Deprescribing in Home Health and Hospice: Reducing Medication Burden While Improving Quality of Life
Written by Jennifer Kennedy
As patients age, accumulate chronic conditions, and transition through various levels of care, medication regimens often become increasingly complex. This is especially true in home-based care, where patients and caregivers manage medications within the realities of daily routines, functional limitations, and changing clinical needs. While numerous medications provide significant clinical benefit, others may stop being beneficial as a disease progresses. In home health and hospice settings, clinicians are uniquely positioned to evaluate whether every medication remains aligned with a patient’s current condition(s), goals for care, and what matters.
Deprescribing is emerging as an essential component of high-quality, person-centered care and aligns closely with Age-Friendly care principles. The Age-Friendly Health Systems 4Ms framework emphasizes What Matters, Medication, Mentation, and Mobility, with Medication focused on ensuring that medicines are necessary, do not cause avoidable harm, and support the patient’s goals, function, and wellbeing. By reducing or discontinuing medications that no longer provide meaningful benefit, healthcare providers can improve safety, reduce treatment, and pill burden, and enhance quality of life.
What Is Deprescribing?
Deprescribing is the systematic process of identifying and discontinuing medications when the potential harms outweigh the benefits or when the medication no longer aligns with the patient’s goals of care. It involves careful clinical evaluation, patient and caregiver engagement, and ongoing monitoring. The goal of deprescribing is ensuring that each medication remains necessary, beneficial, safe, and aligned with the patient’s current goals of care.
Every medication should have a clear purpose, measurable benefit, and alignment with the patient’s current medical needs. When those criteria are no longer met, continuing treatment may introduce unnecessary risks, costs, and burdens. Importantly, deprescribing is not about withholding care. It is about ensuring that treatment remains individualized, evidence-informed, and focused on what matters most to the patient.
The Growing Need for Deprescribing
Polypharmacy, commonly defined as the use of five or more medications, has become increasingly prevalent among older adults and individuals with serious illness. Many home-based care patients contend with multiple chronic conditions and may take ten or more medications each day. As medication profiles expand, so do the risks. Adverse drug events, medication interactions, falls, dizziness, cognitive impairment, and hospitalizations are all associated with excessive or inappropriate medication use. In addition, complex medication regimens can create confusion for patients and caregivers, reducing adherence to medications that are truly needed.
For countless patients, the burden of treatment extends beyond physical side effects. Managing multiple medications can consume considerable time, financial resources, and emotional energy. Deprescribing offers an opportunity to simplify care while maintaining focus on patient outcomes.
Deprescribing in Home Health Care
Home health clinicians are uniquely positioned to see how medications affect patients in daily life. By caring for patients in their homes, they can observe medication use, identify side effects, and assess function in the setting where patients live. Examples of when a prescriber should consider deprescribing include, but are not limited to:
- Signs of Adverse Drug Reactions (ADRs): When a patient exhibits new symptoms such as dizziness, confusion, sudden falls, loss of appetite, or lethargy.
- Multimorbidity and Frailty: When the patient is dealing with multiple complex conditions, making them more vulnerable to adverse drug interactions.
- High-Risk Medications: When the patient is taking medications known to be problematic for older adults (e.g., long-acting benzodiazepines, sedatives, or over-the-counter proton pump inhibitors (PPIs)).
- Shifting Care Goals: When a patient enters palliative or end-of-life care, where the focus pivots from long-term preventive care to comfort and quality of life.
Consistent and accurate medication reconciliation provides an ideal opportunity to identify medications that may no longer be necessary or appropriate.
For older adults, tools such as the American Geriatrics Society Beers Criteria can help clinicians identify potentially inappropriate medications that may increase the risk of adverse drug events, falls, delirium, drug interactions, or other harms. The Beers Criteria should be used as a guide to support individualized medication review and shared decision-making, rather than as a substitute for clinical judgment. The decision to continue, taper, or discontinue any medication should always be based on individualized assessment and collaboration with the prescribing practitioner.
Deprescribing in Home-Based Care
Effective deprescribing depends on interdisciplinary collaboration of the home or hospice team with prescriber of the medication. All disciplines providing care to a patient contribute valuable insights into medication effectiveness and potential risks.
Home health clinicians play a key role by:
- Performing comprehensive medication reconciliation
- Identifying possible medication-related problems
- Educating patients and caregivers about all aspects of medication administration, side effects, adverse reactions, and safety
- Communicating concerns to prescribers
- Monitoring outcomes after medication changes
Hospice clinicians play a key role by:
- Assessing whether medications support comfort-focused goals of care
- Identifying medications that no longer provide meaningful benefit given prognosis
- Recognizing medication-related symptoms such as sedation, nausea, dizziness, or confusion
- Educating patients and families about the purpose, benefits, and burdens of each medication
- Collaborating with the hospice medical director and prescribing practitioners to taper, discontinue, or continue medications as appropriate
- Monitoring for symptom changes after medication adjustments
Through regular assessment and communication, home health and hospice providers can help ensure that medication regimens remain medically necessary, safe, and effective.
Deprescribing in Hospice Care: A Special Consideration
In hospice, deprescribing often takes on even greater significance. As patients approach the end of life, healthcare decisions increasingly focus on comfort, dignity, and quality of life. Many medications prescribed to prevent future health complications may offer little immediate benefit to individuals with limited life expectancy. Continuing these therapies can create unnecessary pill burden, contribute to side effects, and detract from comfort-focused care.
Deprescribing in hospice is not simply eliminating medications. Some medications require gradual dose reductions to prevent withdrawal symptoms or symptom rebound. Others may continue because they contribute directly to patient comfort. The hospice physician and the interdisciplinary team must carefully balance symptom control, patient preferences, caregiver concerns, and overall goals of care.
The Future of Deprescribing
As healthcare continues to emphasize value-based care, medication optimization will play an increasingly significant role. Healthcare organizations are recognizing that high-quality care involves not only prescribing appropriate medications but also reassessing them over time.
Home health and hospice providers are well positioned to lead these efforts. Through comprehensive medication reviews, interdisciplinary collaboration, and patient-centered care planning, clinicians can help ensure that every medication serves a meaningful purpose.
Conclusion
Deprescribing is not about taking medications away. It is about ensuring that treatment remains aligned with the patient’s condition, prognosis, and what matters to them.
In both home health and hospice care, thoughtful deprescribing can reduce medication burden, minimize adverse events, simplify care for the patient and caregiver, and enhance quality of life. By regularly evaluating the necessity and effectiveness of medications, clinicians can support safer, more compassionate, and more goal-concordant care.
Five Questions to Ask During Every Medication Review
- Is this medication still providing meaningful benefit?
- Does it align with the patient’s current goals of care?
- Could it be contributing to adverse effects or treatment burden?
- Is there duplication of therapy or a safer alternative?
- What are the risks and benefits of reducing or discontinuing it?
When clinicians ask these questions consistently, deprescribing becomes more than a medication management strategy. It has become a powerful tool for improving patient-centered care.