“The benefits are huge”: Deprescribing in home health care
Medication overload—adverse events caused by too many medications—harms millions of older adults in the U.S. every year. The Lown Institute’s 2020 action plan for eliminating medication overload emphasized the importance of regular deprescribing, which is “the planned and supervised process of dose reduction or stopping of medication that might be causing harm, or no longer be of benefit.”

One innovative program in Rochester, NY, is already showing how deprescribing can work in the home health setting. The program, called HomeMed-APD, focuses on medication safety, optimization, and deprescribing for older home health care patients with dementia.
We talked to Dr. Jinjiao Wang, associate professor and postdoctoral program director at the University of Rochester School of Nursing, to tell us more about HomeMed-APD. Dr. Wang is an award-winning gerontological nurse scientist with an immense interest and commitment to improving the care older adults receive at home. She also serves at the lead nurse scientist at the UR Medicine Home Care Research Advisory Council and is the co-editor-in-chief of the journal JMIR Aging.
Lown Institute: Tell me about your medication optimization program and the patients you serve.
Dr. Jinjiao Wang: Our medication optimization program includes expertise from multiple disciplines, such as medicine, nursing, pharmacy, and gerontology. It is built upon the existing home health care system. The patients we serve are older adults who are recently hospitalized and discharged home after their acute and post-acute care episodes, who take multiple medications and need a little bit more support to ensure medication safety by optimizing the use of medications. That includes taking the appropriate medications as prescribed and stopping or reducing those that may not be as helpful.
What did you see that showed a need for this type of program?
From my clinical experience as a nurse in both tertiary hospitals and post-acute care settings, I’ve seen so many patients get discharged from the hospital and come back shortly after. Upon further examination, many of these patients had adverse events related to medication use that are by and large preventable.
What are some benefits of deprescribing you have seen for your patients?
The benefits are huge. We have seen multiple cases of potentially life-threatening hypoglycemia (low blood sugar) be averted with de-intensification of insulin. We have successfully reduced and discontinued unrecommended use of CBD related products. (CBD is Cannabidiol, a hemp plant product that has many purported health benefits benefits but also can have side effects.)
We also have patients who came to us complaining about symptoms that bothered them that have reduced after tapering of long-term medications which, upon further investigation, turned out to be more harmful and less needed to the patients than others. And of course, we have also seen cases where the recommendation was to adjust the doses of supplements and vitamins, such as vitamin D, because the patient’s most recent blood draw showed signs of having a bit too much of it.
What are some common challenges to deprescribing?
Time, trigger, and communication. Time – prescribers are often very busy and rarely have dedicated time for deprescribing during a post-hospitalization visit, where there may be many other things to check. Related to this, unless there is a trigger, such as a patient complaint of side effects, deprescribing could take time to occur.
Effective communication between the patient and the provider–and if the patient has multiple providers, among the providers–is key to deprescribing. Communication is needed to find out what medications may be good targets for deprescribing.
After deprescribing is implemented, communication is also essential to keep the patient/caregiver and the provider on the same page regarding symptoms and how the patient feels, so that patient safety can be ensured.
How does your program help overcome those challenges?
Our team did a lot of the heavy lifting required for deprescribing so that the provider can focus on deciding the best plan to implement it. Our home care nurse did home medication review and talked to the patient about their concerns and experience with medications. Our pharmacist reviewed the medications, the patient’s profile and responses, and labs as needed, to recommend deprescribing targets.
“Talk to your provider, and advocate for yourself…You know yourself best, so help your provider help you.”
Dr. Jinjiao Wang, on advice for older adults looking to reduce their medication burden
We then sent the recommendations to the provider in a way that is convenient for them, which was mostly in the electronic health records or sometimes a fax with a phone call. Should the decision is to go ahead with deprescribing, we also support the patient and the provider by making home visits to check on the patient, see how they are taking the new regimen, if they have concerning symptoms, etc. Doing these gave the patient and provider a lot of relief, as they knew the patient would be safe and were more likely to try it. Our recommendation acted as the trigger and we facilitated communication between the patient and provider.
What would you tell an older adult who is considering reducing their medication burden?
Talk to your provider, and advocate for yourself. Document your reasons and always bring your medications to the visit. Explain to the provider why you think you do not need certain medications or have concerns, either it is the side effects, the cost, or other issues that are important to you. You know yourself the best. So help your provider to help you.