Approaches to Deprescribing Psychotropic Medications for Changed Behaviours in Long-Term Care Residents Living with Dementia. Drugs Aging. 2019;36(2):125-136. doi:10.1007/s40266-018-0623-6
15. Baethge C, Goldbeck-Wood S, Mertens S. SANRA-a scale for the quality assessment of narrative review articles. Res Integr Peer Rev. 2019;4:5. Published 2019 Mar 26. doi:10.1186/s41073-019-0064-8
16. Ng BJ, Le Couteur DG, Hilmer SN. Deprescribing Benzodiazepines in Older Patients: Impact of Interventions Targeting Physicians, Pharmacists, and Patients. Drugs Aging. 2018;35(6):493-521. doi:10.1007/s40266-018-0544-4
17. Page AT, Potter K, Clifford R, McLachlan AJ, Etherton-Beer C. Medication appropriateness tool for co-morbid health conditions in dementia: consensus recommendations from a multidisciplinary expert panel. Intern Med J. 2016;46(10):1189-1197. doi:10.1111/imj.13215
18. Gupta, Swapnil; Cahill, John Daniel (2016). A Prescription for “Deprescribing” in Psychiatry. Psychiatric Services, (),–. doi:10.1176/
19. Carrier H, Zaytseva A, Bocquier A, Villani P, Fortin M, Verger P. General practitioners' attitude towards cooperation with other health professionals in managing patients with multimorbidity and polypharmacy: A cross-sectional study. Eur J Gen Pract. 2022;28(1):109-117. doi:10.1080/13814788.2022.2044781
20. Onder G, Petrovic M, Tangiisuran B, et al. Development and validation of a score to assess risk of adverse drug reactions among in-hospital patients 65 years or older: the GerontoNet ADR risk score. Arch Intern Med. 2010;170(13):1142-1148. doi:10.1001/archinternmed.2010.153
21. Cai X, Campbell N, Khan B, Callahan C, Boustani M. Long-term anticholinergic use and the aging brain. Alzheimers Dement. 2013;9(4):377-385. doi:10.1016/j.jalz.2012.02.005
22. Weigand AJ, Bondi MW, Thomas KR, et al. Association of anticholinergic medications and AD biomarkers with incidence of MCI among cognitively normal older adults. Neurology. 2020;95(16):e2295-e2304. doi:10.1212/WNL.0000000000010643
23. Carey IM, De Wilde S, Harris T, et al. What factors predict potentially inappropriate primary care prescribing in older people? Analysis of UK primary care patient record database. Drugs Aging. 2008;25(8):693-706. doi:10.2165/00002512-200825080-00006
24. Steinman MA, Miao Y, Boscardin WJ, Komaiko KD, Schwartz JB. Prescribing quality in older veterans: a multifocal approach. J Gen Intern Med. 2014;29(10):1379-1386. doi:10.1007/s11606-014-2924-8
25. Gnjidic D, Hilmer SN, Blyth FM, et al. Polypharmacy cutoff and outcomes: five or more medicines were used to identify community-dwelling older men at risk of different adverse outcomes. J Clin Epidemiol. 2012;65(9):989-995. doi:10.1016/j.jclinepi.2012.02.018
26. Hilmer SN. ADME-tox issues for the elderly. Expert Opin Drug Metab Toxicol. 2008;4(10):1321-1331. doi:10.1517/17425255.4.10.1321
27. Liacos M, Page AT, Etherton-Beer C. Deprescribing in older people. Aust Prescr. 2020;43(4):114-120. doi:10.18773/austprescr.2020.033
28. Lampela P, Lavikainen P, Garcia-Horsman JA, Bell JS, Huupponen R, Hartikainen S. Anticholinergic drug use, serum anticholinergic activity, and adverse drug events among older people: a population-based study. Drugs Aging. 2013;30(5):321-330. doi:10.1007/s40266-013-0063-2
29. Ailabouni N, Mangin D, Nishtala PS. DEFEAT-polypharmacy: deprescribing anticholinergic and sedative medicines feasibility trial in residential aged care facilities. Int J Clin Pharm. 2019;41(1):167-178. doi:10.1007/s11096-019-00784-9
30. Kuntz JL, Kouch L, Christian D, Hu W, Peterson PL. Patient Education and Pharmacist Consultation Influence on Nonbenzodiazepine Sedative Medication Deprescribing Success for Older Adults. Perm J. 2019;23:18-161. doi:10.7812/TPP/18-161
31. Page AT, Clifford RM, Potter K, Schwartz D, Etherton-Beer CD. The feasibility and effect of deprescribing in older adults on mortality and health: a systematic review and meta-analysis. Br J Clin Pharmacol. 2016;82(3):583-623. doi:10.1111/bcp.12975
32. Paquin AM, Zimmerman K, Rudolph JL. Risk versus risk: a review of benzodiazepine reduction in older adults. Expert Opin Drug Saf. 2014;13(7):919-934. doi:10.1517/14740338.2014.925444
33. Gupta S, Cahill JD, Miller R. Deprescribing antipsychotics: a guide for clinicians. BJPsych Advances. 2018;24(5):295-302. doi:10.1192/bja.2018.2
