Medication review for older people (Structured medication review in older adults)
A careful review of all the medicines an older person takes, to keep the ones that help and safely reduce those that may now do more harm than good.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- It checks that every medicine is still helping and not doing more harm than good, especially when many are taken together.
- Some medicines should never be stopped suddenly; safe reduction is planned and monitored over time.
- The aim is the right medicines for this person's goals, not simply fewer tablets.
- Bring every medicine you take, including over-the-counter and herbal products, so nothing is missed.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your psychiatrist will give you advice for your situation.
Reduces the risk of side effects, interactions and avoidable harm.
When someone is acutely unwell and needs urgent treatment first, rather than a planned review.
You agree an updated medicines plan, with any changes explained and written down. Most medicines you keep can be taken as normal.
A clear, written medicines plan explaining what changed and why.
You agree an updated medicines plan, with any changes explained and written down. Most medicines you keep can be...
Any reductions begin gradually as agreed. You watch for the return of symptoms or any new effects, good or bad.
A review by phone, in person or with blood tests checks how changes are going, and the plan is adjusted if needed.
Medicines are reviewed again periodically, as needs change with age, new conditions or new treatments.
What is a medication review for older people?
A medication review is a careful look at all the medicines a person takes, to make sure each one is still helping, is still needed, and is not causing more harm than good. In older people this matters a great deal, because the body handles medicines differently with age and because taking many medicines at once (sometimes called polypharmacy) raises the risk of side effects and interactions.
The review looks at the whole picture: the conditions being treated, how the person is feeling, falls, memory, mood, and how well they manage their tablets. Some medicines add up to a heavy "anticholinergic burden", which can cloud thinking and increase the risk of falls; others can cause drowsiness, dizziness or low blood pressure.
Where a medicine is no longer helping, or the risks now outweigh the benefits, the clinician may suggest reducing or stopping it. This is called deprescribing, and it is a careful, planned process. Many medicines should never be stopped suddenly, as this can be dangerous; they are reduced step by step with monitoring.
The aim is not simply fewer tablets. It is the right medicines, at the right doses, that match what matters most to the person.
Types, options & approaches
There may be different ways to do this. The right approach depends on the clinical question and your circumstances.
More tablets is not always better
| More medicines | Fewer, well-chosen medicines | |
|---|---|---|
| Side effects | Tend to rise | Often reduced |
| Interactions | More likely | Less likely |
| Goal | Treat every number | Treat what matters most |
Deprescribing is not about going without needed treatment; it is about removing medicines that no longer earn their place.
Preparing for your appointment
- Bring every medicine you take, including the boxes, plus any over-the-counter, herbal or supplement products.
- Bring a current repeat-prescription list and any recent letters from hospital or specialists.
- Note any side effects, falls, dizziness, drowsiness or memory changes you have noticed.
- Think about what matters most to you, for example staying independent, avoiding falls, or fewer tablets.
- Bring details of recent blood tests or blood-pressure readings if you have them.
- If someone helps you with your medicines, ask them to come along or share what they have noticed.
- Write down any questions, including any medicines you would like to stop or are struggling to take.
What happens
The clinician, often a doctor or a clinical pharmacist, goes through every medicine with you: what it is for, whether it is still helping, and whether it is causing any problems. They will ask about falls, dizziness, drowsiness, memory, mood, appetite and how you are managing.
They look at how the medicines work together, whether any are duplicated or no longer needed, and whether the doses still suit you as you have got older. They pay particular attention to medicines that can affect balance, thinking or blood pressure.
Together you agree a plan. This might mean keeping things as they are, adjusting a dose, swapping to a safer option, or reducing and stopping a medicine over time. Anything that needs to be reduced gradually is planned with clear steps and monitoring.
The agreed plan is written down and usually shared with your GP and pharmacy, so everyone is working from the same list.
Is this appointment right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- When someone is acutely unwell and needs urgent treatment first, rather than a planned review.
- When the request is simply to stop all medicines, regardless of benefit; deprescribing must be individualised.
- When essential monitoring or follow-up cannot be arranged, making changes unsafe.
- When the person cannot take part and there is no one to give a full medicines history or consent on their behalf.
Delay or rearrange if…
- There is an acute illness, infection or recent hospital admission still settling.
- Recent medicine changes have not yet had time to show their effect.
- Key information, such as the full medicines list or recent blood tests, is missing.
- The person is in crisis, for example a mental-health crisis, that needs attention first.
- Safe monitoring after a change cannot be put in place yet.
Alternatives to discuss
- Continuing current medicines with closer monitoring if now is not the right time to change.
- A pharmacist-led review in general practice as a first step.
