Dr. Emily McDonald sits in her office at McGill University, listening to patients describe symptoms that sound like aging itself—confusion, falls, bleeding—only to discover the culprit isn't time passing, but the medications meant to help them. This scene plays out across Canada and beyond, where approximately two in three adults age 65 or older take five or more medications, often in combinations that have never been studied together.
The consequences can be profound. When a 78-year-old falls because of dizziness caused by a drug interaction, when memory problems get chalked up to dementia rather than medication side effects, the real harm isn't age—it's overprescribing. Yet for years, there has been little guidance for clinicians on how to prevent these cascading problems. Medication reviews, when they happen at all, typically occur only after a complication forces the issue.
Now, a new Canadian guideline offers a different approach: prevention through routine checkups. Co-led by researchers at McGill University and the University of Toronto and developed by an interdisciplinary panel of experts, the recommendation is clear and practical. Adults 65 or older, particularly those taking five or more medications, should receive annual medication reviews to identify unnecessary or potentially harmful prescriptions and, where appropriate, safely reduce or stop them. The work draws on evidence from more than 100 clinical trials and has been published in the journal Canadian Family Physician, aligning with federal legislation calling for a strategy on appropriate medication use.
"We have a significant issue with overprescribing in Canada and globally. Patients taking 10, 15 or even 20 medications are not uncommon," says Dr. McDonald, Associate Professor in McGill's Department of Medicine. The risks are real and measurable: complex drug combinations can interact in unpredictable ways, contributing to falls, confusion, and bleeding complications—all too often mistaken for the inevitable consequences of aging rather than the actual cause.
What makes this guideline different is its focus on shifting the system from reaction to prevention. Rather than waiting for harm to occur, clinicians now have a clear mandate to review medications annually, using evidence-based approaches to identify what might be discontinued safely. The shift matters not just for individual health outcomes but for quality of life. Patients freed from unnecessary medications often find themselves sharper, steadier, and more engaged in their own lives.
But guidelines alone don't change practice. The authors emphasize the need for government support to make these checkups widely available through physicians, pharmacists, and nurse practitioners. This infrastructure is essential if the recommendation is to reach the seniors who need it most.
In the meantime, patients don't need to wait. McDonald encourages seniors taking multiple medications to advocate for themselves, asking their healthcare providers directly for a medication review and using five key questions to guide the conversation. She also directs the Canadian Medication Appropriateness and Deprescribing Network, which offers a Medication Review Service Finder to help users locate publicly funded medication review services in their area.
What began as a clinical observation—that overprescribing harms the very people it's meant to help—has become a pathway forward. One conversation at a time, one medication review at a time, Canada is beginning to reframe what health care for seniors can mean.