Across the world, families watch their elderly loved ones fade and assume the disease is winning — yet sometimes, the very medicines prescribed to help are quietly compounding the harm. For older adults like Rose, an 86-year-old living with dementia, the sedation and cognitive fog caused by long-term medications can be indistinguishable from the progression of the underlying condition itself. Deprescribing guidelines now offer clinicians and families a framework for asking a harder, more hopeful question: is each medicine still earning its place? In the space between that question and its answ
Medication Review Critical for Dementia Patients Showing Cognitive Decline
Older adults with dementia may experience unnecessary functional decline and reduced quality of life due to medication side effects being misattributed to disease progression.
Some of what looks like disease progression might actually be reversible.
Mark
So the story here is that people think their relative's dementia is getting worse, but it might actually be the medications?
Mimi
Exactly. When you're on multiple drugs, the side effects can pile up—sedation from one, cognitive fog from another—and it looks identical to disease progression. The family sees decline and assumes the dementia is accelerating. But a medication review might show the drugs themselves are the culprit.
Luke
But how often does this actually happen? The piece uses one clinical scenario. Do we know how many older people with dementia are on these problematic combinations?
Mimi
That's a fair question. The piece doesn't give prevalence numbers. It's more about establishing that it *can* happen and that guidelines exist to help clinicians think through it.
Mark
And the guidelines themselves—are they widely followed in Australian aged care?
Mimi
The piece doesn't say. It presents what the guidelines recommend, but not whether they're actually being used in practice or what barriers exist.
Luke
Right. And on the deprescribing side—stopping a benzodiazepine or antipsychotic isn't simple. There can be withdrawal effects, rebound symptoms. The piece mentions deprescribing as an option but doesn't explore the practical difficulty of actually doing it.
Mimi
That's true. It's more of a "here's what the evidence suggests" piece than a "here's how to actually implement this" piece.
Mark
So for Rose specifically—if her doctor did review her medicines and decided to deprescribe, what would that process look like?
Mimi
The piece doesn't detail that. It just says a review could help determine whether deprescribing is appropriate. The actual tapering, monitoring, managing any withdrawal—that's not covered.
Luke
And we don't know Rose's outcome. This is a hypothetical case, not a real patient story. So we're left with the principle but not the lived experience of what happens when you actually try to change someone's medication regimen.
Mark
Is there a risk that this could discourage deprescribing—that doctors might worry it's too complicated to attempt?
Mimi
Possibly. Or it could encourage them to at least ask the question, which is the first step. The piece is really about raising awareness that the question needs to be asked.
Le Pouls
- Families watching elderly relatives deteriorate are often told — implicitly or explicitly — that the disease is simply running its course, when the culprit may be sitting in the medicine cabinet.
- Benzodiazepines, antipsychotics, and cholinesterase inhibitors can each cause sedation, confusion, and functional loss in older people, and together their effects can stack into something that looks exactly like advancing dementia.
- Because the decline mirrors the underlying condition, medication side effects go unrecognised, the drugs continue, and the person's quality of life erodes without anyone questioning why.
- Deprescribing guidelines provide a structured way to assess whether each drug still delivers meaningful benefit — weighing individual goals, tolerability, and the latest evidence on risk — rather than defaulting to continuation.
- For patients like Rose, a careful medication review could restore function that families had already grieved, drawing a critical line between decline that is inevitable and decline that is treatable.
Across the world, families watch their elderly loved ones fade and assume the disease is winning — yet sometimes, the very medicines prescribed to help are quietly compounding the harm. For older adults like Rose, an 86-year-old living with dementia, the sedation and cognitive fog caused by long-term medications can be indistinguishable from the progression of the underlying condition itself. Deprescribing guidelines now offer clinicians and families a framework for asking a harder, more hopeful question: is each medicine still earning its place? In the space between that question and its answer, some of what looks like irreversible decline may yet prove reversible.
Rose is 86 and lives with dementia. In recent weeks her daughter has watched her grow drowsier, quieter, less capable of tasks she once managed alone. The family fears the disease is accelerating. Her doctor has ordered tests for common treatable causes — infection, vitamin deficiency, thyroid problems — but no one has yet turned attention to Rose's medications: a nightly benzodiazepine, an antipsychotic, and donepezil, a drug intended to slow cognitive decline.
