| Course | NU 627 Geriatric Healthcare |
|---|---|
| Unit | Unit 3 |
| Paper type | Deprescribing review |
| Length | About 1,010 words, 6 pages |
| Format | APA 7 student paper |
| School | Herzing University |
| Program | MSN Family Nurse Practitioner |
| Updated | October 2026 |
Free sample paper for NU 627 Unit 3
Deprescribing Review for an 87-Year-Old Man With Moderate Dementia Living in Assisted Living
Student Name
Department of Nursing, Herzing University
NU 627: Geriatric Healthcare
Instructor Name
February 6, 2026
Deprescribing Review for an 87-Year-Old Man With Moderate Dementia Living in Assisted Living
The Patient and His Goals of Care
Mr. W., a composite 87-year-old retired pharmacist, has moderate Alzheimer disease and has lived in an assisted living facility for 18 months. He walks with a walker, needs help with bathing and dressing, and enjoys meals and visits from his son. He has hypertension, benign prostatic hyperplasia, osteoporosis diagnosed after a wrist fracture nine years ago, and hyperlipidemia. At a family meeting last month, his son, who holds health care power of attorney, stated that the family's goals are comfort, avoiding hospital stays, and keeping him walking and eating well, rather than preventing events many years in the future. That statement governs this review: a medication whose benefit arrives years from now weighs less for him than one that affects how he feels this month.
The Full Medication List
Amlodipine 10 mg daily, started 12 years ago for hypertension by his former physician, last reviewed at admission. Lisinopril 20 mg daily, 10 years, same prescriber. Tamsulosin 0.4 mg nightly, 6 years, urology, for urinary hesitancy. Atorvastatin 40 mg daily, 11 years, primary prevention; no history of heart attack or stroke. Aspirin 81 mg daily, 11 years, primary prevention. Alendronate 70 mg weekly, 9 years since the wrist fracture. Omeprazole 20 mg daily, 7 years, started during a hospital stay for a reason no record explains. Donepezil 10 mg nightly, 3 years, neurology. Lorazepam 0.5 mg at bedtime, 2 years, started by a covering clinician for insomnia and never reviewed. Docusate 100 mg twice daily, 2 years. Ten medications, several from prescribers no longer involved in his care.
Explicit Criteria Applied
The STOPP/START criteria, version 3, were applied, with the 2023 Beers Criteria as a cross-check (O'Mahony et al., 2023; 2023 American Geriatrics Society Beers Criteria Update Expert Panel, 2023). Flags raised: lorazepam, a benzodiazepine, flagged by both for falls, sedation, and cognitive impairment. Aspirin for primary prevention, flagged, because in healthy older adults it did not prolong disability-free survival and increased major bleeding (McNeil et al., 2018). Omeprazole beyond eight weeks without a documented indication, flagged. Alendronate beyond five years, flagged for review. Atorvastatin for primary prevention in an older adult with limited life expectancy, flagged for review. Each flag is examined below for whether it applies to him, rather than treated as an instruction.
Prescribing Cascades
Two possible cascades were examined. First, docusate was started around the time lorazepam and reduced mobility began, and constipation is common with reduced activity; docusate itself has weak evidence for benefit, so it is a candidate regardless. Second, donepezil can increase urinary frequency, but tamsulosin predates donepezil by three years and was started for hesitancy, not frequency, so no cascade is present there. The review looks for cascades specifically because a medication treating another medication's side effect is a common and reversible finding.
Candidates for Stopping, Ranked by Harm
1. Lorazepam, highest priority. It increases fall risk in a man who uses a walker and can worsen confusion. The facility reports he sleeps poorly regardless.
2. Aspirin. It offers little benefit in primary prevention at his age and carries a bleeding risk, including gastrointestinal bleeding that would mean a hospital stay, the outcome his family most wants to avoid (McNeil et al., 2018).
3. Omeprazole. No current indication. Once aspirin stops, the one argument for continuing it, gastric protection, disappears too. Long-term use is associated with several adverse effects, although the evidence for many is observational.
