Medication non-adherence among older adults is a growing public health concern, especially as the prevalence of polypharmacy—the use of multiple medications—rises with age. Managing complex regimens for multiple chronic conditions increases the likelihood of medication-related problems. Abruptly stopping a prescribed treatment without guidance from a healthcare professional poses significant and immediate health risks. This action can quickly lead to treatment failure, acute medical complications, or hospitalization.
Why Seniors Choose to Stop Medication
A variety of factors drive older adults to discontinue their medications, often rooted in practical challenges or personal perceptions of their health. Complexity is a common reason, especially with polypharmacy, which can involve taking five or more different prescription drugs daily. Cognitive changes, such as forgetfulness or confusion, make managing complicated schedules difficult, leading to unintentional non-adherence.
Financial strain is another powerful factor, as the high cost of prescription drugs forces seniors on fixed incomes to make difficult choices. Some may ration their medication by skipping doses, splitting pills, or delaying refills to conserve supply. This cost-related non-adherence undermines the medication’s effectiveness and can rapidly lead to health deterioration.
Patients also stop taking medications due to side effects, whether they are real or simply perceived. When a drug causes discomfort, fatigue, or other unwanted symptoms, some individuals choose to stop taking it rather than discussing the issue with their doctor. When chronic conditions are well-managed and symptoms disappear, patients may mistakenly believe they are cured and no longer need the medication, leading to self-discontinuation.
Acute Physiological Responses to Abrupt Cessation
The sudden discontinuation of certain medications can trigger immediate and dangerous physiological reactions. One severe response is the rebound effect, where a biological function suppressed by the drug surges back with greater intensity than before the treatment began. For example, stopping a beta-blocker can cause a dangerous spike in heart rate and blood pressure. This potentially leads to a hypertensive crisis, chest pain, or a heart attack.
A similar rebound effect occurs with medications that suppress stomach acid, such as proton pump inhibitors (PPIs). Abrupt cessation can cause a rebound hypersecretion of gastric acid, resulting in severe acid reflux and heartburn worse than the initial symptoms. This phenomenon occurs because the body adapts to the drug’s presence, allowing the underlying system to overcompensate when the drug is suddenly removed. The worsening of the underlying condition itself is also a major risk.
Many psychotropic drugs, including certain antidepressants and benzodiazepines used for anxiety or sleep, carry a significant risk of withdrawal syndromes if stopped abruptly. Common symptoms of withdrawal include severe anxiety, tremors, insomnia, nausea, and dizziness. These reactions are a direct result of the brain and nervous system adjusting to the sudden absence of the drug and can be mistaken for a relapse of the original condition.
For long-term users of corticosteroids, such as prednisone, an abrupt stop can lead to an adrenal crisis, a life-threatening condition. The medication suppresses the body’s natural production of cortisol. Without a gradual taper, the body cannot produce enough stress hormones to function. This physiological shock can cause severe fatigue, weakness, confusion, and dangerously low blood pressure.
Safe Practices for Medication Review and Deprescribing
If an older adult or caregiver is concerned about a medication, they must initiate an open conversation with the prescribing physician. Patients should never unilaterally stop taking a prescription drug, even if they feel better or experience bothersome side effects. The healthcare provider needs to be aware of all concerns, including financial barriers or difficulties understanding the regimen.
This collaborative discussion leads to a comprehensive medication review, often involving a pharmacist, to identify potentially inappropriate medications or unnecessary drug duplications. Pharmacists ensure all healthcare providers are aware of every drug, supplement, and over-the-counter remedy the patient is using. This collaboration helps streamline the regimen and reduce the risk of adverse drug interactions.
The process of safely and intentionally stopping or reducing medication is known as deprescribing. Deprescribing is a planned, supervised intervention where a drug is systematically withdrawn when its potential harms outweigh its potential benefits. This practice is especially important in older adults susceptible to the negative effects of polypharmacy, such as falls and cognitive impairment.
When deprescribing is deemed appropriate, the withdrawal process is typically done slowly using a “stop slow, go low” approach. This often involves a gradual dose taper over several weeks or months. During this time, it is vital to monitor the patient closely for any return of the original symptoms or the emergence of withdrawal effects. Patient engagement and shared decision-making are central to this process.