Polypharmacy, defined as the concurrent use of five or more medications, is a prevalent and growing global concern in geriatrics. While strongly linked to negative health outcomes, research is complicated by a lack of definitional standardization. Modern management focuses not simply on reducing pill counts, but on transitioning from problematic to appropriate polypharmacy through structured deprescribing.1) Describe the risks and negative health outcomes associated with polypharmacy in older adults 2) Evaluate the role, effectiveness, and implementation of deprescribing as a key management strategy to mitigate these risks.Key systematic reviews, meta-analyses, and randomized controlled trials (RCTs) on the subject were cited in the narrative review of the literature that served as the foundation for the synthesis. The STOPP/START criteria and the AGS Beers Criteria® are two evidence-based deprescribing guidelines that were emphasized. High-quality study designs were used to summarize established associations and intervention outcomes.Adverse drug reactions, falls, frailty, functional and cognitive decline, hospitalization, and increased mortality are just a few of the negative outcomes for which polypharmacy is an independent risk factor. A vicious cycle is produced by a reciprocal relationship with frailty.  Strong evidence supports deprescribing interventions. RCTs and meta-analyses show that these interventions are useful, secure, and successful, dramatically lowering death and fall rates without raising adverse events . Medication review clinics and multidisciplinary team approaches are examples of successful models. The majority of older adults are willing to deprescribe if advised by their clinician.The findings underscore that polypharmacy is a major patient safety issue. The paradigm has shifted from indiscriminate medication reduction to optimized, evidence-based therapy. Deprescribing, facilitated by validated tools and a shared decision-making approach, is a core strategy to break the cycle of harm. Its effectiveness in diverse settings confirms its clinical utility. An acknowledged lack of a single, standardized definition for polypharmacy, complicates research and consistent application.Polypharmacy in older adults is a high-risk, prevalent condition strongly associated with serious negative health outcomes. Structured deprescribing, guided by established criteria and patient-clinician collaboration, is an effective and safe intervention to reduce these risks, moving therapy from problematic to appropriate.

Climate change is a major public health challenge, with direct and indirect impacts on population health. Healthcare systems themselves contribute significantly to greenhouse gas emissions, particularly through the life cycle of medicines, including production, distribution, use, and disposal. In primary care, discussions around appropriate prescribing, deprescribing, and “right care” are increasingly linked to environmental sustainability. However, patients’ perceptions of the carbon footprint associated with medicines remain poorly explored.To explore patients’ perceptions of the carbon footprint of their medication consumption in primary care, including their views on responsibilities and possible individual or collective actions.A qualitative exploratory study was conducted using semi-structured interviews with adult patients receiving primary care. Participants were recruited through purposive sampling to ensure diversity of profiles. Interviews were audio-recorded, transcribed verbatim, and analysed using thematic analysis. Data collection and analysis were performed iteratively. Data saturation was reached after the tenth interview, and the two subsequent interviews confirmed saturation. Triangulation between researchers was undertaken to enhance the credibility of the analysis.Patients demonstrated partial awareness of the carbon footprint of medicines, most often associating it with drug degradation and disposal rather than with manufacturing or distribution processes. Responsibility for medication overconsumption was mainly attributed to the healthcare system, including the state, pharmaceutical industry, and prescribing physicians. Patient education on the links between health and environmental sustainability was perceived as important but currently insufficient. Views on individual actions varied: some participants expressed a perceived necessity to act at a personal level, while others highlighted difficulties in changing behaviours or expressed feelings of powerlessness, sometimes accompanied by pessimistic views regarding the future of the planet.These findings reveal an emerging but fragmented understanding of the environmental impact of medicines among patients. Tensions between individual responsibility and systemic responsibility were prominent, as well as concerns about the effectiveness of individual-level actions.Exploring patients’ perceptions of the carbon footprint of medicines provides valuable insights for supporting discussions on appropriate prescribing and deprescribing in primary care. Integrating these representations into clinical practice may help foster more acceptable conversations around environmental sustainability, right care, and health promotion in primary care.

