In a new study in JAGS, Matthew Growdon found that the average number of medications people with dementia took in the outpatient setting was eight, compared to 3 for people without dementia.   In another study in JAGS, Anna Parks found that among older adults with atrial fibrillation, less than 10% of disability could be explained by stroke over an almost 8 year time period.  She also talked about the need for a new framework for anti-coagulation decisions for patients in the last 6 months of life, based on an article she authored in JAMA Internal Medicine with Ken Covinsky. In today’s podcast we talk with Matthew and Anna, joined by co-author Mike Steinman, to talk about polypharmacy, deprescribing, where we are and what we need to do to stop this freight train of ever more medications for older adults and those living with serious illness. We start by addressing the root cause of the problem.  Clinicians want to “do something” to help their patients.  And one thing we know how to do is prescribe.  It’s much harder psychologically for clinicians to view deprescribing a medication as “doing something.”  This attitude needs to change.  It will take teamwork to get there, with robust involvement of pharmacists, and likely activating patients to advocate for themselves. And Eric might have mentioned aducanumab a time or two… -AlexSmithMD