Medications & Supplements
Past sixty-five, most people take several medicines, prescribed by several people, and the combination is rarely reviewed as a whole. Some of it is essential. Some of it is treating a side effect of something else. Reviewing the list is one of the higher-value things a physician can do. Supplements and the molecules sold as anti-ageing deserve the same scrutiny: a few have evidence in specific situations, most do not, and none reverse ageing.
What this means for healthspan
Many people take several medicines and supplements, prescribed or recommended by different people over many years. Each one may have been right when it was started. As health, weight, kidney function and other medicines change, the balance of benefit and risk can change too.
Medicines can add to dizziness, falls, confusion, constipation and fatigue, and these are sometimes mistaken for ageing. A regular, whole-list review can show what is still needed, what may no longer help, and what may be interacting. Reviewing is not the same as stopping. Some medicines are essential, and nothing should be stopped without a conversation with your prescriber or pharmacist.
What we assess, and why
We go through everything you take: prescriptions, over-the-counter products, vitamins, herbal and other supplements. We ask what each is for, how you take it, whether it is helping, and whether it causes side effects or is hard to keep up with.
We then look for duplication, interactions, doses that may no longer suit you, and medicines with a higher risk in older adults. Supplements are held to the same standard: we ask what the evidence is for your situation, and whether you need it.
What we may assess
Medication reconciliation, potential interactions, duplication, side effects, adherence, supplement use and the appropriateness of ongoing treatment. Additional tools or pharmacogenetic testing may be considered in selected cases.
What is used is chosen for you, according to your individual risk, clinical appropriateness, the evidence and what you decide with your physician.
Why it matters
Regular, coordinated review can help reduce avoidable medication-related harm and ensure treatment remains appropriate as health needs change.
Examples of assessments and investigations
These are examples of what may be considered. Which of them are used for you depends on your history, your risk and what you decide with your physician.
Medication reconciliation
Building one accurate list from your pharmacy records, bottles and your own account. Done at the start and when anything changes.
Review for interactions and duplication
Checking whether medicines or supplements overlap or affect each other. Done as part of every review.
Review with deprescribing tools
Using published criteria such as the AGS Beers Criteria and STOPP/START to flag medicines that may carry more risk than benefit, or treatments that may be missing. These are prompts for clinical judgment, not rules.
Side effect and symptom review
Asking whether new symptoms, such as dizziness, memory change or fatigue, could be linked to a medicine. Considered whenever symptoms arise.
Adherence and practical barriers
Talking about cost, side effects, timing, packaging and understanding. Considered when doses are missed or the routine is complicated.
Supplement review
Reviewing each product for purpose, dose, evidence and safety. A few supplements have evidence in specific situations, such as a confirmed deficiency. Most do not, and none reverse ageing.
Laboratory checks for medicine safety
Tests such as kidney function or levels of certain nutrients when a medicine or deficiency makes them relevant.
Pharmacist medication review
A structured review with a community pharmacist. We may suggest this and share our findings with them.
Pharmacogenetic testing
A genetic test that shows how your body may process certain medicines. Considered only in selected cases, for example after repeated side effects or poor response to a specific drug that has guideline support for genotype-guided dosing. It is not a routine test.
What the evidence supports, and where it is uncertain
What the evidence supports
- Structured medication review is widely recommended for people who take many medicines, and tools like the AGS Beers Criteria and STOPP/START are used internationally to guide it.
- Canadian deprescribing guidelines recommend offering a slow taper of sedative sleep medicines (benzodiazepine receptor agonists) to adults 65 and older, with the strength of recommendation rated as strong although the supporting evidence is low in quality.
- Some medicine classes, including sedatives and anticholinergic medicines, are associated with falls and confusion in older adults, which is why they are often reviewed.
- Supplements can help in specific situations, such as treating a confirmed nutrient deficiency, under clinical guidance.
Limits and uncertainties
- Beers and STOPP/START are lists to prompt review. The AGS notes they are not a substitute for clinical judgment, and a listed medicine may still be the right choice for you.
- Evidence that deprescribing improves long-term outcomes such as falls or hospital stays is mixed. Stopping a medicine can also cause withdrawal or bring back the original problem, so changes are made gradually and monitored.
- For healthy adults, the US Preventive Services Task Force found the evidence insufficient on multivitamins for preventing heart disease or cancer, and recommends against beta carotene and vitamin E for that purpose. Supplements are not free of risk.
- No supplement has been shown to reverse ageing. Product claims, especially for serious conditions, should be treated with caution. Health Canada advises looking for an NPN, DIN or DIN-HM on the label.
- Pharmacogenetic testing is useful for only some medicine and gene pairs. Results can be misread, rarely change treatment for most people, and may not be funded. Testing is not recommended for everyone.
From findings to a plan, and what follows
How findings can inform a plan
Findings guide a shared plan with you and your prescribers. That may mean keeping what is working, lowering or stopping a medicine that no longer fits, adjusting timing or dose, suggesting an alternative, or adding a treatment that appears to be missing. Supplements are kept only where there is a clear reason. We do not stop prescribed medicines on our own; changes are discussed with you and, where appropriate, with the prescriber who started them, and made one step at a time.
Follow-up, monitoring and coordination
We usually repeat the review at regular intervals and whenever there is a hospital stay, a new diagnosis or a new prescriber. We may share an updated list with your family doctor, specialists and community pharmacist, and we monitor for effects after any change, such as blood pressure, sleep, mood or blood tests. Bring all your medicines and supplements, in their containers, to each review.
What happens here
The approach is the same in every area: establish where you are, change something on a cadence, then measure again to find out whether it worked. Medications & Supplements does not have a program of its own. It is assessed as part of every membership and worked on with your physician, and with the dietitian, kinesiologist or counsellor where that is what it needs.
Reliable places to read more
These are independent organizations. Monarch Health does not control their content and has no arrangement with them.
Canadian Deprescribing Network
Canadian Medication Appropriateness and Deprescribing Network: public resources and medication review finder(opens in a new tab)
Deprescribing.org (University of Toronto and partners)
Deprescribing.org: patient pamphlets and tools for talking about medications(opens in a new tab)
Health Canada
Safe use of natural health products(opens in a new tab)
Health in Aging, American Geriatrics Society
Medications older adults should avoid or use with caution (Beers Criteria explained)(opens in a new tab)
Where to go next
The other areas we work on