Why Families Hesitate (or Don't) When It Comes to Cutting Back a Loved One's Medications in Nursing Homes

If you have a parent or relative living in a long-term care facility, there's a good chance they're taking a lot of medications — sometimes a dozen or more. A new study from South Korea looked at what shapes how family caregivers feel about the idea of scaling those medications back, a practice known as deprescribing.

The research, published in BMC Geriatrics, surveyed 973 family caregivers of residents in long-term care facilities and asked them to complete a validated questionnaire measuring attitudes toward deprescribing. The goal wasn't to test whether deprescribing works, but to understand which caregivers are more open to the conversation — and which factors are linked to hesitation or concern.

A Common but Risky Situation

Polypharmacy, generally defined as taking five or more medications at once, is widespread among older adults in care facilities. Prior research cited in the study found that in Korean nursing homes, residents take an average of over ten medications, with nearly half taking eleven or more. That matters because taking many medications simultaneously has been associated with higher rates of falls, confusion, hospital visits, and other complications, particularly among frail older adults nearing the end of life.

Deprescribing is the term for a deliberate, supervised process of reducing or stopping medications that may no longer be helping — or that might be doing more harm than good given a person's overall health and goals. Family caregivers frequently take part in these decisions, especially when residents themselves have cognitive or communication difficulties, yet relatively little research has focused on what drives caregivers' openness to the idea.

What the Survey Measured

In this study, caregivers answered questions covering four dimensions of attitude: how burdened they feel by managing medications, how involved they want to be in decisions, how concerned they are about stopping a drug, and how appropriate they judge the current medication regimen to be. On average, caregivers reported a strong desire to be involved in decisions and a notable sense of burden, while they were somewhat more skeptical about whether all the medications their relative took were truly appropriate.

The residents these caregivers were responsible for took an average of 5.6 medications, and about 16% had experienced some kind of adverse drug event in the past.

What Actually Correlated with Caregiver Attitudes

The researchers tested 16 different factors — including caregiver demographics like age, education, and gender, as well as resident-related factors like number of medications and health history — against the attitude scores. Because so many comparisons were run, they applied a statistical correction (the Benjamini-Hochberg method) to reduce the chance of false positives.

After that correction, eight associations held up. Caregivers of residents who had experienced an adverse drug event reported higher levels of burden and more concern about stopping medications, along with lower confidence that the current regimen was appropriate. Higher medication costs were linked to greater burden and more concern about stopping drugs. A higher number of medications was associated with greater caregiver burden. And residents with more chronic health conditions were linked to caregivers reporting both more concern about stopping medications and a stronger desire to be involved in the process.

Notably, caregiver characteristics themselves — such as age, sex, or education — did not show a significant relationship with attitudes once the statistical correction was applied. The factors that mattered most were tied to the resident's medical situation, not who the caregiver was.

Reading the Findings with Appropriate Caution

Because this was a cross-sectional survey — a single snapshot in time — the findings point to associations rather than cause and effect. The authors describe their results as hypothesis-generating rather than conclusive, meaning they help identify patterns worth exploring further rather than proving why caregivers feel the way they do.

Still, the pattern is a useful starting point for clinicians and facility staff. It suggests that conversations about deprescribing might be most relevant, and perhaps most welcomed, when caregivers are already dealing with a resident who has had an adverse drug reaction, faces high medication costs, is on many prescriptions, or lives with several chronic conditions. In those circumstances, caregivers appear more attuned to the downsides of continuing current treatment and may be more receptive to reviewing it.

If you're navigating medication decisions for a family member in long-term care, this research is a reminder that your concerns about burden, safety, or cost are shared by many others in similar situations. Any changes to an individual's medications should always be discussed with their physician or care team, who can weigh the specific risks and benefits involved.

Source: BMC Geriatrics, DOI: 10.1186/s12877-026-08333-6, based on a cross-sectional survey study by Jung, Shin, and Kim.