New Delhi: For many elderly people, a typical day starts with a handful of pills – for blood pressure, diabetes, cholesterol and heart disease. But a new global review suggests that in very frail older adults, it may not always be necessary to continue all long-term medications – and in many cases, it may be safe to stop some of them cautiously.The findings, published in the journal ‘BMC Geriatrics’, come from an analysis of patients with advanced frailty, dementia or limited life expectancy – a group often prescribed multiple medications despite unclear long-term benefits. The researchers found that reducing or stopping such medications did not increase deaths or major complications in most cases.Many of these medications are meant to prevent problems years later. But for weak or seriously ill patients, those benefits may never be realized. Instead, taking multiple medications can increase the risk of dizziness, weakness, confusion, and falls, often leading to hospitalization.This pattern of “polypharmacy”, where patients take multiple medicines simultaneously, is becoming increasingly common among the elderly in India, doctors say. “They often see multiple specialists and prescriptions are not always reviewed together. In frail older adults, over-treatment can do more harm than good – for example, aspirin should be avoided for primary prevention, excessive blood pressure control can lead to deterioration, and drugs such as diuretics, insulin or sulfonylureas can cause electrolyte imbalance or hypoglycaemia. “The focus should be on reducing medications where the risks outweigh the benefits,” said Dr Pulin Gupta, professor in the department of medicine at Ram Manohar Lohia Hospital.“In frail elderly patients, stopping some preventive medications is generally safe if done carefully, although those with a prior heart attack or stroke need to exercise caution,” said Dr Rommel Tikku, director of internal medicine at Max Hospital, Saket. Commonly overused medications include statins, controlled diabetes medications like insulin or sulfonylureas for primary prevention, many blood pressure medications, sleeping pills, long-term acid suppressants, and anticholinergics, he said.“The prescription should be structured — based on goals of care, frailty and life expectancy — with careful tapering and monitoring,” he said, adding that reducing medications often results in fewer falls, better cognition and improved energy levels.Families often believe that more medications means better care, but the opposite can also be true. Each added drug increases the risk of interaction. The review reflects a shift from aggressive prevention to patient-centred care, where treatment is tailored to health and preferences. Experts caution that medications should not be simply stopped; Depletion should be monitored, with each medication reviewed as required.