Multiple potentially inappropriate drug prescriptions increase in older adults. There are many benefits to deprescribing, for patients and for One Health.The objective was to measure the acceptability and rate of deprescribing among seniors aged 75 and over, using deprescribing support tools, as REMEDI[e]S (REview of potentially inappropriate MEDIcation pr[e]scribing in Seniors). The secondary objective was to collect the reasons for deprescribingObservational study in a multidisciplinary health center from October 2023 to May 2024. The study population consisted of patients aged 75 and older with at least five medications. The data collected were: age, sex, medical history, creatinine clearance. The data presented were in numbers, mean, standard deviation, median, interquartile range. Deprescribing was compared using Fisher's exact tests for age, gender, and number of medications. The effect of each variable was estimated using the adjusted odds ratio and its 95% confidence interval. All statistical tests were two-tailed and performed at a 5% risk of type I error by BiostaTGV. The South East CPP validated this study (2023/CE 26).Sixty-nine patients participated; average age 85.4 years and 68% women. The average number of drugs was 6.9. Deprescribing was accepted at 95.6%. Deprescribing carried out in 49% of prescriptions. Deprescribing was more performed when patients had seven or more medications (p < 0.05). PPIs accounted for 44% of deprescribed medications, followed by anxiolytics, antidiabetics, and antihypertensives. The main reason for deprescribing was “lack of indication” (49%), followed by “dose unsuitable for renal function” (22%), “unfavorable risk-benefit ratio” (16%), and “inappropriate prescription duration” (13%).Few studies focus on analyzing deprescribing in practice by general practitioners.Tools to assist with deprescribing exist in France. The application of REMEDI in everyday practice should enable the implementation of deprescribing, which is widely accepted by older people, while reducing the time doctors spend on this process.  This study encourage general practitioners to implement deprescribing, given its feasibility and acceptability as highlighted in this study.The rates of acceptability and implementation of deprescribing can encourage general practitioners to discuss the subject of deprescribing with their patients.

Long-term use of antidepressants (ADs) is common, particularly among older adults who are at greater risk of adverse effects and drug interactions due to age and polypharmacy. Informal caregivers often play a role in managing care and medication, making their perspectives of the discontinuation of unnecessary long-term AD use in older adults relevant.   This study examines caregivers’ views on discontinuing long-term AD in older adultsEleven semi-structured interviews were conducted with caregivers of individuals aged 75+ who had been using ADs for over a year for depression and clinically stable. Interviews were thematically analyzed. The 11 participants (9 females; 49–75 years) were all family members (e.g. partners, children). Caregivers identified several factors influencing their perspectives. Many were hesitant to discontinue ADs due to perceived benefits for the older adult’s quality of life and fears of relapse, which they believed could negatively affect the older adult’s well-being as well as increase their own caregiving burden. Limited knowledge about ADs, depression, and their side effects contributed to their preference for maintaining the status quo. Caregivers emphasized the importance of a stable social network and living conditions as facilitators of discontinuation but noted that these factors were often lacking in older adults. While some caregivers preferred leaving decisions to the GP and the older adult, others expressed a desire to be actively involved in the process. Moreover, they saw themselves as potential facilitators by monitoring mental health changes during discontinuation and providing support. GPs were viewed as central to initiating and guiding the discontinuation process. This is the first study exploring caregivers' perspectives on discontinuing long-term AD in older adults, highlighting their pivotal but underutilized role in this process. We purposely sampled 11 caregivers from different geographic regions in xx to ensure we fully captured a wide range of opinions and the data reached saturation.Caregivers’ perspectives on discontinuing long-term AD use are shaped by limited knowledge, concerns about relapse, and a strong desire to support the older adult. Caregiver education, improved communication, and active involvement of caregivers by the GP is recommneded to facilitate the discontinuation of long-term AD in older adults.

Long-term antidepressant use is high in high-income countries. Depression guidelines recommend that antidepressants should be taken up to 6-12months after remission and up to 2years after remission in those at high risk of relapse. However, an increasing number of patients who feel well continue to use antidepressants much longer than recommended, even for years, without clear indication. This long-term usage contributes to the rising consumption of antidepressants. For health care professionals and patients, fear of relapse is a major reason for not initiating a discussion about discontinuing the antidepressant. The workshop integrates the latest research findings with clinical aspects and offers practical insights for safe and effective deprescribing long-term antidepressant use.Learning objectives: • Understanding the rationale, the pro and the cons of deprescribing long-term antidepressants, including the risks and benefits with long-term use • Insights into the pharmacological principles and the tapering schemes for deprescribing antidepressants • Recognize potential barriers to deprescribing antidepressants and explore strategies to overcome them. • Develop strategies for engaging patients in discussions about deprescribing antidepressants, and supporting them through the deprescribing process. • Collaborating with a multidisciplinary healthcare team in the deprescribing process.This workshop stimulates intensive interaction with the participants by using clinical cases, poll votes, video fragments and discussions of participants’ views and experiences.dentify indications for deprescribing long-term antidepressant use based on current evidence and clinical guidelines. Develop individualized tapering plans applying pharmacological principles and considering withdrawal risks. Recognize common barriers to deprescribing and propose targeted strategies to overcome them. Formulate patient-centered conversation starters and follow-up plans for deprescribing, utilizing shared decision-making frameworks. Understand the role of multidisciplinary teams, including pharmacists and mental health professionals, in supporting safe antidepressant tapering. Reflect on their clinical practice and identify at least one actionable change to improve deprescribing of long-term antidepressants.This workshop aims to increase participants’ confidence by providing practical tools, and to facilitate safe and effective deprescribing long-term antidepressants in clinical practice. In addition, the workshop encourages a dialogue between researchers, clinicians, and other stakeholders to address this deprescribing challenge.

