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GERICLINICS

Clinical case · Polypharmacy

Thirteen medicines in a care home

An 88-year-old care-home resident with advanced dementia and very severe frailty takes thirteen regular medicines. Her daughter asks whether they are all still needed.

Advanced 20 minNeeds clinical reviewPro · free in beta

You will learn to

  • Recognise when a person is likely to be approaching the end of life and apply STOPPFrail eligibility
  • Prioritise medicines for deprescribing by benefit, harm and time to benefit
  • Plan deprescribing as a shared decision with safe tapering and monitoring

Presentation

Step 1 of 10

You are asked to see an 88-year-old woman in her care home. Staff report that she struggles to swallow her tablets, which they now crush into yoghurt. Her daughter, who holds lasting power of attorney for health and welfare, asks: "Does Mum really still need all of these?"

References

  1. Curtin D, Gallagher P, O'Mahony D. Deprescribing in older people approaching end-of-life: development and validation of STOPPFrail version 2. Age Ageing. 2021;50(2):465–471. doi:10.1093/ageing/afaa159 · PubMed 32997135
  2. Kutner JS, Blatchford PJ, Taylor DH, et al. Safety and benefit of discontinuing statin therapy in the setting of advanced, life-limiting illness: a randomized clinical trial. JAMA Intern Med. 2015;175(5):691–700. doi:10.1001/jamainternmed.2015.0289 · PubMed 25798575
  3. Scott IA, Hilmer SN, Reeve E, et al. Reducing inappropriate polypharmacy: the process of deprescribing. JAMA Intern Med. 2015;175(5):827–834. doi:10.1001/jamainternmed.2015.0324 · PubMed 25798731
  4. LeRoith D, Biessels GJ, Braithwaite SS, et al. Treatment of diabetes in older adults: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2019;104(5):1520–1574. doi:10.1210/jc.2019-00198 · PubMed 30903688
  5. Masnoon N, Shakib S, Kalisch-Ellett L, Caughey GE. What is polypharmacy? A systematic review of definitions. BMC Geriatr. 2017;17(1):230. doi:10.1186/s12877-017-0621-2 · PubMed 29017448

Last updated 2026-10-06.

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