- Treating a specific problem, such as falls or low blood pressure, with a focused review.
- A staged approach, changing one medicine at a time.
- A specialist opinion (for example old age psychiatry, cardiology or geriatrics) for complex cases.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Benefits
- Reduces the risk of side effects, interactions and avoidable harm.
- Can lessen drowsiness, dizziness, falls and confusion linked to certain medicines.
- Makes sure medicines that genuinely help are kept and taken correctly.
- Simplifies routines, which can make medicines easier to manage.
- Aligns treatment with what matters most to the person.
Risks & complications
- Symptoms that had been controlled may return if a medicine is reduced, so changes are monitored.
- Needing follow-up checks or blood tests after a change.
- Feeling unsure or anxious about stopping a long-standing medicine.
- Withdrawal effects if a medicine is reduced too quickly, which is why changes are gradual.
- A condition becoming less well controlled, needing the medicine to be restarted or adjusted.
- Disagreement about which medicines to change.
- A serious flare of an underlying condition if a medicine is stopped abruptly or without monitoring.
- An interaction or side effect only becoming clear after a change is made.
The main risk is changing too much, too fast, or without follow-up. Some medicines, including certain heart, steroid, antidepressant, anti-seizure and strong painkiller medicines, must never be stopped suddenly. Ask the clinician how any change will be made step by step, what to watch for, and who to contact if you feel worse.
Published figures to discuss
There are no fixed complication rates for a medication review itself, because it is a consultation rather than a procedure. The real risks come from how changes are made: reducing too quickly or without monitoring can cause symptoms to return or withdrawal effects to appear. Done gradually and with follow-up, deprescribing is generally well tolerated.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Adverse drug reaction or fall | Increases with polypharmacy and frailty | Sedatives, antihypertensives, anticholinergics, opioids and hypoglycaemics commonly contribute. | Guide sourcesClinical context |
| Stopping medicine causes rebound or relapse | Medicine-dependent | Benzodiazepines, antidepressants, beta-blockers, steroids and Parkinson's medicines may need tapering or specialist advice. | Guide sourcesClinical context |
| Kidney or liver function not considered | Common prescribing issue | Dose adjustment is often needed with changing renal function, low body weight or frailty. | Guide sourcesClinical context |
| Patient goals ignored | Common care-planning risk | Good review balances prevention, symptom control, pill burden, life expectancy and what matters to the person. | NHS Specialist Pharmacy Service — resources to support medication reviewsps.nhs.ukSource-linked context |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
What happens afterwards
There is no physical recovery. "Afterwards" is about following the new medicines plan and noticing how any changes affect you.
- Adjusting to a simpler or changed routine over a few weeks.
- Watching to see whether symptoms stay controlled after a reduction.
- Some uncertainty at first about stopping a long-standing tablet.
- Often feeling clearer-headed or steadier if sedating medicines are reduced.
Aftercare
- Follow the agreed plan, reducing medicines only as advised and never stopping suddenly unless told to.
- Keep an up-to-date list of what you now take and share it with any clinician you see.
- Use the same pharmacy where possible so they can spot problems.
- Watch for the return of symptoms after a reduction, and report them.
- Attend any follow-up appointments or blood tests arranged.
- Keep details of who to contact if you feel worse after a change.
- All medicines and boxes gathered, including over-the-counter and herbal
- Current repeat-prescription list
- Recent blood tests or blood-pressure readings if available
- Notes on falls, dizziness, drowsiness or memory changes
- Your goals written down (for example independence, fewer tablets)
- Contact details for questions after a change
⚠ Get urgent help if…
- Chest pain, breathlessness or palpitations after a heart-medicine change, which needs urgent medical help (999 if severe).
- Severe dizziness, fainting or a fall, especially after a blood-pressure or sedating-medicine change.
- Sudden confusion, drowsiness or a marked change in behaviour, which needs urgent advice from your GP or NHS 111 (in Northern Ireland, contact your GP out-of-hours service or your HSC Trust's Phone First service instead of 111).
- Return of severe symptoms the medicine was controlling, such as severe pain, seizures or mood crisis.
- Severe low mood or any talk of self-harm after an antidepressant change; call 999 if there is immediate danger, otherwise seek urgent help from your GP or NHS 111 (in Northern Ireland, use your GP out-of-hours service or your HSC Trust's Phone First service instead of 111).
- Signs of withdrawal such as sweating, shaking or a racing heart after a medicine is reduced.
Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your psychiatrist gives you.
Results & realistic expectations
A good review leaves you with a clear, agreed list of medicines that each have a reason to be there, at doses that suit you, with any changes planned safely. You should understand what every medicine is for and what to watch for.
