Standardising Deprescribing for Frail Older Australians

Australia's population is ageing rapidly. By the time the youngest baby boomers reach their eighties, the country will have more than a million people living past eighty-five, many of them with multiple long-term conditions. For frail older adults, the burden of polypharmacy often outweighs the benefits of continued prescribing, yet the act of stopping medicines safely has long lacked a consistent, system-wide approach.

Brisbane Diamantina Health Partners (BDHP) brings together researchers, clinicians, and health services across south-east Queensland with a shared interest in closing the gap between evidence and everyday care. Standardising deprescribing protocols for vulnerable older adults sits squarely within that mission. A coordinated strategy that spans hospital, community, and residential aged care settings can reduce adverse drug events, improve quality of life, and support the people and families who manage increasingly complex medication regimens.

The Polypharmacy Burden in Older Australians

Frail older adults commonly take five or more medicines daily. Some are essential, but others accumulate over years of specialist consultations, hospital discharges, and well-intended prescribing cascades. Within Australian residential aged care facilities, average medication counts often sit between eight and ten per resident, a level strongly associated with falls, delirium, and unplanned hospital admissions. The Royal Commission into Aged Care Quality and Safety highlighted inappropriate psychotropic use as a specific concern, prompting renewed attention to medication review practices across the country.

The Pharmaceutical Benefits Scheme subsidises a wide range of treatments, which makes access straightforward but can also encourage long-term continuation of medicines whose original indication has faded. Frailty changes the way the body handles drugs: renal function declines, muscle mass falls, and the brain becomes more sensitive to sedatives and anticholinergics. A pill that helped a 70-year-old manage mild hypertension can cause profound hypotension in someone who is 85 and unsteady on their feet.

Designing a Standardised Deprescribing Pathway

A trustworthy deprescribing pathway begins with a comprehensive medication review and a clear conversation about goals of care. Tools such as the Beers Criteria and STOPP/START provide evidence-based lists of potentially inappropriate medicines, and Australian adaptations increasingly incorporate local prescribing data and PBS schedules. The next step is shared decision-making with the patient, family members, and carers, followed by a written tapering plan that defines what will be stopped, in what order, and how response will be monitored.

A practical pathway includes four stages: comprehensive review, prioritisation of medicines to cease, gradual tapering with safety milestones, and long-term follow-up. Australian clinicians often adapt international frameworks by adding explicit checks against PBS continuation rules and by involving community pharmacists in dispensing and monitoring. Embedding the pathway into electronic medical records in hospitals from Sydney to Perth makes it easier for junior doctors, who rotate frequently, to follow the same workflow regardless of where they trained.

Medication classes often considered for tapering

• Sedative-hypnotics and benzodiazepines linked to falls and confusion
• Proton pump inhibitors used beyond the recommended 8 to 12 weeks
• Long-acting sulfonylureas and other hypoglycaemics with high hypoglycaemia risk
• Anticholinergic antidepressants and bladder agents affecting cognition

The Multidisciplinary Team in Action

Deprescribing is rarely the work of a single clinician. Hospital pharmacists flag medicines during discharge reconciliation, general practitioners coordinate ongoing review in the community, and aged care nurses observe day-to-day changes that no clinic visit can capture. Allied health professionals contribute equally important perspectives: physiotherapists note balance changes after a dose reduction, dietitians flag nutritional supplements that may no longer be needed, and speech pathologists address swallowing issues that affect tablet formulation choices. The collaborative strength of this team is detailed in resources covering the role of allied health professionals in research translation.

For the pathway to work, each discipline needs a defined responsibility and a communication channel back to the prescriber. Regular case conferences in Brisbane's major hospitals and regional Queensland have proven particularly useful for residents with complex regimens, allowing a geriatrics specialist, a clinical pharmacist, and the patient's GP to align on a single tapering plan.

Putting the Framework into Practice Across Settings

Translating a written pathway into routine care demands attention to workflow, funding, and local culture. In metropolitan hospitals, embedding deprescribing prompts into electronic medication charts has produced measurable reductions in inappropriate prescribing within twelve months. In regional communities around Townsville, Cairns, and Toowoomba, outreach pharmacist visits to general practices have helped rural GPs adopt the same approach, although travel distances and workforce shortages remain real obstacles.

Residential aged care presents its own challenges. Many residents see multiple prescribers within a single quarter, and consent discussions must often involve family members who live interstate. Practical steps that have helped facilities in Brisbane and Melbourne include:

Practical steps that have helped facilities

• Allocating protected time for medication review rounds
• Linking deprescribing plans to existing care plan meetings
• Training care workers to document subtle changes after dose reductions
• Sharing protocols with locum doctors unfamiliar with the home

Measuring Impact and Sustaining the Approach

Standardisation only earns its keep when outcomes are tracked and shared. Useful indicators include the number of medicines deprescribed per resident, hospitalisations for medication-related events, changes in cognitive and functional scores, and patient or family-reported quality of life. BDHP's translational network supports these evaluations by connecting frontline clinicians with health economists, biostatisticians, and implementation scientists who can design robust before-and-after studies. The breadth of this work extends well beyond deprescribing; recent whiplash research advances show how the same collaborative model accelerates evidence uptake across very different clinical domains.

Funding agencies, including the National Health and Medical Research Council and state-level partners, increasingly require evidence of translation alongside traditional publications. A standardised, measurable deprescribing pathway gives research teams in Queensland, Victoria, and New South Wales a shared platform for grant applications, multi-site trials, and policy briefings to the Department of Health and Aged Care.

Across Australia, the shift from reactive prescribing to proactive deprescribing is gathering pace. Health services that adopt a standardised pathway are reporting fewer adverse drug events and stronger trust between clinicians, residents, and families. If your organisation works with frail older adults and would like to collaborate on a deprescribing pilot, contribute to guideline development, or access BDHP's research translation support, reach out through the Brisbane Diamantina Health Partners partnership page to start the conversation.