Families can request a medication review by contacting their older adult’s primary care physician or pharmacist and asking for a comprehensive medication assessment, often called a “brown bag review” or “deprescribing evaluation.” This request should be made in writing when possible—via email, patient portal, or a letter—so there’s a documented record. For someone with dementia, a medication review becomes even more important because cognitive decline can mask side effects, drug interactions may accumulate silently, and unnecessary medications can accelerate confusion or cause falls. A medication review typically involves a healthcare provider or clinical pharmacist examining every pill, supplement, and over-the-counter drug the person takes, assessing whether each one is still needed and at the right dose.
For example, a person prescribed a blood pressure medication five years ago may no longer need it at the same strength, especially if their condition has changed or other medications now affect their blood pressure. During a medication review for someone with dementia, the provider looks not just at whether drugs are medically appropriate, but whether they’re contributing to the person’s cognitive or behavioral symptoms. The review process usually takes 30 to 60 minutes and may involve a follow-up phone call or office visit. Some insurance plans and Medicare Advantage plans cover medication therapy management (MTM) services at no cost, making this a practical step families can take without additional expense.
Table of Contents
- Who Should Conduct Your Family Member’s Medication Review?
- When Medication Reviews Are Most Urgent
- How to Start the Conversation With Your Doctor
- Understanding the Deprescribing Process
- Red Flags and Medication Side Effects in Dementia
- Insurance Coverage and Medication Therapy Management
- Documentation and Following Up After the Review
- Frequently Asked Questions
Who Should Conduct Your Family Member’s Medication Review?
A medication review can be conducted by several types of healthcare providers, each bringing different expertise. The primary care physician is the most common starting point, but clinical pharmacists often provide more thorough reviews because their training focuses specifically on drug interactions, dosing, and medication side effects. some insurance plans assign a pharmacist to high-risk patients automatically; others require a referral from the doctor. If your family member is in a nursing home or assisted living facility, the facility’s consulting pharmacist may conduct a review as part of regulatory requirements, though you can still request an independent review from your own provider. Cardiologists, neurologists, and other specialists may have reviewed medications in their specific area, but they typically don’t see the full picture of what your family member is taking across all doctors.
This gap is where problems hide. For instance, a neurologist might prescribe an antidepressant for memory concerns without knowing that the primary care doctor also prescribed a different class of antidepressant, creating a dangerous combination. A comprehensive review coordinated by one provider—usually the primary care physician or a pharmacist—prevents these overlaps. In some regions, community pharmacies offer free medication reviews as a service. Some retail pharmacies employ clinical pharmacists who specialize in this work. It’s worth calling ahead to ask whether your pharmacy offers this service and whether your family member’s insurance covers it.
When Medication Reviews Are Most Urgent
A medication review should happen as soon as possible after a dementia diagnosis or when cognitive symptoms worsen unexpectedly. Many families don’t realize that confusion, agitation, or wandering can be side effects of medication rather than disease progression. One common culprit is benzodiazepines (drugs like lorazepam), which are prescribed for anxiety but often cause severe confusion and falls in older adults with dementia—yet they’re frequently continued for years without reassessment. After any hospitalization, a medication review is critical because hospitals often add or change medications during acute illness, and patients are sometimes discharged with drugs they didn’t take before.
The original prescribing doctor may not be aware of these changes, creating medication duplications and interactions. A 70-year-old admitted to the hospital for pneumonia might leave with a new antibiotic, pain medication, anti-anxiety drug, and a changed diabetes dose—and nobody coordinated whether these all work together safely. Medication reviews also matter when costs become a barrier and your family member skips doses or splits pills to make them last longer. A review might uncover lower-cost alternatives or drugs that can be stopped entirely, removing the temptation to ration medication and potentially preventing serious health consequences.
How to Start the Conversation With Your Doctor
Approach the request as a partnership, not a confrontation. Many doctors welcome medication reviews because they reveal prescribing problems they didn’t know existed. Start by scheduling a dedicated appointment—don’t try to squeeze a full medication review into a regular visit. When booking, tell the office staff that you want a “comprehensive medication review” or “medication therapy management,” so they allocate enough time.
Bring a list of every medication, including over-the-counter drugs, supplements, and herbal remedies. Write down the drug name, dose, frequency, and reason it was prescribed if you know it. Include eye drops, pain creams, vitamins, and anything from the health food store. Many families are surprised to learn that vitamin D supplements interact with certain heart medications, or that herbal sleep aids can worsen urinary incontinence in someone with dementia. During the visit, ask the doctor specifically: “Are there any medications we could reduce or stop?” and “Are there any side effects we’re attributing to dementia that might actually be medication side effects?” If your family member has multiple doctors, ask which one will be the “medication quarterback” and ensure that person receives copies of the review from any other providers or pharmacists involved.
Understanding the Deprescribing Process
Deprescribing—the planned reduction or stopping of medications—is the goal of most medication reviews for older adults. It’s not about stopping all drugs, but about stopping those that aren’t helping and may be harming. The process is gradual, not abrupt, because stopping certain medications suddenly (like beta-blockers for heart disease or antidepressants) can cause rebound effects or withdrawal symptoms. A deprescribing plan typically involves stopping one medication at a time and monitoring for 2 to 4 weeks before discontinuing another. For someone with dementia, this caution is essential because behavioral or cognitive changes that appear after stopping a drug might actually represent relief from a side effect—which is good—but could be mistaken for disease progression.