A review cannot guarantee that symptoms will never return or that no medicine will ever need restarting. It is a considered balance of benefit and risk at this point in time, and it should be revisited as your health changes.
Medicines and circumstances change, so a review is not a one-off. As new conditions arise, new medicines are started, or health changes, the balance of benefit and risk shifts. Older people are usually reviewed regularly, and any time several medicines are taken together or a new one is added.
Related tests, treatments or support
A medication review often goes alongside a falls assessment, a memory or cognitive assessment, or a review of a specific condition such as blood pressure, diabetes or pain. Where thinking or decision-making is affected, it may link to a capacity or best-interests assessment.
Follow-up & long-term care
Follow-up is usually with the GP or clinical pharmacist who knows your full medicines list. Any reductions are reviewed to check they are going well, with blood tests or blood-pressure checks where needed. The plan is shared with your GP and pharmacy so everyone uses the same up-to-date list.
- Keep one up-to-date medicines list and bring it to every appointment.
- Use a single pharmacy where possible so interactions can be spotted.
- Ask for a review whenever a new medicine is started or your health changes.
- Have agreed monitoring, such as blood tests or blood-pressure checks, done on time.
- Never stop or change a medicine suddenly without advice.
Repeat, follow-on and what comes next
- Some medicines reduced or stopped may need to be restarted if symptoms return.
- Doses may need adjusting more than once to find the right balance.
- Reviews are repeated over time as health and treatments change.
- A change that does not suit can usually be reversed, which is why monitoring matters.
Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.
What good aftercare looks like
- A clear, written medicines plan explaining what changed and why.
- Step-by-step tapering plans for any medicine being reduced, with what to watch for.
- Arranged follow-up and any needed blood tests or blood-pressure checks.
- The updated list shared with the GP and pharmacy.
- A named contact if symptoms return or the person feels worse after a change.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- The length and depth of the appointment and whether more than one visit is needed.
- Whether the review is with a doctor, a specialist or a clinical pharmacist.
- Whether it is done in clinic, at home or by video.
- How many medicines and conditions are involved.
- Whether blood tests or other monitoring are arranged as part of the review.
- Whether a written report and a plan shared with your GP are included.
- The clinician's fee for the review and any written plan.
- Whether follow-up appointments are included or charged separately.
- Whether any blood tests or monitoring are included.
- Whether the plan will be shared with your GP and pharmacy.
- Any home-visit or video-consultation charge.
- What happens, and what is charged, if changes need closer follow-up.
- Whether liaison with your other clinicians is included.
On the NHS? Structured medication reviews are commonly available on the NHS through GPs and clinical pharmacists; private reviews may offer more time, a second opinion or specialist input.
You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Stopping medicines without explaining why, or without the person's agreement.
- Reducing medicines that should be tapered without a clear, monitored plan.
- Not warning which medicines must never be stopped suddenly.
- Failing to share the updated plan with the GP and pharmacy.
- Treating fewer tablets as a target rather than the right medicines as the goal.
Marketing red flags
- Promising to "get you off all your medicines" regardless of need.
- Quick reviews that do not see your actual medicines or recent results.
- Selling supplements or products in place of properly assessed treatment.
- No plan for monitoring or follow-up after changes.
Choosing a specialist safely
- Check the psychiatrist is on the GMC Specialist Register for this area.
- Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
- You're entitled to time to consider and to have your questions answered before you agree — the psychiatrist who looks after you should explain it, not a salesperson.
- Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including any follow-up — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good psychiatrist will welcome every one of these.
- Which of my medicines are still clearly helping, and which might be reduced?
- Are any of my medicines adding to falls risk, drowsiness or confusion?
- If we reduce a medicine, how will that be done and what should I watch for?
- Which medicines must never be stopped suddenly?
- What monitoring or follow-up will I need after any change?
- Who do I contact if I feel worse after a change?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the psychiatrist who carries out my appointment, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this appointment not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Is the aim just to stop my tablets?
Is it safe to stop a medicine I have taken for years?
Can I get a medication review on the NHS?
Why do older people need this more than others?
What is anticholinergic burden?
What should I bring?
Who do I contact if I feel worse after a medicine change?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: NICE — Medicines optimisation (NG5) NICE — Multimorbidity and polypharmacy (KTT18) NHS Specialist Pharmacy Service — resources to support medication review NICE — Medicines associated with dependence or withdrawal (NG215) NHS — Why take medicines safely / polypharmacy Royal College of Psychiatrists — old age psychiatry nidirect — urgent and emergency care services nidirect — GP out-of-hours service
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
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