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REDUCING THE ADVERSE OUTCOMES OF POLYPHARMACY
Barbara Farrell, PharmD is making stopping medications just as easy as starting
- More than two decades ago, when Barbara Farrell, PharmD, began conducting medication assessments at the Bruyère Health Geriatric Day Hospital, she encountered a troubling pattern: older adults routinely taking long lists of medications. Some medications were unnecessary, some harmful, and many patients didn’t fully understand why they were being used.
“Polypharmacy increases the risk of drug interactions and can lead to unintended side effects like disrupted sleep, dizziness, falls, and fractures,” says Farrell, Senior Investigator at Bruyère Health Research Institute and Founder of the Deprescribing Guidelines Research Team at deprescribing.org. “I’ve even seen patients diagnosed with dementia whose symptoms improved when we deprescribed.”
Despite the risks, she also noticed that prescribers often felt bound by clinical guidelines that emphasized when to start medications but provided little guidance on when or how to stop them safely.
This experience sparked the idea that would define the latter part of her career: What if stopping medications could be as routine as starting them?
Tackling the prevalence and problems of multiple medications
- Farrell and her team set out to build something new: evidence based deprescribing guidelines that clinicians everywhere could trust.
“Deprescribing guidelines include practical algorithms for reducing or discontinuing medications that are no longer beneficial,” says Farrell, whose team piloted the original three guidelines in primary care practices and long-term care homes in Ottawa. “For patients who were taking multiple medications, that could mean a significant reduction in polypharmacy and improvement in quality of life.”
The work took off.
Today, the team behind deprescribing.org has published six guidelines with decision-support algorithms. The first four have been downloaded over 400,000 times from Canadian Family Physician, cited in more than 750 publications, and implemented in more than 20 countries. These guidelines are now influencing polypharmacy assessment tools, drug information resources, and electronic prescribing and are being integrated into clinical practice worldwide.
It’s contributed to a global shift toward safer, more intentional medication use.
"When we started this work, deprescribing was an emerging concept. Today, it is reshaping care delivery and empowering clinicians."
Barbara Farrell, PharmD
Senior Investigator, Bruyère Health Research Institute
Founder and Senior Advisor of deprescribing.org
Building an international movement of deprescribing
- International collaboration is underway to embed deprescribing principles in all clinical guidelines—ensuring clinicians consider not just when to prescribe, but when to reassess, reduce, or remove medications altogether.
Farrell’s team has provided open access to their methodology since the beginning, allowing others to build off their foundation. The work is transforming medication related care for older adults, offering them fewer side effects, more clarity, and a better quality of life.
“When we started this work, deprescribing was an emerging concept. Today, it is reshaping care delivery and empowering clinicians,” says Farrell. “Most importantly, deprescribing guidelines help patients live healthier, safer lives.”
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