This is the central difficulty in caring for older people on multiple medicines. When several drugs are taken together, their effects layer in ways that are easy to miss. Sedation from one, cognitive clouding from another — combined, they can look precisely like a disease getting worse. Because the decline resembles the underlying condition, it goes unquestioned. The person stays on the drugs. The family assumes the illness is simply running its course.
Deprescribing guidelines offer a framework for stepping back and asking whether each medicine still helps more than it hurts. For benzodiazepines, the evidence in older age tilts strongly toward caution — sedation, cognitive impairment, falls, and dependence are well-documented risks. Antipsychotics warrant review if behavioural symptoms have resolved or if the person carries a diagnosis like Lewy body dementia, where the risks are particularly acute. Even cholinesterase inhibitors like donepezil deserve reassessment when dementia has reached a severe stage or when side effects are diminishing quality of life.
For Rose, a thorough medication review could change the picture entirely. It might reveal that one or more of her medicines is driving the very decline her daughter has been grieving. The goal is not to remove all treatment, but to ensure every medicine is genuinely earning its place — delivering real benefit that justifies its burden. That distinction, in a life already shaped by dementia, is the difference between accepting loss as inevitable and recognising that some of it may still be undone.
Rose is 86 and lives with dementia. Her daughter has watched her slip further in recent weeks—more drowsy than before, quieter in conversation, needing help with tasks she once managed alone. The family worries the disease is accelerating. Her doctor ordered tests to check for treatable causes: a urinary tract infection, vitamin B12 deficiency, thyroid problems, anaemia. But Rose's medicine cabinet has barely changed in years. She takes a benzodiazepine at night, an antipsychotic, and donepezil, a drug meant to slow cognitive decline. No one has asked whether these medicines themselves might be the problem.
This is the central puzzle in caring for older people on multiple medications. When someone takes several drugs at once, the effects can layer on top of each other in ways that are hard to see. A medicine that causes drowsiness here, a drug that clouds thinking there—together they can look exactly like the disease getting worse. The sedation, the confusion, the loss of function: these feel like dementia progressing. But they might be the medicines talking. And because the decline looks like the underlying condition, it gets missed. The person stays on the drugs. The decline continues. The family assumes the disease is simply running its course.
Deprescribing guidelines, available through resources like deprescribing.com, offer a framework for stepping back and asking a harder question: Does this medicine still help more than it hurts? The answer depends on the individual—their goals, their circumstances, what they can tolerate. But for certain classes of drugs commonly prescribed to older people, the evidence tilts toward caution.
Benzodiazepines, for instance, carry real risks in older age. They cause sedation, cognitive impairment, falls, and dependence. For most older people, these harms outweigh any benefit, though there are exceptions. Antipsychotics present a similar calculation. They may be appropriate for psychotic symptoms, but if someone is taking them for behaviour change and has shown little improvement after 12 weeks, or if the behaviour has resolved or stabilised, the case for continuing them weakens. The same applies if the person has Parkinson's disease or Lewy body dementia without actual psychotic symptoms—the risks often exceed the gains. Cholinesterase inhibitors like donepezil, the drug Rose takes, deserve review too. If dementia has progressed to severe or end-stage disease, or if side effects are eroding quality of life, it may be time to stop.
For Rose, a thorough medication review could shift everything. It might reveal that one or more of her medicines is driving the drowsiness and functional decline her daughter has noticed. It might show that deprescribing—carefully, with medical guidance—could restore some of what she has lost. The goal is not to strip away all treatment, but to ensure that every medicine Rose takes is pulling its weight, delivering real benefit that justifies its burden. In a life already complicated by dementia, that distinction matters. It is the difference between accepting decline as inevitable and recognising that some of what looks like disease progression might actually be reversible.
Citations marquantes
Deprescribing guidelines suggest considering deprescribing when the potential harms or treatment burdens of a medicine outweigh its benefits, with decisions tailored to the individual's goals and circumstances.— Deprescribing guidelines (deprescribing.com)
Envie de l'histoire complète ?
Lire l'original sur Australian Ageing Agenda ↗