For example, if agitation improves after stopping a certain blood pressure medication, that improvement is a success. The tradeoff is that some medications take weeks to fully clear the system, so patience and close monitoring are necessary. Not all medications should be deprescribed. A person on a statin after a heart attack, or on a medication that’s truly controlling a dangerous condition, should stay on that medication. The goal is to eliminate drugs that were prescribed for a problem that’s resolved, that are duplicated by another medication, or that are causing more harm than benefit.
Red Flags and Medication Side Effects in Dementia
Families often attribute changes in behavior or physical function to dementia when medications are actually responsible. Constipation, urinary incontinence, dizziness, falls, hallucinations, and aggression can all be medication side effects. Anticholinergic drugs—a large class that includes some blood pressure medications, antihistamines, and medications for overactive bladder—are particularly problematic in dementia because they impair memory and cognition. Ironically, people with dementia are sometimes prescribed anticholinergic drugs to manage symptoms caused by other anticholinergic drugs. Opioid pain medications are another warning zone.
They’re often continued long-term even after the original injury has healed, and they cause confusion, constipation, and falls in older adults. If your family member is on opioids, ask during the medication review whether a physical therapy approach, topical pain cream, or non-opioid medication might work instead. Some people tolerate these alternatives better and experience clearer thinking as a result. If your family member is on more than 10 medications—which is called polypharmacy—the risk of adverse effects and drug interactions rises steeply. A medication review is not optional in this situation; it’s a safety necessity.
Insurance Coverage and Medication Therapy Management
Most Medicare beneficiaries are eligible for free medication therapy management (MTM) services if they take at least two chronic medications, spend at least $35 out of pocket per year on medications, and have a condition requiring ongoing treatment. The insurance plan contacts eligible patients directly, but families can also initiate the request by calling the plan or asking the pharmacist. Some Medicare Advantage plans offer MTM automatically as an added benefit.
Medicaid in many states covers medication reviews for seniors, and some private insurance plans include them as well. It’s worth calling your family member’s insurance company to ask whether MTM is covered and what the process is for accessing it. If insurance doesn’t cover a comprehensive review, some independent pharmacies charge a modest fee (typically $50 to $150) for a clinical pharmacist’s review, which can be money well spent if it prevents a serious drug interaction or adverse effect.
Documentation and Following Up After the Review
After the review, ask for a written summary that lists which medications were kept, which were stopped or reduced, and what the plan is for monitoring. This document should go in your family member’s medical file and be shared with all their healthcare providers. Some pharmacists provide this automatically; others only if asked. Schedule a follow-up visit two to four weeks after any medication changes to assess how your family member is doing.
Improvements in alertness, mood, or physical function may take time to appear, but worsening should be reported immediately. Keep notes on any changes you observe—sleep, appetite, mood, balance, or confusion—and bring them to the follow-up appointment. If a medication was stopped and problems emerge weeks later, don’t assume the medication is needed again; other factors (infection, dehydration, pain) might be the cause. Contact the prescribing doctor before restarting anything.
Frequently Asked Questions
How do I know if my family member’s confusion is caused by dementia or by medication?
It’s difficult to distinguish without professional assessment. A medication review by a pharmacist can help by identifying drugs known to cause cognitive impairment. If confusion improves after stopping or reducing a medication, that suggests the drug was a contributing factor. If it persists, the cause is more likely the dementia itself.
Can we stop all medications and just try lifestyle changes?
No. Some medications prevent immediate, serious harm (like blood pressure medications after a stroke or heart disease medications). The goal of a medication review is to stop unnecessary drugs while keeping essential ones. A clinician determines which medications are truly needed based on your family member’s specific health conditions.
My family member’s nursing home says they can’t change medications without doctor approval. What do we do?
This is correct; medications can only be changed by a prescriber. However, you can still request that the facility’s consulting pharmacist conduct a medication review and provide recommendations to the doctor. The facility is required by law to consider these recommendations. If the doctor refuses to address safety concerns, you can file a complaint with your state’s nursing home ombudsman.
How long does a medication review take?
The actual review appointment typically takes 30 to 60 minutes. If changes are recommended, the follow-up process—getting prescriber approval, dispensing new prescriptions, monitoring for effects—can take 2 to 4 weeks or longer.
Will stopping medications save money?
Sometimes. If your family member is on expensive brand-name drugs that can be replaced by generics, or on medications no longer needed, costs may drop. However, the goal of a medication review is safety and quality of life, not cost savings. Don’t stop medications to save money without medical guidance.
What if the doctor refuses to do a medication review?
Ask for a specific reason. If the doctor is unwilling, request a referral to a clinical pharmacist who can conduct an independent review. Some pharmacists can communicate recommendations directly to the doctor. If you feel your family member is at risk due to medication side effects, you have the right to seek a second opinion from another physician.