34. Reeve E, To J, Hendrix I, Shakib S, Roberts MS, Wiese MD. Patient barriers to and enablers of deprescribing: a systematic review. Drugs Aging. 2013;30(10):793-807. doi:10.1007/s40266-013-0106-8
35. Cahill D J, Gupta S. Deprescribing for Psychiatry: The Right Prescription?, Current Psychiatry Reviews 2018; 14(1) . doi:10.2174/1573400514666180531095016
36. Stanhope V, Ingoglia C, Schmelter B, Marcus SC. Impact of person-centered planning and collaborative documentation on treatment adherence. Psychiatr Serv. 2013;64(1):76-79. doi:10.1176/
37. Jacobson N, Greenley D. What is recovery? A conceptual model and explication. Psychiatr Serv. 2001;52(4):482-485. doi:10.1176/
38. By the 2019 American Geriatrics Society Beers Criteria® Update Expert Panel. American Geriatrics Society 2019 Updated AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults. J Am Geriatr Soc. 2019;67(4):674-694. doi:10.1111/jgs.15767
39. O'Mahony D. STOPP/START criteria for potentially inappropriate medications/potential prescribing omissions in older people: origin and progress. Expert Rev Clin Pharmacol. 2020;13(1):15-22. doi:10.1080/17512433.2020.1697676
40. Pazan F, Weiss C, Wehling M; FORTA. The FORTA (Fit fOR The Aged) List 2021: Fourth Version of a Validated Clinical Aid for Improved Pharmacotherapy in Older Adults [published correction appears in Drugs Aging. 2022 Jun;39(6):485]. Drugs Aging. 2022;39(3):245-247. doi:10.1007/s40266-022-00922-5
41. Radomski TR, Decker A, Khodyakov D, et al. Development of a Metric to Detect and Decrease Low-Value Prescribing in Older Adults. JAMA Netw Open. 2022;5(2):e2148599. doi:10.1001/jamanetworkopen.2021.48599
42. Ruxton K, Woodman RJ, Mangoni AA. Drugs with anticholinergic effects and cognitive impairment, falls and all-cause mortality in older adults: A systematic review and meta-analysis [published correction appears in Br J Clin Pharmacol. 2015 Oct;80(4):921-6]. Br J Clin Pharmacol. 2015;80(2):209-220. doi:10.1111/bcp.12617
43. Frank C, Weir E. Deprescribing for older patients. CMAJ. 2014;186(18):1369-1376. doi:10.1503/cmaj.131873
44. Ailabouni NJ, Nishtala PS, Mangin D, Tordoff JM. Challenges and Enablers of Deprescribing: A General Practitioner Perspective. PLoS One. 2016;11(4):e0151066. Published 2016 Apr 19. doi:10.1371/journal.pone.0151066
45. Klopotowska JE, Wierenga PC, Smorenburg SM, et al. Recognition of adverse drug events in older hospitalized medical patients. Eur J Clin Pharmacol. 2013;69(1):75-85. doi:10.1007/s00228-012-1316-4
46. Lee IM, Shiroma EJ, Lobelo F, et al. Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy. Lancet. 2012;380(9838):219-229. doi:10.1016/S0140-6736(12)61031-9
47. Schuling J, Gebben H, Veehof LJ, Haaijer-Ruskamp FM. Deprescribing medication in very elderly patients with multimorbidity: the view of Dutch GPs. A qualitative study. BMC Fam Pract. 2012;13:56. Published 2012 Jul 9. doi:10.1186/1471-2296-13-56
48. Jennings AA, Foley T, Walsh KA, Coffey A, Browne JP, Bradley CP. General practitioners' knowledge, attitudes, and experiences of managing behavioural and psychological symptoms of dementia: A mixed-methods systematic review [published online ahead of print, 2018 Jun 13]. Int J Geriatr Psychiatry. 2018;33(9):1163-1176. doi:10.1002/gps.4918
49. Qi K, Reeve E, Hilmer SN, Pearson SA, Matthews S, Gnjidic D. Older peoples' attitudes regarding polypharmacy, statin use and willingness to have statins deprescribed in Australia. Int J Clin Pharm. 2015;37(5):949-957. doi:10.1007/s11096-015-0147-7
50. Anderson K, Stowasser D, Freeman C, Scott I. Prescriber barriers and enablers to minimising potentially inappropriate medications in adults: a systematic review and thematic synthesis. BMJ Open. 2014;4(12):e006544. Published 2014 Dec 8. doi:10.1136/bmjopen-2014-006544
51. Seals DR. Edward F. Adolph Distinguished Lecture: The remarkable anti-aging effects of aerobic exercise on systemic arteries. J Appl Physiol (1985). 2014;117(5):425-439. doi:10.1152/japplphysiol.00362.2014
52. Martínez-Velilla N, Casas-Herrero A, Zambom-Ferraresi F, et al. Effect of Exercise Intervention on Functional Decline in Very Elderly Patients During Acute Hospitalization: A Randomized Clinical Trial. JAMA Intern Med. 2019;179(1):28–36. doi:10.1001/jamainternmed.2018.4869
53. Fiuza-Luces C, Garatachea N, Berger NA, Lucia A. Exercise is the real polypill. Physiology (Bethesda). 2013;28(5):330-358. doi:10.1152/physiol.00019.2013