Deprescribing is often framed as a clinical decision, yet in everyday general practice it emerges from broader system dynamics: professional routines, organizational arrangements, medico-legal concerns, economic incentives, and the growing importance of environmental considerations. Understanding these interacting factors is essential for designing scalable deprescribing strategies. The DEPREFLEX study adopts a systems-oriented and action-research approach embedded within a network of GPs, specialists, pharmacists, nurses, patients, associations, and policy interlocutors.To examine how clinicians and patients perceive deprescribing, how different framings (clinical, economic, environmental) gain or lose legitimacy, and which organizational mechanisms in primary care enable or hinder deprescribing in practice. Findings will directly inform the co-construction of a discrete choice experiment (DCE) and practical tools for general practice.This mixed-methods study combines qualitative interviews and subsequent quantitative stated-preference modeling. The qualitative phase (February–May 2026) includes ~30 purposively sampled participants across diverse practice settings (solo GPs, multidisciplinary centers, pharmacists, and patients). Interview guides explore perceived levers/barriers, coordination and documentation routines, medico-legal “cover”, and interpretations of deprescribing framed through clinical priorities, cost considerations, or environmental sustainability. Interviews are recorded, transcribed, anonymized, and analyzed thematically through an abductive approach by a multidisciplinary team. Iterative member-checking with our actor network refines interpretations and supports the development of DCE attributes and levels.Data collection is underway. By July 2026, we expect to report clearly identified preliminary themes such as: dominant framings of deprescribing among different actors; the role of team routines and pharmacist collaboration; organizational facilitators and bottlenecks; and areas of convergence/divergence between professionals and patients. These results will be presented as robust interim findings from the qualitative phase.Early insights indicate that deprescribing decisions cannot be separated from system context: accountability distribution, documentation practices, perceived risks, and coordination mechanisms profoundly shape what GPs consider feasible or legitimate. Understanding these dynamics is essential for designing deprescribing policies and tools aligned with real-world primary care constraints.DEPREFLEX provides system-aware evidence to inform policy-relevant, scalable deprescribing strategies. By integrating qualitative insights into a co-constructed DCE and practice tools, this study aims to support GPs in implementing deprescribing within realistic organizational conditions.

Deprescribing is recommended especially in elderly population where polypharmacy would lead to many adverse effects. Previous studies have focused solely on disease specific or medication-specific deprescribing such as reducing potentially inappropriate (e.g., antipsychotics) or unnecessary (e.g., proton pump inhibitors) medications.One Australian study evaluated a hospital-based deprescribing intervention designed to reduce total drug burden . There were no such studies done in Sri Lanka.General Deprescribe the medications that are no longer required Specific To assess the prevalence of   deprescribng medications  To identify categories of deprescribing medications   To assess patient and disease characteristics which are associated with deprescribing medications  To identify reasons of deprescribingMethod It was a Randomized controlled study with sample size of 135. We used interview-based questionnaire to collect data from clinic patients. Study setting was medical clinic of National Hospital Kandy-Sri lanka Analyzing method used was SPSS-20.Results Prevalence of the long-term unnecessary drugs was 30.3%. Categories of unnecessary drug groups identified were antiplatelets, proton pump inhibitors, frusemide and drugs used for neuropathic pain such as amitriptyline. There were patients ranging from 30year to 87years. Most of the unnecessary drugs were found in patients treated for ischemic heart disease (44.4%), diabetes (34.1%), hypertension (52.6%) and strokes (13.3%). Two main reasons for deprescribing were, no indication to continue the drug and long duration. According to our study majority of deprescribing was due to no proper indication (68.1%)Rising costs attributed to unnecessary drugs represent a major threat to achieving sustainable health care [13]. By doing this study we found  out the commonly encountered drugs which were continued unnecessarily.Sri Lanka is going through an economic crisis, this quality improvement project, will reduce medication burden and save a huge amount of money spent on these medications.Conclusion Most of our patients with ischemic heart disease, stroke, hypertension, diabetes was started on drugs to be continued for long durations.We should deprescribe the unnecessary drugs according to guidelines. The drugs which were started for short lasting complaints should be stopped when the indication is over. There by we can reduce the cost spent on these medications.