4. Docusate. Little evidence of benefit, and it adds a pill twice a day.
5. Alendronate. After nine years, a drug holiday is reasonable for many patients, because the benefit persists for years after stopping and the risk of rare adverse effects rises with duration (Adler et al., 2016). His fracture risk remains high, so this is a genuine judgment call rather than a clear stop.
Sequence, Tapers, and Monitoring
Changes are made one at a time, about two weeks apart, so that any change in sleep, behavior, bowel habits, or reflux can be attributed. First step, now: stop aspirin; no taper is needed. Monitor for nothing specific; the benefit of stopping is the removal of a risk. Second step, two weeks later: begin tapering lorazepam, reducing to 0.25 mg nightly for two weeks, then 0.25 mg every other night for two weeks, then stop. Abrupt withdrawal after two years can cause rebound insomnia, anxiety, and, rarely, seizures. Facility staff will record sleep and nighttime agitation nightly, and sleep hygiene measures, including daytime activity and limiting daytime naps, begin at the same time. Third step, two weeks after the last lorazepam dose: reduce omeprazole to 20 mg every other day for two weeks, then stop; restart at the lowest effective dose if heartburn persists for more than a week. Fourth step, two weeks after that: stop docusate; monitor bowel movements and use polyethylene glycol as needed if constipation develops.
Alendronate is stopped last, about three months from now, as a drug holiday, with a plan to reassess fracture risk in two to three years; given his goals of care, a repeat bone density scan is not planned.
What Was Deliberately Continued
Atorvastatin was flagged but continued for now. His son said his father, a retired pharmacist, was proud of "taking care of his heart," and stopping it is a low priority compared with the higher-harm drugs above; it will be revisited once the other changes settle. Donepezil was continued because his family reports he is more engaged in conversation on it, which aligns with their goals; it will be reviewed if his dementia progresses to the point where that benefit is no longer visible. Amlodipine and lisinopril were continued, but his blood pressure will be checked standing as well as sitting, because tight control in a man with a walker increases fall risk.
Communication: the plan was discussed with his son, who agreed with each step, and the facility nurse received the written sequence. His neurologist and urologist were sent letters describing the changes, since both still prescribe for him.
References
Adler, R. A., El-Hajj Fuleihan, G., Bauer, D. C., Camacho, P. M., Clarke, B. L., Clines, G. A., Compston, J. E., Drake, M. T., Edwards, B. J., Favus, M. J., Greenspan, S. L., McKinney, R., Jr., Pignolo, R. J., & Sellmeyer, D. E. (2016). Managing osteoporosis in patients on long-term bisphosphonate treatment: Report of a task force of the American Society for Bone and Mineral Research. Journal of Bone and Mineral Research, 31(1), 16-35. https://doi.org/10.1002/jbmr.2708
2023 American Geriatrics Society Beers Criteria Update Expert Panel. (2023). American Geriatrics Society 2023 updated AGS Beers Criteria for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society, 71(7), 2052-2081. https://doi.org/10.1111/jgs.18372
McNeil, J. J., Woods, R. L., Nelson, M. R., Reid, C. M., Kirpach, B., Wolfe, R., Storey, E., Shah, R. C., Lockery, J. E., Tonkin, A. M., Newman, A. B., Williamson, J. D., Margolis, K. L., Ernst, M. E., Abhayaratna, W. P., Stocks, N., Fitzgerald, S. M., Orchard, S. G., Trevaks, R. E., ... Murray, A. M. (2018). Effect of aspirin on disability-free survival in the healthy elderly. New England Journal of Medicine, 379(16), 1499-1508. https://doi.org/10.1056/NEJMoa1800722
O'Mahony, D., Cherubini, A., Guiteras, A. R., Denkinger, M., Beuscart, J.-B., Onder, G., Gudmundsson, A., Cruz-Jentoft, A. J., Knol, W., Bahat, G., van der Velde, N., Petrovic, M., & Curtin, D. (2023). STOPP/START criteria for potentially inappropriate prescribing in older people: Version 3. European Geriatric Medicine, 14(4), 625-632. https://doi.org/10.1007/s41999-023-00777-y
What the NU 627 Unit 3 instructions ask for
For Unit 3 you review an older adult's medications and propose which to stop or reduce. Expect to start from the patient's goals of care and the full list, including start dates and indications. Explicit criteria such as the Beers Criteria or STOPP/START should be applied and cited, but the paper should explain judgment rather than simply list flagged drugs. Many sections ask you to look for prescribing cascades. Candidates should be ranked by harm or benefit, and the plan should describe the order of changes, any tapers and what will be monitored. Decisions to continue a flagged drug should be explained. Family or caregiver involvement is often relevant in dementia. Cite criteria, guidelines and deprescribing research in APA 7. Base the review on an invented resident, and keep within the length your rubric gives.
