Elderly Care Specialists: Challenges and Solutions in Deprescribing

In recent years, the health care landscape has been shifting dramatically, especially regarding how care is provided to the elderly. Elderly care specialists, tasked with giving the best possible treatment to older adults, are increasingly grappling with a critical issue: deprescribing practices within nursing homes. A groundbreaking focus group study by researchers Malek Makan, M.C. Lee, and H. van Hein sheds light on the barriers and enablers that influence these practices. The findings have broad implications for improving pharmaceutical management in long-term care settings, where polypharmacy can often lead to adverse health outcomes.

Deprescribing, defined as the process of tapering or stopping medications that may no longer be beneficial or may be causing harm, is crucial for the elderly population, particularly those in nursing homes. With age comes an increased likelihood of multiple health conditions, which often results in patients being prescribed numerous medications. However, this extensive medication regimen can lead to complications. Therefore, understanding the factors that support or hinder deprescribing practices is essential for promoting better health outcomes for these vulnerable patients.

The study conducted by Makan and colleagues engaged elderly care specialists in focus group discussions to explore their perceptions and experiences related to deprescribing in nursing homes. Participants included a diverse range of healthcare professionals, comprising nurses, physicians, pharmacists, and geriatricians. This multifaceted approach allowed for a richer understanding of the various viewpoints and experiences surrounding the topic. One key finding highlighted that while many specialists recognize the importance of deprescribing, there are systemic barriers that often impede their efforts.

One of the most significant barriers identified in the study was the lack of adequate evaluation protocols tailored for deprescribing. The absence of standardized guidelines leaves healthcare professionals uncertain about when to consider reducing or discontinuing medications. This gap often leads to a reliance on established prescribing habits, rather than evidence-based decision-making. Moreover, the concerns about potential negative outcomes associated with deprescribing—such as the risk of withdrawal symptoms or the return of previously managed conditions—serve as a deterrent. Such apprehensions reinforce the necessity for developing rigorous clinical guidelines that provide clear pathways for safe deprescribing practices.

Another critical enabler emerged from the study: the role of interprofessional collaboration. Specialists who worked closely with colleagues across various disciplines reported a more supportive environment for discussing medication management. Regular team meetings to review patient medications created an atmosphere where concerns regarding polypharmacy could be openly addressed, fostering a culture of learning and improvement. Such collaboration can significantly enhance the quality of care, as it ensures that all team members are on the same page regarding patient needs and treatment plans.

Patients and their families also play an integral role in the deprescribing process. The focus group revealed that having open lines of communication with patients and their caregivers can facilitate better understanding and acceptance of medication changes. Health care specialists noted that when they involved patients in discussions about their medications—explaining the potential risks and benefits—they were more likely to gain cooperation and trust. This collaborative approach not only honors patient autonomy but also aligns treatment with the patients’ values and preferences.

Despite recognizing the benefits of involving patients and families, many specialists indicated that time constraints significantly hindered their ability to engage in such meaningful conversations. The fast-paced nature of nursing home environments often leaves little room for in-depth discussions about medication management. This highlights the need for systematic changes in time allocation and workflow to better incorporate patient-centered care into daily practices. Healthcare facilities must prioritize training and support for staff to ensure they can dedicate sufficient time to these crucial interactions.

Additionally, the research pointed to the role of education in empowering care specialists. Continuous professional development and training sessions focused on deprescribing principles could equip healthcare professionals with the necessary skills and confidence to undertake this task effectively. Familiarizing staff with successful deprescribing strategies and real-life examples can foster a stronger commitment to optimizing medication regimens for elderly patients. This educational aspect is paramount, especially as more specialists enter the field and grapple with the complexities of geriatric pharmacotherapy.

Importantly, the study underscores that deprescribing should not be viewed as a one-time event but as an ongoing process. Patients’ health statuses, goals of care, and medication efficacy should be periodically reassessed to ensure treatment remains appropriate and beneficial. Healthcare providers must adopt a proactive approach to medication management that emphasizes regular reviews, rather than waiting for an adverse event to trigger a re-evaluation of the treatment plan.

The implications of this research extend beyond the nursing home walls. As the global population ages, the challenges of medication management in elderly care will only become more pronounced. Policymakers and healthcare leaders must prioritize initiatives that promote safe prescribing and deprescribing practices as integral components of elder care. This includes advocating for research funding, establishing guidelines, and creating supportive regulatory frameworks that recognize the unique needs of this demographic.

Moreover, the findings serve as a reminder of the importance of a patient-centered approach in healthcare. By acknowledging the voices of both care specialists and patients, we move towards a more collaborative model that ultimately seeks to empower those who are often disenfranchised in their care journeys. Incorporating all stakeholders in discussions about medication management not only enhances transparency but also fosters stronger relationships that are key to successful healthcare interventions.

As we reflect on the findings of the focus group study, it’s clear that addressing the barriers to deprescribing is vital to enhancing the quality of care for elderly patients in nursing homes. The awareness of the importance of medication management is growing, but a collective effort is necessary to turn acknowledgment into action. By drawing on the insights provided by Makan and colleagues, we can work towards creating an environment that not only encourages deprescribing practices but also champions the health and autonomy of our aging population.

Ultimately, the quest for improved elderly care through effective deprescribing practices is a crucial step towards empowering both patients and healthcare providers. As the discussion continues, we must remain committed to fostering an adaptable, informed healthcare system that prioritizes the well-being of the elderly, ensuring they receive safe, effective, and personalized care tailored to their unique needs and circumstances.

Malek Makan, A., Lee, M.C., van Hein, H. et al. Barriers and enablers of elderly care specialists towards deprescribing practices in the nursing homes: a focus group study.
BMC Health Serv Res 25, 1466 (2025). https://doi.org/10.1186/s12913-025-13630-8