How the NU 627 Unit 3 example is put together
The review begins with the patient's goals: comfort, staying mobile with his walker and avoiding hospital stays. The full medication list gives each drug with when it started and who last reviewed it, which reveals several drugs continued for years without review. Explicit criteria are applied in a table-like section that flags lorazepam, a proton pump inhibitor, docusate and others. The cascades section examines whether docusate and another drug were started to treat side effects of earlier prescriptions. The ranked list puts lorazepam first and gives reasons for each later rank. The sequence section stops one drug every two weeks so any change can be traced, with a lorazepam taper and specific monitoring of sleep and behavior. The final section explains continuing atorvastatin for now because of what it means to him.
Reading the NU 627 Unit 3 rubric
Herzing rubrics for a deprescribing review usually reward goal-based assessment, use of explicit criteria, clinical reasoning, the deprescribing plan, monitoring and evidence. Goal points require the plan to reflect what the patient and family want. Criteria points go to correct application of a current tool with citations. Reasoning is often the most heavily weighted criterion; markers look for judgment about each drug, including cascades and drugs deliberately continued. Plan points depend on ranked candidates, a safe sequence and tapers where needed. Monitoring is credited when specific effects, such as sleep, falls or reflux, are tracked after each change. Evidence points require current guidelines and deprescribing studies. For writing, graders look at structure and at respectful wording about the son's role.
NU 627 Unit 3 help before you submit
Deprescribing papers often lose points by listing every drug flagged by the Beers Criteria and recommending that all of them stop at once. Students also skip goals of care, so the plan has no direction. Tapers are frequently missing for drugs that need them, such as benzodiazepines. Prescribing cascades are rarely examined, though many rubrics expect them. Another common gap is monitoring that is vague or absent. Some papers ignore the patient's or family's views, which matters most in dementia. Continuing a flagged drug without explanation looks like an oversight; explaining it shows judgment. Finally, use the current versions of the criteria, since both Beers and STOPP/START were updated in 2023.
Get a NU 627 Unit 3 example written to your instructions
Send the Unit 3 instructions and the rubric from your NU 627 classroom, plus the medication list and patient case your review covers. We write a custom example that applies the criteria with judgment, sequences the stops and specifies tapers and monitoring, returned in 24 to 48 hours. The first custom sample is free.
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NU 627 Unit 3 questions, answered
How should explicit criteria be used?
As a screen, not a verdict. Lists of potentially inappropriate medications flag things worth examining, and the word potentially is doing real work: a flagged medication can be entirely correct for a particular patient. Apply the tool, report what it caught, then judge each flag against this person's situation and say why you agree or disagree.
What is a prescribing cascade?
A medication prescribed to treat a side effect of another medication, where nobody recognized the side effect as one. They accumulate quietly over years and are among the most rewarding findings in a deprescribing review, because removing the original drug can remove two or three. Look for them explicitly by asking what each medication started shortly after.
Why stop only one medication at a time?
So that any change can be attributed. Stop three and a patient who feels worse leaves you unable to say which one mattered, and the usual outcome is that all three are restarted. Sequence the stops, monitor between them, and state the interval. It is slower and it is the difference between deprescribing and simply reducing a list.
Where can I find a free NU 627 Unit 3 sample paper?
You can read the entire NU 627 Unit 3 deprescribing review on this page free, from the goals of care through the ranked list, the sequence and the drug deliberately kept. If your resident's list is different, send it and a free custom review comes back, usually in about two days.
Why stop only one medication at a time when deprescribing?
Stopping one drug every week or two lets you see which change caused any new symptom, such as poor sleep or reflux. If several stop together and the patient worsens, you cannot tell which drug to restart.